Fajardo-Felix CF, Rodriguez-Negrete EV, Morales-González JA, Triana-Romero A. Incidence of spontaneous fungal peritonitis in patients with liver cirrhosis in a Mexico City population. World J Hepatol 2025; 17(10): 108700 [DOI: 10.4254/wjh.v17.i10.108700]
Corresponding Author of This Article
Elda V Rodriguez-Negrete, MD, Doctorate Student, Department of Gastroenterology, Instituto Mexicano del Seguro Social, Avenida Cuauhtemoc 330, Doctores, Cuauhtemoc, Mexico City 06720, Ciudad de México, Mexico. jev_rn@yahoo.com.mx
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Gastroenterology & Hepatology
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Prospective Study
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Oct 27, 2025 (publication date) through Oct 27, 2025
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World Journal of Hepatology
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1948-5182
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Fajardo-Felix CF, Rodriguez-Negrete EV, Morales-González JA, Triana-Romero A. Incidence of spontaneous fungal peritonitis in patients with liver cirrhosis in a Mexico City population. World J Hepatol 2025; 17(10): 108700 [DOI: 10.4254/wjh.v17.i10.108700]
World J Hepatol. Oct 27, 2025; 17(10): 108700 Published online Oct 27, 2025. doi: 10.4254/wjh.v17.i10.108700
Incidence of spontaneous fungal peritonitis in patients with liver cirrhosis in a Mexico City population
Carlos F Fajardo-Felix, Elda V Rodriguez-Negrete, José A Morales-González, Arturo Triana-Romero
Carlos F Fajardo-Felix, Elda V Rodriguez-Negrete, Arturo Triana-Romero, Department of Gastroenterology, Instituto Mexicano del Seguro Social, Mexico City 06720, Ciudad de México, Mexico
José A Morales-González, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Ciudad de México, Mexico
Arturo Triana-Romero, Digestive Physiology and Motility Lab, Universidad Veracruzana, Veracruz 91400, Mexico
Co-corresponding authors: Elda V Rodriguez-Negrete and José A Morales-González.
Author contributions: Fajardo-Felix CF and Rodriguez-Negrete EV conceived and designed the study; Morales-González JA and Triana-Romero A edited and wrote the paper; Rodriguez-Negrete EV and Morales-González JA contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Instituto Mexicano del Seguro Social, approval No. R-2023-3601-240.
Clinical trial registration statement: There is no document.
Informed consent statement: The local research committee approved informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: We have no objection to share our data in case it is required.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Elda V Rodriguez-Negrete, MD, Doctorate Student, Department of Gastroenterology, Instituto Mexicano del Seguro Social, Avenida Cuauhtemoc 330, Doctores, Cuauhtemoc, Mexico City 06720, Ciudad de México, Mexico. jev_rn@yahoo.com.mx
Received: April 21, 2025 Revised: May 27, 2025 Accepted: September 2, 2025 Published online: October 27, 2025 Processing time: 189 Days and 14.1 Hours
Abstract
BACKGROUND
Individuals with liver cirrhosis (LC) are likely to experience multiple infectious processes due to the immune dysfunction caused by the disease. Our hypothesis is that this group of patients is predisposed to fungal infections. To date, the incidence of spontaneous fungal peritonitis (SFP) has not been determined in Mexico; this endeavor is of great importance because many patients may be suffering from this condition without receiving targeted treatment, which may increase mortality.
AIM
To report the incidence of SFP in patients presenting with decompensated LC with ascites.
METHODS
This was a prospective, single-center, descriptive, observational and cross-sectional study where patients presenting with decompensated LC with ascites were evaluated from November 2023 to May 2024 in Mexico City. Fungal cultures of ascites were performed and the samples kept in an incubator for 10 days to 14 days, and molecular tests (the API 20 C AUX test) were used for molecular characterization.
RESULTS
Of the 48 patients included, 54.2% were women, 77.1% had a comorbidity, 47.9% had LC secondary to metabolic dysfunction, 43.8% were classified as Child-Pugh C with a model for end-stage liver disease 3.0 median score of 22, and 10.4% were in secondary prophylaxis for spontaneous bacterial peritonitis (SBP). Only four patients had positive cultures where Candida parapsilosis and Candida albicans were isolated, with two of the four patients being positive for Rhodotorula minuta; an SBP incidence of 8.3% was thus calculated. Chronic kidney disease [P = 0.012 and relative risk (RR) = 15] and secondary prophylaxis for SBP (P = 0.049 with RR = 8.6) were statistically significant and associated with a high mortality risk (P = 0.001 with RR = 33).
CONCLUSION
The presence of infection of fungal origin in ascites in patients presenting with cirrhosis increases short- and medium-term mortality; therefore, it is recommended that fungal culture tests are performed in those patients who visit the emergency room or experience continuous admission with acute decompensation and no bacteria identified in ascites cultures, and even more so in patients with chronic kidney disease and a history of antibiotic use as prophylaxis for SBP. Further studies are needed for the identification of clinical and biochemical data that can help to define SFP so that its presence may be assessed without the need to wait for a positive fungal culture. Thus, treatment may be initiated early in the hope of having a positive impact on the prognosis in this group of patients.
Core Tip: Liver cirrhosis is a condition that causes immune dysfunction, which predisposes the patient to infections. In this study, we investigated the presence of mycotic microorganisms in ascites to calculate their incidence in patients in a Mexico City hospital. For this purpose, ascites samples were taken, and mycotic cultures were performed, revealing an incidence of 8. The microorganisms identified were Rhodotorula minuta, and Candida parapsilosis and Candida albicans. It was found that chronic renal disease and secondary prophylaxis for spontaneous bacterial peritonitis are associated with spontaneous fungal peritonitis and that patients with positive mycotic cultures have a high mortality risk.
