Mechanisms of abnormalities in host defences against bacterial infection in liver disease

Abstract

Introduction: The clinical course of chronic liver disease is frequently complicated by bacterial infection. A series of studies over the years has shown that patients with cirrhosis of the liver are particularly susceptible to bacteraemia/septicaemia, bacterial endocarditis and pneumonia [1-7]. In addition, patients with ascites have a high frequency of spontaneous bacterial peritonitis [8,9], irrespective of the aetiology of underlying liver disease [10]. Bacterial infection appears not to be so common in patients with acute viral hepatitis [5] and, indeed, there is little mention in the literature of bacterial infection in association with acute liver disease. However, in the small proportion of patients with acute viral hepatitis and drug-induced liver damage who develop the clinical syndrome of fulminant hepatic failure, severe bacterial infection is common [11-14]. In this condition, as well as in chronic liver disease, infection may be the immediate cause of death and it may also be an important factor in precipitating gastrointestinal haemorrhage, renal failure and other complications.