Secondary bacterial, fungal, and viral infections in patients with liver diseases: from immune dysfunction to clinical management

BACKGROUND: Compromised hepatic function and dysregulated immune responses render individuals with liver pathology highly vulnerable to pathogenic bacterial invasion. Consequently, the elevated morbidity and mortality rates associated with these infections have emerged as a critical challenge in clinical practice. Within the cohort of patients suffering from acute and chronic liver conditions, there is a pronounced prevalence of bacterial, viral, and fungal infections, alongside frequent coinfections; notably, these infectious agents exhibit substantial heterogeneity regarding their distinct characteristics, pathogenic mechanisms, and clinical presentations. METHODS: This review synthesizes contemporary literature focusing on the epidemiological profiles, pathogen taxonomy, immunopathological underpinnings, diagnostic modalities, and therapeutic interventions for secondary infections in patients with advanced liver disease, particularly decompensated cirrhosis. Furthermore, it specifically addresses existing gaps in research concerning post-liver transplantation infection risk factors and management strategies, as well as the detrimental impact of emerging viruses and viral coinfections on hepatic integrity. RESULTS: Current scholarship has predominantly elucidated the foundational aspects of infection epidemiology and treatment, yet remains sparse in its exploration of specific risk determinants following liver transplantation and the nuanced effects of novel viral pathogens. This paper introduces recent advancements in these underexplored domains. CONCLUSION: By integrating these novel findings, this work aims to furnish robust theoretical support for the clinical diagnosis and management of secondary infections in patients with decompensated cirrhosis. Ultimately, these insights are intended to facilitate the earlier detection of secondary infections in susceptible patients and enable more precise, targeted therapeutic management.