Spontaneous bacterial peritonitis due to Clostridium perfringens in a patient with liver cirrhosis and pure red cell aplasia.

A 63-year-old man with decompensated liver cirrhosis and pure red cell aplasia complained of pyrexia, abdominal distention and abdominal pain. A diagnosis of spontaneous bacterial peritonitis (SBP), Conn's syndrome, was made upon the isolation of an anaerobe Clostridium perfringens from both ascitic fluid and peripheral blood. The bacteria were found to be susceptible to piperacillin, and administration of the antimicrobial agent markedly improved his SBP. The anaerobes should be kept in mind as one of the possible pathogens of SBP, although anaerobic infection has been reported to be quite rare in the disease.     

肝硬化并发自发性细菌性腹膜炎诊治现状

<正>细菌感染是肝硬化的主要并发症^[1],占肝硬化患者急性失代偿事件住院率的25%～46%^[2]。细菌感染使失代偿期肝硬化患者病死率增加4倍,最常见的死亡原因是慢加急性肝衰竭引发的多脏器功能衰竭^[3]。自发性细菌性腹膜炎(spontaneous bacterial peritonitis, SBP)是肝硬化患者最常见的细菌感染之一,其次是尿路感染、肺炎、皮肤软组织感染和自发性菌血症^[4]。SBP是指在没有明显腹腔感染因素的情况下发生于肝硬化和腹水患者的腹水细菌感染,     

肝硬化并发自发性细菌性腹膜炎临床研究进展*

目的 自发性细菌性腹膜炎(SBP)为目前肝硬化患者最常见的并发症之一,具有发病率高,疾病发展快,病死率高等特征。该病临床表现常不典型,腹腔感染的诊断主要基于腹腔积液白细胞计数。治疗则以经验性抗生素使用为主,联合调节肠道菌群、补充白蛋白等。有条件者可考虑肝移植。早期发现并积极实施干预对改善本病预后、降低病死率都有着重要的意义,但在有关SBP诊断、治疗和预防方面,仍面临巨大的挑战,需要深入研究进一步解决相关问题的策略,从而更好地指导临床实践,改善患者预后。     

Spontaneous bacterial peritonitis due to methicillin-resistant Staphylococcus aureus in patients with cirrhosis

A substantial epidemiologic change in the etiology of spontaneous bacterial peritonitis (SBP) has been observed in recent years. Gram-positive, as well as multiresistant bacteria, have emerged as an important cause of SBP mainly among hospitalized patients. In this setting, SBP caused by methicillin-resistant Staphylococcus aureus (MRSA) could become a major clinical problem in the near future. We present two cases of SBP due to MRSA without clinical response to vancomycin, even though in vitro sensitivity was observed in both cases. We review the current literature on the incidence and clinical significance of SBP due to MRSA infection in cirrhotic patients, as well as its prevention and treatment.     

Spontaneous remission in pure red cell aplasia associated with thymoma.

A 57-year-old woman with thymoma-associated pure red cell aplasia (PRCA) manifested spontaneous recovery of erythropoiesis. Anemia recurred before the surgical removal of her thymoma, however, and the second anemic remission following surgery did not occur promptly. In this report, we describe a rare occurrence of spontaneous remission in PRCA.     

Spontaneous bacterial peritonitis due to Brucella Melitensis in a cirrhotic patient.

Spontaneous bacterial peritonitis is a well-known entity, with a reported incidence of 15-20% in advanced cirrhotic patients. Escherichia coli and Klebsiella pneumoniae are the most common causes of spontaneous bacterial peritonitis; Brucella is extremely rare. We aimed to present one case of such a rare condition in a cirrhotic patient who also had hepatocellular carcinoma. Routine laboratory tests, abdominal ultrasonography and peritoneal fluid examinations were studied in a cirrhotic patient with ascites. Peritoneal fluid white blood cell count was 1300/mm3, with lymphocyte predominance (80%). Peritoneal fluid and blood culture both yielded Brucella melitensis. The patient also had a mass in the right lobe of the liver confirmed as hepatocellular carcinoma by biopsy. Brucella should be suspected as a cause of spontaneous bacterial peritonitis in cirrhotic patients with no response to standard spontaneous bacterial peritonitis treatments and with immunodeficiency such as hepatocellular carcinoma.     

Spontaneous bacterial peritonitis in liver cirrhosis: Treatment and prophylaxis

Spontaneous bacterial peritonitis in liver cirrhosis is due to the passage of intestinal bacteria into intestinal lymph vessels, systemic circulation and ascitic fluid. It may occur in patients with severe portal hypertension and hepatic failure, impaired reticuloendothelial phagocytic activity and low ascitic fluid opsonic activity. Spontaneous bacterial peritonitis is a monomicrobial infection usually caused by gram-negative bacteria. The treatment of choice of spontaneous bacterial peritonitis is cefotaxime. Several subgroups of cirrhotic patients have been shown to be predisposed to develop spontaneous bacterial peritonitis, including cases with gastrointestinal hemorrhage, patients with high serum bilirubin and low ascitic fluid protein concentration (<1 g/dl),=" and=" patients=" who=" had=" recovered=" from=" an=" episode=" of=" spontaneous=" bacterial=" peritonitis.=" since=" spontaneous=" bacterial=" peritonitis=" is=" associated=" with=" a=" relatively=" high=" in-hospital=" mortality=" rate=" (20–40%),=" prophylactic=" measures=" to=" prevent=" this=" infection=" are=" required.=" short-term=" and=" long-term=" selective=" intestinal=" decontamination=" with=" oral=" norfloxacin=" has=" proved=" highly=" effective=" in=" preventing=" bacterial=" infection=" and=" spontaneous=" bacterial=" peritonitis=" in=" bleeding=" cirrhotic=" patients=" as=" well=" as=" recurrence=" of=" spontaneous=" bacterial=">Die spontane bakterielle Peritonitis bei Leberzirrhose beruht auf einer Passage der Bakterien über die Lymphgefäße des Dünndarms in den systemischen Kreislauf und in den Aszites. Betroffen sind Patienten mit schwerer portaler Hypertension und Leberversagen, gestörter Phagozytoseaktivität des retikuloendothelialen Systems und geringer Opsonisierungsfähigkeit des Aszites. Die spontane bakterielle Peritonitis ist eine monobakterielle Infektion, die meist durch gramnegative Bakterien ausgelöst wird. Cefotaxim ist das Mittel der Wahl bei spontaner bakterieller Peritonitis. Bei betimmten Untergruppen von Patienten mit Leberzirrhose besteht eine besondere Prädisposition für eine spontane bakterielle Peritonitis, einschließlich der Patienten mit gastrointestinaler Blutung, mit hohem Serumbilirubin und geringer Eiweißkonzentration im Aszites (<1 g/dl),=" sowie=" patienten,=" die=" bereits=" eine=" episode=" von=" spontaner=" bakterieller=" peritonitis=" durchgestanden=" haben.=" prophylaktische=" maßnahmen=" sind=" wegen=" der=" hohen=" letalität=" (20–40%)=" der=" erkrankung=" während=" der=" hospitalisierungsphase=" erforderlich.=" die=" kurzfristige=" oder=" langfristige=" selektive=" dekontamination=" des=" darmes=" mit=" oralem=" norfloxacin=" erwies=" sich=" als=" hochaktive=" präventionsmaßnahme=" gegen=" bakterielle=" infektionen=" und=" die=" spontane=" bakterielle=" peritonitis=" bei=" blutenden=" patienten=" mit=" leberzirrhose=" und=" reduzierte=">     

Spontaneous bacterial peritonitis in Saudi Arabian patients with non-alcoholic liver cirrhosis

BACKGROUND/AIMS: Spontaneous bacterial peritonitis is a frequent and serious complication of liver cirrhosis. Its prevalence varies from one survey to another. There are only very few reports of its occurrence among Arab patients. METHODOLOGY: We studied 115 Saudi Arabian patients with cirrhotic ascites in the Gizan region, an area of hyperendemic hepatitis B, over a 2-year period. RESULTS: Of these patients 12 (10.4%) had at least 1 episode of culture-positive spontaneous bacterial peritonitis (group A), an additional 34 (29.6%) had culture-negative neutrocytic ascites. The occurrence of spontaneous bacterial peritonitis was more frequent in males but was not influenced by the severity of liver disease or age. The overall mortality was 13.9%, however, only 1 patient died of spontaneous bacterial peritonitis-related cause. The remaining deaths were due to other complications of hepatic failure and portal hypertension. The low clinical threshold for treatment and the use of effective broad-spectrum antibiotics have reduced the mortality due to spontaneous bacterial peritonitis. There were a total of 56 recurrent episodes of infection in the patients. Of these episodes 46 occurred among 29 patients with spontaneous bacterial peritonitis and 10 among 62 patients with no infection during the index admissions. CONCLUSIONS: Prophylactic therapy against spontaneous bacterial peritonitis is a feasible strategy in reducing the frequency of recurrent peritonitis and should be recommended in these patients.     

Corticosteroid treatment of pure red cell aplasia in a patient with hepatitis A

Secondary pure red cell aplasia (PRCA), as an extrahepatic manifestation of hepatitis A virus infection, has been reported on rare occasions. We report herein an unusual case of hepatitis A complicated by PRCA. In addition, we reviewed nine cases reported in the English literature. Our case of nonfulminant hepatitis A complicated by PRCA and hemolytic anemia was successfully treated with initial transfusion and corticosteroid therapy for 18 weeks. The patient's hematologic abnormalities and liver function tests re-normalized completely. We review clinical features and effective therapeutic strategies for this disease entity.     

Spontaneous bacterial peritonitis and bacteremia due to Leuconostoc species in a patient with end-stage liver disease: a case report.

This report describes a case of spontaneous bacterial peritonitis in a patient with end stage liver disease in whom Leuconostoc spp. was isolated from blood and ascitic fluid. In common with several previously described patients with cultures positive for Leuconostoc from other body sites, this patient had recently received vancomycin. The antibiotic susceptibilities and mechanism of vancomycin resistance of this Gram-positive bacteria are reviewed.