Non tuberculous bacterial peritonitis in Egyptian patients with ascites

ABSTRACT

Biochemical, cytological and non tubercoulous bacterial culture of ascitic fluid of 50 patients [25[M], 25[F]. with mean age 35y] with chronic liver diseases admitted to Ahmed Maher Hospital liver unit care, were done for detection of spontaneous bacterial peritonitis [SBP]. Patients were classified into 25 patients with bilharzial hepatic fibrosis and 25 patients with non bilharzial hepatic cirrhosis [viral hepatitis]. The levels of specific gravity and lactic dehydrogenase [LDH] enzyme were higher in bilharzial [mean 1012 and 27.52 mg/dl] than the non bilharzial group [mean 1009 and 26.88 mg. dl] respectively, while there was no marked difference in the levels of ascitic fluid protein contents, ALT, AST, bilirubin and glucose. The cytological examination of the ascitic fluid showed that white cell, PMN and lymphocytic cell counts were higher in non bilharzial [mean 485. 6, 227. 68 and 34. 24 /mm[3]] than the bilharzial group [mean 397.68, 221.68 and 34.12/mm[3]] respectively. Ascitic fluid culture was positive in 9/50 [18%] cases of suspected SBP. [10%] of the non bilharzial group compared to [4%] of the bilharzial group were bacterial culture positive. Single isolated strain was found in [16%] and combined bacterial infection in [2%] of the two studied groups. A good correlation was found between PMN cell count >/= 1000 cell/mm[3] and positive bacterial culture in both groups studied. We concluded that indirect parameters of diagnosis of SBP i. e. ascitic fluid PMN cell count and LDH beside the routine bacterial culture provide rapid diagnosis and alter the bad prognosis of SBP