Lahmer T, Peçanha-Pietrobom PM, Schmid RM, et al. - Susceptibility towards invasive fungal infections such as candidemia and invasive pulmonary aspergillosis is reported to be higher among patients with acute and chronic liver impairment as a result of cirrhosis-associated immune dysfunction, humoral immunodeficiency, cell-mediated dysfunction and systemic inflammation. Researchers herein performed a systematic review on this topic based on the broad spectrum of diverse reports with varying content and quality and in some cases lack of evidence.

• Beside classical risk factors for invasive fungal infection, the risk of developing fungal infections is higher in correlation with the following conditions additionally: acute on chronic liver failure, corticosteroid use, gastrointestinal bleeding, and prophylactic use of antibiotics.

• Careful follow-up of high risk patients is recommended by microbiological surveillance including cultures as well as by imaging and fungal biomarkers for providing early diagnosis.

• For cases with invasive candidiasis, echinocandins are still the mainstay and first line antifungal therapy.

• Liposomal amphotericin B is a suitable alternative to voriconazole in patients invasive pulmonary aspergillosis due to concerns of liver toxicity and in cases of renal impairment; although, promising data were gained for isavucoanzole and posaconazole use in these patients, there is a necessity for more specific studies in the subgroup of patients with liver impairment.

• Morbidity and mortality rates remain high especially because of the late diagnosis and multiple organ dysfunction usually present in patients with liver impairment.