Biliary infections

Many of the advances in research concerning biliary infections in the past year have focused on elucidation of mechanisms of disease in humans and in animal models. The influence of biliary obstruction and sepsis on the reticuloendothelial system in an animal model is reported as are the effects of endotoxin administration on biliary immunoglobulins. Microsporidiosis has emerged as a new etiology of cholangitis in patients who are seropositive for HIV and who were previously thought to have idiopathic disease. Risk factors and classification of patients with acute cholangitis along with factors that influence the development of cholangitis and its severity are reported. Progress in the understanding of biliary infections and their pathogenesis has occurred, but many important questions remain unanswered. This article reviews the mechanisms of infection of the biliary tract with emphasis on the immune factors, the hepatobiliary complications of AIDS, ascending cholangitis, animal models of infection, and factors that are altered during acute cholecystitis. Briefly mentioned are new reports on the management and clinical evaluation of both cholangitis and acute cholecystitis.