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Role of ascitic fluid C3 in spontaneous bacterial peritonitis
AT Kamal, EN Osman, RY Shahin
Egyptian Journal of Medical Human Genetics , 2012,
Abstract: Background: The C3 component of complement tends to be reduced in cirrhosis and patients with reduced ascitic fluid C3 concentration and reduced opsonic activities have been shown to be predisposed to SBP. Aim of the work: To compare the level of ascitic fluid C3 concentration in cirrhotic patients with and without spontaneous bacterial peritonitis to determine its possible protective role against acquiring infection. Methods: This is a prospective case-control study in which we recruited 45 cirrhotic patients presenting with ascites, of which 25 showed evidence of SBP. All patients had diagnostic paracentesis, received the appropriate treatment, discharged and followed-up monthly for 3 months, with ascitic fluid C3 measurement. Ascitic fluid C3 was compared between both groups at baseline and for three successive reading over 3 months. It was also compared in the same patients group over this interval and correlated with other AF parameters at baseline reading. Conclusion: Ascitic fluid C3 is reduced in cirrhotic patients with SBP and stays lower compared with those without the infection after the first episode. So we conclude that C3 plays an important role in the local defense of ascitic fluid and needs further long term follow-up studies to evaluate its role as a predictor of prognosis for cirrhotic ascitic patients.
Ascitic fluid analysis for diagnosis and monitoring of spontaneous bacterial peritonitis  [cached]
Oliviero Riggio, Stefania Angeloni
World Journal of Gastroenterology , 2009,
Abstract: Polymorphonuclear (PMN) cell count in the ascitic fluid is essential for the diagnosis and management of spontaneous bacterial peritonitis (SBP). To date, PMN cell count is routinely performed by traditional manual counting. However, this method is time-consuming, costly, and not always timely available. Therefore, considerable efforts have been made in recent years to develop an alternative test for a more rapid diagnosis and monitoring of SBP. The use of urinary reagent strips was proposed to achieve an “instant” bedside diagnosis of SBP. A series of reports evaluated the urine strip test for SBP diagnosis and reported promising results. However, a recent large multicenter study revealed a surprising lack of diagnostic efficacy of the urine screening test for SBP diagnosis. Another method, more recently proposed as an alternative to the manual PMN count, is the measurement of lactoferrin in ascitic fluid, but the data available on the diagnostic value of this test are limited to a single study. However, both urinary reagent strips and ascitic lactoferrin tests are qualitative methods and need, therefore, to be further confirmed by standard cytology of the ascitic fluid. To date, the only quantitative method proposed as a valid alternative to manual PMN counting is automated blood cell counters, commonly used in all laboratories for blood cell counting. Data available in the literature on the diagnostic performance of this method are limited but very promising, and this tool seems to have the potential to replace the manual counting method.
Biochemical Differntiation of Ascitic Fluid Associated with Spontaneous Bacterial Peritonitis, Cirrhosis and Malignancy
Rexi. P,Rajendern. K
Advanced Biotech , 2013,
Abstract: Ascities is the accumulation of free fluid in the peritoneal cavity. The chronic liver disease with portal hypertension, congestive cardiac failure tuberculosis and malignancy are important causes of ascities. Ascities fluid and serum were collected from malignant and non malignant patients biochemical parameters such as cholesterol, total protein and albumin radient were studied throughly. The results revealed that the level of cholesterol in malignant Ascities is silightly greater increase than non malignant. The total protien in both serum and ascitic fluid were slightly higher in malignant patients than non malignant person. Albumin gradient showed promises in Ascities differentiation. Further Ascities fluid samples were cultured in Nutrient Agar medium (NA) and bacterial populations were isolated and identified. The predominant species of bacteria were Escherichia coli, Steptrococcus aureus and Enterococcus fecalis from patients with spontaneous bacterial peritonitis. The present study inferred that there was a light fluctuation noticed in Ascities fluids biochemical parameter and microbial population.
Diagnosis of spontaneous bacterial peritonitis: Role of tween 80 and triton X in ascitic fluid cultures  [cached]
Iyer R,Kapoor D
Indian Journal of Medical Microbiology , 2009,
Abstract: A patient with alcoholic cirrhosis of the liver, portal hypertension with hepatic encephalopathy and spontaneous bacterial peritonitis (SBP) was admitted in an obtunded condition. Attempts at delineating the aetiology of the SBP using conventional cultures as well as automated systems were not successful. The use of non-anionic surfactant agents such as Tween 80-incorporated blood agar and Triton X treatment of the specimens facilitated the growth of Klebsiella pneumoniae from the ascitic fluid, which otherwise would have been concluded to represent culture-negative neutrocytic ascites. Thus, the use of the aforementioned agents could be explored in elucidating the aetiology of body cavity infections when conventional methods fail.
Fibronectin in the ascitic fluid of cirrhotic patients: correlation with biochemical risk factors for the development of spontaneous bacterial peritonitis
Brazilian Journal of Medical and Biological Research , 1997, DOI: 10.1590/S0100-879X1997000700004
Abstract: cirrhotic patients (23 with alcoholic cirrhosis, 5 with posthepatitic cirrhosis and 2 with cryptogenic cirrhosis) with ascites and portal hypertension were studied and divided into two groups corresponding to high or low risk to develop spontaneous bacterial peritonitis (sbp) related to the concentration of total protein in the ascitic fluid (a-tp): group i (high risk): a-tp£1.5 g/dl and group ii (low risk): a-tp>1.5 g/dl. fibronectin (fn), c3 and c4 concentrations were measured by radial immunodiffusion while total protein was measured by the biuret method. the mean values (group i vs group ii) of c3 (12.59 ± 4.72 vs 24.53 ± 15.58 mg/dl), c4 (4.26 ± 3.87 vs 7.26 ± 4.14 mg/dl) and fn (50.47 ± 12.49 vs 75.89 ± 24.70 mg/dl) in the ascitic fluid were significantly lower (p<0.05) in the group considered to be at high risk for sbp. no significant difference was observed in the plasma/ascites fibronectin ratio (3.91 ± 1.21 vs 3.80 ± 1.26) or gradient (131.46 ± 64.01 vs 196.96 ± 57.38) between groups. fibronectin in ascites was significantly correlated to c3 (r = 0.76), c4 (r = 0.58), total protein (r = 0.73) and plasma fn (r = 0.58) (p<0.05). the data suggest that the fn concentration in ascites is related to the opsonic capacity of this fluid, and that its concentration in the ascitic fluid may be a biochemical risk factor indicator for the development of spontaneous bacterial peritonitis
Fibronectin in the ascitic fluid of cirrhotic patients: correlation with biochemical risk factors for the development of spontaneous bacterial peritonitis  [cached]
Mesquita R.C.A.,Leite-Mor M.M.B.,Parise E.R.
Brazilian Journal of Medical and Biological Research , 1997,
Abstract: Cirrhotic patients (23 with alcoholic cirrhosis, 5 with posthepatitic cirrhosis and 2 with cryptogenic cirrhosis) with ascites and portal hypertension were studied and divided into two groups corresponding to high or low risk to develop spontaneous bacterial peritonitis (SBP) related to the concentration of total protein in the ascitic fluid (A-TP): group I (high risk): A-TP£1.5 g/dl and group II (low risk): A-TP>1.5 g/dl. Fibronectin (FN), C3 and C4 concentrations were measured by radial immunodiffusion while total protein was measured by the biuret method. The mean values (group I vs group II) of C3 (12.59 ± 4.72 vs 24.53 ± 15.58 mg/dl), C4 (4.26 ± 3.87 vs 7.26 ± 4.14 mg/dl) and FN (50.47 ± 12.49 vs 75.89 ± 24.70 mg/dl) in the ascitic fluid were significantly lower (P<0.05) in the group considered to be at high risk for SBP. No significant difference was observed in the plasma/ascites fibronectin ratio (3.91 ± 1.21 vs 3.80 ± 1.26) or gradient (131.46 ± 64.01 vs 196.96 ± 57.38) between groups. Fibronectin in ascites was significantly correlated to C3 (r = 0.76), C4 (r = 0.58), total protein (r = 0.73) and plasma FN (r = 0.58) (P<0.05). The data suggest that the FN concentration in ascites is related to the opsonic capacity of this fluid, and that its concentration in the ascitic fluid may be a biochemical risk factor indicator for the development of spontaneous bacterial peritonitis
Characteristics of ascitic fluid from patients with suspected spontaneous bacterial peritonitis in emergency units at a tertiary hospital
Reginato, Thiago José Buer;Oliveira, Marcelo José Andrade;Moreira, Luiz César;Lamanna, Antonieta;Acencio, Milena Marques Pagliarelli;Antonangelo, Leila;
Sao Paulo Medical Journal , 2011, DOI: 10.1590/S1516-31802011000500006
Abstract: context and objective: spontaneous bacterial peritonitis (sbp) is a complication of ascites, especially in cirrhosis. ascitic fluid with 250 or more neutrophils/mm3 is an acceptable criterion for diagnosis, even when bacterial fluid cultures are negative. the aims here were to estimate sbp frequency among emergency room patients based on cellular criteria and evaluate the biochemical profile of these fluids. design and setting: retrospective study at a public tertiary hospital. methods: laboratory records of patients with ascites attended in emergency rooms between november 2001 and november 2006, from whom ascitic fluid samples were sent to the laboratory due to suspected sbp, were evaluated. the 691 samples included were divided into group a (presumed sbp: > 250 neutrophils/mm3; n = 219; 31.7%) and group b (no presumed sbp: < 250 neutrophils/mm3; n = 472; 68.3%). patients' sex and age; ascitic fluid characteristics (numbers of neutrophils, leukocytes and nucleated cells); bacteriological characteristics; and protein, lactate dehydrogenase, adenosine deaminase and glucose concentrations were evaluated. results: among group a cultured samples, 63 (33.8%) had positive bacterial cultures with growth of pathogens commonly associated with sbp. in total, the group a samples showed higher lactate dehydrogenase levels than seen in the group b samples. the latter presented predominance of lymphocytes and macrophages. conclusion: among the ascitic fluid samples with clinically suspected sbp, 31.7% fulfilled the cellular diagnostic criteria. positive bacterial isolation was found in 33.8% of the cultured samples from the presumed sbp group
Evaluation of reagent strips for ascitic fluid leukocyte determination: is it a possible alternative for spontaneous bacterial peritonitis rapid diagnosis?
Ribeiro, Tarsila C.R.;Kondo, Mario;Amaral, Ana Cristina C.;Parise, Edson Roberto;Bragagnolo Júnior, Maurício A.;Souza, Aécio Flávio Meirelles de;
Brazilian Journal of Infectious Diseases , 2007, DOI: 10.1590/S1413-86702007000100017
Abstract: in order to evaluate the accuracy of a urine reagent dipstick (multistix 10sg?) to determine ascitic fluid leukocyte count, we prospectively studied 106 cirrhotic patients from april 2003 to december 2004, in two different centers (federal university of s?o paulo - unifesp-epm and federal university of juiz de fora - hu-ufjf) for the rapid bedside diagnosis of spontaneous bacterial peritonitis. the mean age 54 ± 12 years, there was a predominance of males (eighty-two patients, 77%), and alcohol was the most frequent etiology (43%). forty-four percent of patients were classified as child b and fifty-one as child c (51%). abdominal paracentesis was performed both in outpatient and inpatient settings and the multistix 10sg? was tested. eleven cases of spontaneous bacterial peritonitis were identified by means of polymorphonuclear count. if we considered the positive multistix 10sg? result of 3 or more, the sensitivity, specificity, positive and negative predictive value were respectively 71%, 99%, 91% and 98%. with a positive reagent strip result taken as grade 2 (traces) or more, sensitivity was 86% and specificity was 96% with positive and negative predictive values of 60% and 99%, respectively. diagnostic accuracy was 95%. we concluded that the use of a urine reagent dipstick (multistix 10sg?) could be considered a quick, easy and cheap method for ascitic fluid cellularity determination in sbp diagnosis.
Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice  [cached]
Stefania Angeloni, Cinzia Leboffe, Antonella Parente, Mario Venditti, Alessandra Giordano, Manuela Merli, Oliviero Riggio
World Journal of Gastroenterology , 2008,
Abstract: AIM: To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis (SBP) in clinical practice.METHODS: All SBP episodes occurring in a group of consecutive cirrhotics were managed accordingly and included in the study. SBP was diagnosed when the ascitic fluid polymorphonuclear (PMN) cell count was > 250 cells/mm3, and empirically treated with cefotaxime.RESULTS: Thirty-eight SBP episodes occurred in 32 cirrhotics (22 men/10 women; mean age: 58.6 ± 11.2 years). Prevalence of SBP, in our population, was 17%. Ascitic fluid culture was positive in nine (24%) cases only. Eleven episodes were nosocomial and 71% community-acquired. Treatment with cefotaxime was successful in 59% of cases, while 41% of episodes required a modification of the initial antibiotic therapy because of a less-than 25% decrease in ascitic PMN count at 48 h. Change of antibiotic therapy led to the resolution of infection in 87% of episodes. Among the cases with positive culture, the initial antibiotic therapy with cefotaxime failed at a percentage (44%) similar to that of the whole series. In these cases, the isolated organisms were either resistant or with an inherent insufficient susceptibility to cefotaxime.CONCLUSION: In clinical practice, ascitic PMN count is a valid tool for starting a prompt antibiotic treatment and evaluating its efficacy. The initial treatment with cefotaxime failed more frequently than expected. An increase in healthcare-related infections with antibiotic-resistant pathogens may explain this finding. A different first-line antibiotic treatment should be investigated.
Spontaneous Bacterial Peritonitis Caused by Listeria monocytogenes Associated with Ascitic Fluid Lymphocytosis: A Case Report and Review of Current Empiric Therapy  [PDF]
Todd Yecies,Sanae Inagami
Case Reports in Hepatology , 2013, DOI: 10.1155/2013/832457
Abstract: Spontaneous bacterial peritonitis (SBP) is a potentially deadly complication of ascites. We describe a case of SBP caused by Listeria monocytogenes in a patient with alcoholic cirrhosis. This was associated with the unusual finding of ascitic fluid lymphocytosis, which previously had only been associated with tuberculoid or malignant ascites. Given increasing rates of cefotaxime-resistant SBP alongside the possibility of Listeriosis, the use of cefotaxime as first-line therapy in SBP should be reevaluated. 1. Introduction Spontaneous bacterial peritonitis is the most common life-threatening infectious complication of cirrhosis, affecting between 10 and 30% of cirrhotic patients hospitalized for ascites [1]. Hospital mortality rates range from 10 to 30%, with the development of progressive renal impairment being the strongest predictor of mortality [2]. SBP is thought to result from increased bacterial translocation across gastrointestinal mucosa combined with diminished host immunity in cirrhotic patients [2]. Enteric gram-negative bacteria are the most common cause of SBP, with E. coli and Klebsiella responsible for more than half of SBP cases [3]; however there is a recent evidence for increasing prevalence of SBP caused by gram-positive cocci [4]. In addition, cases of SBP caused by Candida, anaerobes, and Listeria have been reported [3]. Intravenous cefotaxime is considered standard of care for empiric therapy for SBP after it was demonstrated superior to ampicillin-amikacin [5]. However, recent studies suggest that cefotaxime resistance is increasingly common [4]. Other studies show that empiric amoxicillin-clavulanic acid or ciprofloxacin may be equally effective in select patients [6, 7]. Appropriate selection of empiric antibiotics is essential as absolute mortality rates in patients not covered by the initial antibiotic therapy were 20% higher than in patients with appropriate coverage [8]. Cefotaxime-resistant bacteria that can cause SBP include extended-spectrum beta-lactamase (ESBL) producing gram-negative rods, Enterococci, anaerobes, and Listeria [9]. Fewer than 5 cases of Listeria SBP have been reported in the United States. 2. Case Report This patient is a 62-year-old Caucasian male with a history of alcoholic cirrhosis and ascites who presented with one month of increasing abdominal distention and discomfort. His distention had been worsening since his last paracentesis one-month prior. He was afebrile and otherwise asymptomatic on presentation. Prior to this hospitalization, he had undergone 8 therapeutic large-volume paracenteses over
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