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

Intracatheter streptokinase (SK) is advocated as effective treatment with minimal adverse effects in both recurrent bacterial peritonitis and catheter fibrin blockage in continuous ambulatory peritoneal dialysis (CAPD) patients. We reviewed 35 instillations in 20 patients noting a high (86%) side effect profile consisting of fever, onset of turbid dialysis effluent and/or abdominal pain. SK probably releases fibrin clot containing bacteria, leukocytes and debris from the colonized catheter into the peritoneal cavity causing a "peritonitis-like syndrome" of 1 to 3 days duration. Fungal peritonitis occurred after SK in 2 patients. Failure of SK therapy was encountered in Staphylococcus epidermidis infection (p less than 0.05 versus other organisms), which may be related to its protective capsular polysaccharide slime and ability to adhere to plastic prosthetic devices. SK, in this study, was useful treatment in relapsing bacterial peritonitis (50% overall cure) but failed to correct catheter malfunction.
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PMID:Intracatheter streptokinase for recurrent peritonitis in CAPD. 195 50

Spontaneous bacterial peritonitis rarely complicates high-protein (greater than 2.5 g/dl) ascites. The relatively high endogenous antimicrobial (opsonic) activity of the ascitic fluid in this setting appears to protect the patient from infection. We report two patients with high-protein, noncirrhotic ascites complicated by spontaneous peritonitis due to Salmonella species. One patient had ascites due to heart failure, whereas the other patient's ascites was due to peritoneal carcinomatosis. The ascitic fluid total protein concentrations were 3.1 and 3.3 g/dl, respectively, and the opsonic activity of the ascitic fluid specimens were 2.03 and 2.00 log kill, respectively, indicating a high degree of bacterial killing. We hypothesize that the virulence of the Salmonella species was able to overcome the high opsonic activity in the ascitic fluid, resulting in infection in these two patients. Fever, abdominal pain, or encephalopathy in a patient with high-protein ascites may suggest the presence of an unusual organism causing spontaneous bacterial peritonitis.
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PMID:Spontaneous Salmonella infection of high-protein noncirrhotic ascites. 220 53

We have retrospectively studied 89 episodes of spontaneous bacterial peritonitis (SBP) attended at our service with the purpose of analyzing clinical features, microbiologic data and possible etiopathogenic factors, treatment and course. The most frequent symptoms were ascites, abdominal pain and fever. Only 3.3% of episodes were asymptomatic. Twenty-four episodes (26.96%) resulted in death of the patient and only the presence of septic shock and prothrombin time lower than 35% statistically correlated with a higher mortality (100% and 53.8%, respectively, p less than 0.01) of the possible factors analyzed. The culture of ascitic fluid (AF) was positive in 52.8% of the episodes and there were no clinical or time course differences between these cases and those who presented negative culture. The isolated microorganisms were the usual ones in this condition, outstanding 37.5% of gram-positive cocci in monomicrobial SBP. Treatment was initiated within the first 12 hours from admittance in 76.4% of cases, between 12 and 72 hours in 12.3% and after 72 hours in 11.2%. Cefotaxime was given to 47.1% of episodes and 52.9% of patients received ampicillin or cefoxitin plus aminoglycoside; the mortality was lower with the first schedule (11.9% versus 40.4%, p less than 0.01).
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PMID:[Spontaneous bacterial peritonitis: clinical, microbiological and clinical course study of 89 episodes]. 249 Apr 77

During a two-year period, 30 patients with spontaneous bacterial peritonitis were documented. All patients had ascites and 70% were alcoholic cirrhosis. Fever and abdominal pain were the most frequent presenting manifestations (96.66% and 76.66% respectively). Triads of fever, abdominal pain and rebound tenderness were found in 40%. A third had hepatic encephalopathy and decreased bowel sound. Ascitic fluid was transudate. Positive ascitic fluid culture and blood culture were obtained in 40% and 59% respectively, and three quarters were due to gram negative enteric bacilli. There was no significant statistic correlation among the result of ascitic fluid gram's stain and ascitic fluid culture, and of ascitic fluid culture and blood culture. The clinical and laboratory findings of patients with positive and negative ascitic fluid culture were similar. Significant increased mortality was found in patients who had hepatic encephalopathy, hypotension, increased bilirubin level and serum creatinine. The over all mortality was 33.33%. We recommend abdominal paracentesis in every cirrhotic patients with ascites who were admitted into hospital.
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PMID:Spontaneous bacterial peritonitis in cirrhotics: clinical and ascitic fluid findings. 353 Jan 6

Spontaneous bacterial peritonitis (SBP), a fascinating disease that had been reported perhaps 50 times in varying guises over the preceding century, suddenly burst forth in the 1960s and was recognized in clusters of cases almost simultaneously in Paris, London, and West Haven, Connecticut. The spectrum of the disease has broadened. Initially, it was associated almost exclusively with alcoholic cirrhosis, but it has now been found in association with posthepatitic cirrhosis, cryptogenic cirrhosis, chronic active liver disease, and, occasionally, in biliary cirrhosis and cardiac cirrhosis. Recently, it has been reported in alcoholic hepatitis and acute viral hepatitis. It occurs occasionally in malignant ascites and in pancreatitis in the absence of cirrhosis. It is surprisingly common in disseminated lupus, in which it occurs relatively more commonly than in alcoholic cirrhosis. A similar syndrome, primary peritonitis, occurs frequently in children with nephrotic ascites. The clinical pattern of SBP has broadened. Initially it consisted of abdominal pain, fever, rebound tenderness, hypoactive bowel sounds, hypotension, encephalopathy, and cloudy ascites with large numbers of polymorphonuclear leukocytes in ascitic fluid. Each and every symptom, sign, and laboratory abnormality may be absent; indeed, the syndrome can be completely silent. Initially, the causative bacteria appeared to be almost exclusively enteric, but now the list of bacteria isolated in cases of SBP looks like a bacteriology textbook. Anaerobes are rare. Multiple organisms usually suggest nonspontaneous origin such as perforation or vasopressin induction. The differentiation between spontaneous and nonspontaneous bacterial peritonitis is crucial in the differential diagnosis. The great majority of cases of SBP develop in the hospital, 80% more than one week after admission. It is therefore a nosocomial disease that may be precipitated by procedure-induced bacteremia, gastrointestinal bleeding, or diarrhea, and it tends to occur in patients with low ascitic fluid protein (complement) concentrations and severe portal-systemic shunting.
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PMID:Spontaneous bacterial peritonitis: variant syndromes. 368 33

A total of 32 episodes of infectious peritonitis developed in 90 patients receiving intraperitoneal chemotherapy. Staphylococcus epidermidis was the organism most commonly cultured, accounting for 65 percent of isolates. Result of initial gram stain was positive in 35 percent of cases. The development of fever and abdominal pain as well as rising peripheral and peritoneal fluid white blood cell counts was helpful in the making of a diagnosis of infectious peritonitis. Seventy-five percent of patients were cured with antibiotic therapy alone whereas one quarter also required removal of the semi-permanent catheter. Patients treated with intraperitoneal chemotherapy delivered by dialysis exchange over several days exhibited significantly more episodes of infection than patients treated by a single-drug instillation each month. Although the development of bacterial peritonitis remains a problem during intracavitary chemotherapy, the use of subcutaneous ports and meticulous sterile technique during catheter manipulation will hopefully decrease the risk of occurrence of this potentially avoidable complication.
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PMID:Infectious peritonitis in patients receiving intraperitoneal chemotherapy. 396 89

We analyzed the clinical and bacteriologic features of 12 episodes of spontaneous bacterial peritonitis (SBP) in 11 children (four boys, median age 5.5 years) with chronic liver disease. All patients had cirrhosis and ascites; four had hypersplenism, and one was asplenic. Symptoms included increasing abdominal distention, pyrexia, abdominal pain, gastrointestinal disturbance, and encephalopathy. Nine had rebound tenderness on abdominal palpation, and 12 had reduced bowel sounds. The most frequent organisms isolated from culture of ascitic fluid were Streptococcus pneumoniae (nine). Klebsiella (two), and Haemophilus influenzae (one); blood cultures grew identical organisms in nine. Seven patients died despite intensive antibiotic therapy. In the 3 months prior to onset of SBP, defective yeast opsonization and reduced serum concentration of C4 were found in all nine children tested; eight had reduced concentration of C3. Functional deficiency of all complement components was present in four tested within 1 to 5 months of the onset. In contrast, only eight of 59 cirrhotic children without SBP had low C3, and eight had defective yeast opsonization, although 35 had low C4 values. Four of the patients with SBP and low C3 and C4 concentrations had normal concentrations at the time of diagnosis of liver disease 2 to 5 years previously. Opsonization of type III pneumococci was reduced in sera from three patients who subsequently developed pneumococcal peritonitis. The incidence of SBP in children with chronic liver disease is similar to that in adults, as are the clinical features. Our observations suggest that complement deficiency induced by chronic liver disease may be important in the pathogenesis of SBP.
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PMID:Spontaneous bacterial peritonitis in children with chronic liver disease: clinical features and etiologic factors. 399 46

A phase II study of ip 5-FU was performed in 14 patients with ovarian cancer who were refractory to systemic chemotherapy including prior iv 5-FU in 12 of the patients. 5-FU was administered via a semipermanent Tenckhoff peritoneal dialysis catheter. The starting concentration of 5-FU in the dialysate was 4 mM. The patients received eight consecutive 2-L exchanges, each of 4-hour duration, for a total of 36 hours including time for instillation and drainage. Treatment courses were repeated every 2 weeks for six cycles or until disease progression occurred. A total of 69 cycles of ip 5-FU were administered to 14 patients. There was one complete response to therapy documented by second-look laparotomy. While the response rate was only 7%, in seven of eight (88%) patients with small volume disease (tumor masses less than 2.0 cm in diameter), there was no evidence for disease progression while receiving ip 5-FU therapy. In this phase II trial, the major toxic effect of ip 5-FU was abdominal pain. While there were no cases of documented bacterial peritonitis, all of the patients experienced some degree of abdominal discomfort while receiving therapy. Fifty percent of the patients had severe abdominal pain with at least one cycle of therapy. Other toxic effects included myelosuppression, mucositis, nausea and vomiting, and skin rash. The results of this study indicate that ip 5-FU should be further evaluated in patients with ovarian cancer who have a small volume of disease and who have not had prior therapy with 5-FU.
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PMID:Phase II trial of 5-FU administered Ip to patients with refractory ovarian cancer. 652 96

A three year old child with cirrhosis of the liver and ascites caused by alpha-1-antitrypsin deficiency, developed severe abdominal pain with diarrhea and fever. Spontaneous bacterial peritonitis was diagnosed by demonstrating a purulent ascitic fluid with gram-positive cocci in the smear which were identified as pneumococci in the bacterial culture. The peritonitis subsided under antibiotic treatment without complications. Spontaneous bacterial peritonitis in children with cirrhosis of the liver is mentioned in the literature, but up to now, however, only three cases were reported in detail. In order to establish the diagnosis, abdominal tap should be tried rather than explorative laparotomy, the demonstration of gram-positive cocci is diagnostic of spontaneous bacterial peritonitis. With early antibiotic therapy, prognosis of the disease is favourable. Newborns and children with nephrotic syndrome, however, are particularly at risk.
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PMID:[Spontaneous bacterial peritonitis in cirrhosis of the liver caused by alpha-1-antitrypsin deficiency (author's transl)]. 698 Oct 63

Aerobic enteric organisms, especially Escherichia coli, are the most common cause of spontaneous bacterial peritonitis in alcoholic cirrhosis with ascites, despite the preponderance of anaerobic bacteria in the bowel flora. The major routes of infection are transmural migration of gastrointestinal flora, lymphatic spread, and hematogenous seeding. Most patients present with fever and chills, abdominal pain, leukocytosis, and hypotension, although some may be asymptomatic. Differentiation from secondary peritonitis, which is essential in determining appropriate therapy, is difficult. Microbiologic studies of the ascitic fluid can provide valuable clues in this regard. Although most patients respond favorably to antibiotic therapy, mortality is high because of complications of the underlying disorder.
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PMID:Spontaneous bacterial peritonitis in alcoholic cirrhosis with ascites. 708 47


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