Dr. Jasmohan S Bajaj
Early Diagnosis and Prevention of Infection in Cirrhosis
Infections in cirrhosis can be caused due to immune dysfunctions, altered microbiota and external factors including medications and exposures. In most cases, it has been seen that usual signs of infection may be absent in patients due to impaired immune response leading to delay and diagnosis.
Hence, it can be said that early diagnosis is a major problem among cirrhotic patients. Additionally, several other challenges add to the existing diagnostic burden, such as: Logistic barrier; challenges with culture-positivity; delay in turnaround time; prevalence of multidrug-resistant (MDR) organisms; prevalence of viral and fungal infections.
Therefore, there is an urgent need for non-culture-based strategies. Although cultureindependent techniques are being developed to tackle several problems associated with culture-dependent techniques such as contamination with host DNA and the inability to distinguish between dead and live bacteria, they are not ready for prime time yet.
Currently, several factors that can be used to improve diagnosis and prevent infection are: High index of suspicion and adequate coverage of MDR and fungal infections; up-todate vaccinations; nonantibiotic medications, such as statins and beta-blockers; removal of unnecessary PPI and antibiotic; consideration for continued masking.
Dr. Jasmohan S Bajaj
Dr Jasmohan S. Bajaj, MBBS, MD, MS, is an Associate Professor of Medicine, Division of Gastroenterology, Hepatology, and Nutrition at Virginia Commonwealth University and McGuire VA Medical Center in Richmond, VA. He is a Fellow of the American Gastroenterological Association and American College of Gastroenterology. Dr. Bajaj earned his MBBS from Delhi University at Maulana Azad Medical College. He completed an internship in internal medicine at Delhi University at Maulana Azad Medical College and internal medicine residency at the State University of New York Health Science Center in Brooklyn. He furthered his medical training with a fellowship in gastroenterology and hepatology at the Medical College of Wisconsin Affiliated Hospitals, then went on to earn an MS in epidemiology at the Medical College of Wisconsin in Milwaukee.
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