Ascitic Fluid Calprotectin and Serum Procalcitonin as Accurate Diagnostic Markers for Spontaneous Bacterial Peritonitis

BACKGROUND/AIMS: The diagnosis of spontaneous bacterial peritonitis (SBP) is based on a polymorphonuclear leukocytes (PMNs) exceeding 250/μL in ascitic fluid. The aim of the study was to evaluate serum procalcitonin and ascitic fluid calprotectin as accurate diagnostic markers for detecting SBP. METHODS: Seventy-nine patients with cirrhotic ascites were included. They were divided into a SBP group, including 52 patients, and a non-SBP group of 27 patients. Serum procalcitonin, ascitic calprotectin, and serum and ascitic levels of tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) were measured using an enzyme-linked immunosorbent assay. RESULTS: Serum procalcitonin and ascitic calprotectin were significantly higher in SBP patients than in non-SBP patients. Significant increases in both serum and ascitic levels of TNF-α and IL-6 were observed in SBP patients versus non-SBP patients. At a cutoff value of 0.94 ng/mL, serum procalcitonin had 94.3% sensitivity and 91.8% specificity for detecting SBP. In addition, at a cutoff value of 445 ng/mL, ascitic calprotectin had 95.4% sensitivity and 85.2% specificity for detecting SBP. Both were positively correlated with ascitic fluid proteins, PMN count, TNF-α, and IL-6. CONCLUSIONS: According to our findings, determination of serum procalcitonin levels and ascitic calprotectin appears to provide satisfactory diagnostic markers for the diagnosis of SBP.

Socioeconomic Factors Associated with Compliance with Mass Drug Administration for Lymphatic Filariasis Elimination in Kenya: Descriptive Study Results

Background: Annual Mass Drug Administration (MDA) to at least 65 - 80of the population at risk is necessary for Lymphatic Filariasis (LF) elimination. In Kenya; MDA based on diethylcarbamazine and albendazole; using the community-directed treatment (ComDT) approach has been implemented thrice in the Kwale and Malindi districts. To identify the socioeconomic factors influencing compliance with MDA; a retrospective cross-sectional study was conducted in the two districts after the 2008 MDA. Materials and Methods: In Kwale; the Tsimba location was selected for high and Gadini for low coverage; while in Malindi; the Goshi location represented high and Gongoni; low coverage. Using systematic sampling; nine villages were selected from the four locations. Quantitative data was collected from 965 systematically selected household heads and analyzed using SPSS v. 15. For qualitative data; which was analyzed manually according to core themes of the study; 80 opinion leaders and 80 LF patients with clinical signs were purposively selected and interviewed; and 16 focus group discussions (FGDs) conducted with adult and youth male and female groups. Results: Christians were slightly more (49.1) in the high compliance areas compared to Muslims (34.3); while Muslims prevailed (40.6) in the low compliance areas compared to Christians (29). On the income level; 27from the low compared to 12.2from the high compliance areas had a main occupation; indicative of a higher income; and 95from the low compared to 78from high compliance areas owned land; also an indicator of higher economic status. Accurate knowledge of the cause of swollen limbs was higher (37) in the high compared to 25.8in the low compliance areas; and so was accurate knowledge about the cause of swollen genitals (26.8in high compared to 14in low). Risk perception was higher in the high compliance areas (52compared to 45) and access to MDA information seemed to have been better in the high compared to low compliance areas. Patients from the high compliance areas had a higher mean number of years with chronic disease (15.2 compared to 9.7). Conclusions: There is a need for more investment in reaching out to groups that are often missed during MDAs. Different strategies have to be devised to reach those in specific religious groupings and those in casual employment. This could include prolonging the duration of MDA to capture those who are out during the week seeking for casual and other forms of employment

Occult hepatitis C virus infection versus chronic hepatitis C among Egyptian patients with persistently abnormal liver-function tests of unknown etiology

Background: Occult hepatitis C virus [HCV] infection is a type of recently identified chronic infections that is evidenced only by detection of HCV- RNA in patients' liver tissue with consistently negative serum tests for antibodies to HCV and HCV-RNA

Aim: To study the prevalence of occult HCV infection among Egyptian patients with abnormal liver function tests and compare the characteristics of those patients with other patients with overt chronic hepatitis C infection

Methods: The presence of HCV-RNA was tested by reverse-transcription polymerase chain reaction [RT-PCR] in both liver tissue and peripheralblood mononuclear cells [PBMCs] for forty five patients with abnormal liver function tests. Clinical features of 27 patients with occult HCV infection [ 27 out of 45 patients who were negative for anti-HCV and serum HCV-RNA] were compared to 50 untreated patients with chronic HCV [anti-HCV antibodies and serum HCV-RNA positive], matched for age, gender, duration of abnormal liver function tests and body mass index

Results: HCV-RNA was detected in liver tissue of 27 [59.4%] out of 45 patients with abnormal liver function tests who were negative for both anti-HCV antibodies and serum HCV-RNA with abnormal liver function tests [i.e., who had occult HCV infection]. Twenty patients out of the 27 [74%] having intrahepatic HCV-RNA, had also viral RNA in their PBMCs. Regarding the biochemical characteristics there was significant impairment in classic HCV infection; serum bilirubin [P < 0.001], ALT [P = 0.009], AST [P = 0.013], alpha fetoprotein [P < 0.001], and fasting blood glucose [P < 0.008], but serum albumin, cholesterol, triglycerides and prothrombin time were significantly higher in occult HCV than chronic HCV [P <0.001]. No significant difference regarding Gamma-glutamyl transpeptidase [P< 0.10] was found. Necroinflammatory reactions, fibrosis, [P<0.0001] and cirrhosis [P = 0.03] were significantly higher in chronic HCV than occult HCV, but there was no significant difference regarding steatosis [P = 0.41]

Conclusion: Patients with abnormal liver functions may have intrahepatic HCVRNA in the absence of anti-HCV antibodies and serum HCV-RNA. Occult HCV infection is a milder disease than chronic HCV. Screening of those patients with persistently abnormal liver function for occult HCV-RNA can be firstly done by examining PBMCs

Streptococcus milleri is not an uncommon pyogenic pathogen

Members of Streptococcus milleri group [SMG] may be unrecognized or misidentified in many laboratories, and their clinical role in causing invasive pyogenic infections may be underestimated. To study the bacteriological, antimicrobial susceptibility, and clinical significance of Streptococcus milleri [SMG]. A prospective study. King Hussein Medical Centre, Amman, Jordan. Seventy-three SMG isolated between November 2003 to October 2006 were examined. The phenotypic characteristics and hemolytic patterns of the bacterial colonies were noted. Lancefield sero-grouping was determined by rapid latex agglutination slide test. All isolates were tested using Vitek GPI System for identification. Antimicrobial susceptibility testing was performed by both disk diffusion method and Vitek GPS System. The clinical conditions associated with SMG isolates were recorded. All SMG colonies consistently produced characteristic caramel-like odor. They showed variable hemolysis and sero-grouping patterns. Forty [54.8%] isolates were non-hemolytic. Forty-One out of 73 [56.2%] were nongroupable. Only 13 [17.8%] isolates were identified by the Vitek GPI system. SMG isolates were resistant to gentamicin but sensitive to all the other tested antimicrobial agents. Cervical abscess was the commonest clinical presentation in this study. SMG is a significant cause of serious invasive infections. Awareness of SMG by microbiologists and clinicians is important and may aid in laboratory and clinical diagnosis and better patient management. This is the first report from Jordan demonstrating the bacteriological, antimicrobial susceptibilities, and clinical significance of 73 isolates in our hospital