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Query: UMLS:C0341503 (bacterial peritonitis)
 1,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe a case of spontaneous bacterial peritonitis in a 53 year old man affected by cryptogenic micro-macronodular cirrhosis, portal hypertention, splenomegaly and hypersplenism, who was admitted with hepatic failure and septic shock and successfully treated with antibiotics (combination of clindamycin and netilmycin), surgical abdominal drainage and splenectomy. This case gave reason for a literature review and an update on the therapeutic options in these high risk patients, especially concerning the role of surgery. Spontaneous Bacterial Peritonitis (SBP) is defined as a bacterial infection of ascitic fluid in the absence of any septic focus. It is a typical life-threatening complication of hepatic cirrhosis with ascites. Mortality is very high and ranges from 75% to 97% of patients, due to septic shock and hepatic failure (hepatorenal syndrome, hepatic encephalopathy, gastrointestinal bleeding). Infection with a single organism is found in most cases. Gram negative bacilli are present in about 70% of cases and E. coli (less frequently Klebsiella, Serratia, Pseudomonas) is principally found. Gram positive cocchi comprise an additional 30% of cases. Anaerobic and microaerophilic organisms seem to be rare causes of SBP (2.7-6%); this finding is probably due to the intrinsic bacteriostatic activity of ascites, which contains high oxygen tension (70 mmHg) and is an inhospitable environment for bacteroides and Clostridia. The prevalent isolation of enteric organism suggest that the gut is the most frequent source of infection, even if the pathogenetic mechanism is not yet well known. The right treatment depends on differentiating primary (SBP) from secondary peritonitis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Is the surgical treatment of spontaneous bacterial peritonitis still up-to-date?]. 824 98

Infection is a common complication in patients who receive continuous ambulatory peritoneal dialysis (CAPD). Fungi causing peritonitis in these patients is less common compared with bacterial peritonitis. Fungal peritonitis accounts for less than 10% of cases in chronic CAPD, which usually follows either bacterial peritonitis or earlier exposure to broad-spectrum antibiotics. Most of these cases are caused by Candida albicans or other Candida species. There are only two case reports of Penicillium species peritonitis in patients with CAPD in the literature. We report the known third case of Penicillium species-related peritonitis in a patient receiving CAPD. The patient's condition improved dramatically after catheter removal.
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PMID:Penicillium peritonitis in a patient receiving continuous ambulatory peritoneal dialysis. 949 86

Intraabdominal infection continues to be one of the major challenges in general surgery. Whilst the term "peritonitis" means an inflammation of the peritoneum regardless of its etiology, intraabdominal infections encompass all forms of bacterial peritonitis, of intraabdominal abscesses and of infections of intraabdominal organs. Several classification systems have been suggested for peritonitis and intraabdominal infections, respectively. However, neither phenomenological classifications nor classification systems with respect to the origin of bacterial contamination have a proven relevance for the clinical course of this disease. Moreover, most of the studies dealing with secondary peritonitis or intraabdominal infections are ill-comparable because of wide variations of inclusion criteria. Thus the true incidence of secondary bacterial peritonitis is difficult to assess. With respect to its etiology perforation of hollow viscus is the leading cause followed by postoperative peritonitis, ischemic damage of bowel wall, infection of intraabdominal organs and translocation in nonbacterial peritonitis. The anatomic origin of bacterial contamination and microbiological findings are no major predictors of outcome. However, the preoperative physiological derangement, the surgical clearance of the infectious focus and the response to treatment are established prognostic factors. The pathogenesis of intraabdominal infections is determined by bacterial factors which influence the transition from contamination to infection. Intraabdominal adjuvants and the local host response are additionally important. Bacterial stimuli lead to an almost uniform activation response which is triggered by reaction of mesothelial cells and interspersed peritoneal macrophages and which also involves plasmatic systems, endothelial cells and extra- and intravascular leukocytes. The local consequences of this activation are the transmigration of granulocytes from peritoneal capillaries to the mesothelial surface and a dilatation of peritoneal blood vessels resulting in enhanced permeability, peritoneal edema and lastly the formation of protein-rich peritoneal exudate.
Infection
PMID:Epidemiology and pathophysiology of intraabdominal infections (IAI). 979 1

The prevalence of human immunodeficiency virus (HIV) infection is increasing in Singapore. The surgical experience, however, remains limited. A retrospective review of 13 HIV-positive patients requiring abdominal surgery within Singapore was done. There were 4 females and 9 males with age ranging from 21 to 44 years. Operations included appendicectomy, colectomy, splenectomy, intestinal bypass, gastrostomy and exploratory laparotomy. Pathologic findings directly related to HIV infection were found in two-fifths (5 out of 13) of these patients. A low CD4+ count or signs of full-blown acquired immunodeficiency syndrome (AIDS) were not associated with a higher likelihood of HIV-related pathology; neither did it preclude a successful outcome. There were 2 early postoperative deaths, both with HIV-related pathology. Five of our patients who survived their abdominal surgery died on follow-up with a median survival of 17 months. In patients with typical surgical problems, e.g. appendicitis and torsion of the ovary, early surgery allows for rapid recovery similar to normal surgical patients. Care of these patients is best provided by surgeons with experience and interest in this condition together with infectious diseases physicians. Even palliative surgery offers a respite from acute and often severe problems and improves the quality of life significantly. Two patients with AIDS presented with sepsis and diffuse abdominal tenderness. Subsequent laparotomy revealed only primary bacterial peritonitis. For patients with AIDS and non-localizing abdominal signs, alternative non-invasive diagnostic modalities such as computed tomographic (CT) scan should be considered.
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PMID:Abdominal surgery in human immunodeficiency virus (HIV) infected patients--early local experience. 1010 44

Forty patients with spontaneous bacterial peritonitis, three of whom had complicating acute hepatitis syndrome, eight late-onset hepatic failure, and 29 with cirrhosis, were treated with ceftriaxone 2 g intravenously once daily for 5 days. Ascitic fluid culture was positive in 28 patients, with Escherichia coli and Klebsiella as common isolates. All the bacteria isolated were sensitive to ceftriaxone except Enterococcus faecalis, which was isolated in a cirrhotic patient. All culture-positive patients sensitive to ceftriaxone showed bacteriological cure and 26 (65%) patients showed cytological cure after 48 hours of treatment. A total of 95% were cured of their infection after 5 days of treatment. Twelve (30%) patients died during hospitalisation after documented cure of their spontaneous bacterial peritonitis (renal failure, gastrointestinal bleed and cerebral oedema were the primary causes of death). Infection-related mortality due to Pseudomonas septicaemia was seen in one cirrhotic patient.
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PMID:Short-course ceftriaxone therapy in spontaneous bacterial peritonitis. 1021 51

Non-typhoidal Salmonella is a rare cause of spontaneous bacterial peritonitis (SBP). Non-typhoidal Salmonella SBP has been reported in patients with relatively normal ascitic fluid protein levels. Five patients with non-typhoidal Salmonella SBP and a review of the literature are reported. These patients had chronic underlying disorders, such as malignancy, or other conditions causing immunosuppression. In previous reports, an ascitic fluid protein level above 1.5 g/dl was present in six patients, and under 1.5 g/dl in two. In the present report, ascitic fluid protein is above 2.5 g/dl in three patients and under 1.5 g/dl in one. Immunosuppression and the virulence of the organism seem to play a major role in non-typhoidal Salmonella SBP. Physicians should be alert to the possibility of non-typhoidal Salmonella infection in patients with SBP and normal protein levels in ascitic fluid.
Infection
PMID:Spontaneous non-typhoidal Salmonella peritonitis in patients with serious underlying disorders. 1037 38

296 patients with first clinical symptoms of alcoholic liver disease were hospitalized in Probationary-Infectious Diseases Department in Kielce, between 1994-2000. In 52 (17.6%) of them, acute hepatic failure was diagnosed by detection of hepatic encephalopathy. Initial laboratory data of those patients who died (6.1%), and those who survived (11.5%) was compared. No statistically significant differences in analyzed parameters were found, except for significantly higher bilirubin concentration in the group of deceased. In both groups of patients, the frequency of hepatic failure complications, present at the admission to the hospital or those developed in the course of the disease, was also analyzed. The following complications were observed significantly more often in deceased: ascites, hepatorenal syndrome (HRS), spontaneous bacterial peritonitis (SBP), and gastrointestinal haemorrhage (GIH), while sepsis was similarly frequent in both groups.
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PMID:Acute hepatic failure in alcoholic liver disease. 1221 30

Hepatic cirrhosis is the most common cause of ascites. It is caused by liver failure leading to complex interrelated circulatory and renal changes resulting in retention of sodium and water and portal hypertension localising that sodium and water in the peritoneum. Ascites is an important development in cirrhosis as it implies a generally poor long term prognosis. Investigation is important as ascites is not always dueto cirrhosis, may bethe consequence of complications of cirrhosis such as hepatocellular carcinoma, and may be associated with infection which is fatal if untreated. Most patients respond to treatment with sodium restriction and diuretic drugs. This treatment takes time, and increasingly doctors use therapeutic paracentesis with sodium restriction and diuretics to prevent recurrence of ascites. Paracentesis, however, is not without complications, and it is particularly important to give colloid replacement to prevent hypovolaemia which can lead to renal failure. Patients who do not respond to this treatment may be helped by a TIPSS procedure or a peritoneovenous shunt. However, these patients usually have very poor liverfunction and the possibility of fiver transplantation should be considered. Infection is a very serious complication of ascites (spontaneous bacterial peritonitis) and carries a generally poor prognosis.Antibiotic prophylaxis is important to prevent recurrence and liver transpiantation shoulcl be considered.
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PMID:[ASCITES IN HEPATIC CIRRHOSIS: RECOGNITION INVESTIGATIONAND TREATMENT] 1221 41

PCT is a new highly sensitive and specific marker of bacterial and fungi infection--to be used in differential diagnosis at Infectious Diseases Departments. Author in this paper presents structure and mechanism of stimulation of PCT as a factor of "early infection's fase" for many infectious agents: bacteria, fungi, viruses and parasites. PCT may be found useful in diagnosing diseases; for ex.: sepsis, meningitis, inflammation of respiratory system, spontaneous bacterial peritonitis (SPB) and other local inflammatory foci (otitis media, endocarditis). PCT level is low in systemic inflammatory response syndrome (SIRS) and multiorgan dysfunction syndrome (MODS) of non-infectious origin (< 0.5 ng/ml), medium in case of localized infections (1.0-2.0 ng/ml) and in severe cases of disseminated infections (sepsis-->SIRS-->MODS) high (approximately 20 ng/ml).
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PMID:[Usefulness of plasma procalcitonin (PCT) estimation to diagnose patients in departments of infectious diseases]. 1292 30

Haemophilus influenzae rarely causes spontaneous bacterial peritonitis. We describe a typical case of spontaneous bacterial peritonitis in which the causative organism was identified as nontypeable H. influenzae, biotype III. Infection progressed despite the presence of adequate serum bactericidal antibody, probably due to the absence of complement in ascites fluid.
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PMID:Nontypeable Haemophilus influenzae as a cause of spontaneous bacterial peritonitis. 1675 47


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