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Frequency of Fungal Peritonitis in Patients with End Stage Liver Disease
Ascites is the most frequent symptom of liver decompensation (Cirrhosis). Spontaneous bacterial peritonitis (SBP) is an acute infection of the abnormally accumulated fluid in the abdomen (ascites) in the absence of an intra-abdominal source of infection and with no obvious source of bacteria. Sponta...
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Published in: | QJM : An International Journal of Medicine 2024-10, Vol.117 (Supplement_2) |
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Main Authors: | , , , |
Format: | Article |
Language: | English |
Online Access: | Get full text |
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Summary: | Ascites is the most frequent symptom of liver decompensation (Cirrhosis). Spontaneous bacterial peritonitis (SBP) is an acute infection of the abnormally accumulated fluid in the abdomen (ascites) in the absence of an intra-abdominal source of infection and with no obvious source of bacteria. Spontaneous bacterial peritonitis is more common in patients with advanced cirrhosis. The bulk of the isolated species in SBP are gram-negative enteric organisms (e.g., Escherichia coli or Klebsiella pneumoniae), implying that the GI tract is the main source of infection. Enterotoxin is often extracted from ascitic fluid, lending credence to the idea that bacteria implicated in SBP move transmurally from the intestinal lumen (i.e., bacterial translocation). The most important risk factor is a prior episode of SBP; two thirds of patients will have a recurrence of infection within the following year, GI bleeding (specifically variceal hemorrhage), total protein in ascitic fluid lower than 1.0 g/dL which indicates low opsonic activity, severe liver cell dysfunction, and use of proton pump inhibitors.
Spontaneous fungal peritonitis (SFP) is characterized as fungal infection of the ascitic fluid and the presence of an ascitic neutrophil count of more than 250 cells/mL, which is a devastating and underappreciated complication of ESLD. When antibiotics are used to avoid SBP in patients with ascites, the intestinal bacterial flora is reduced, resulting in significant fungal colonization. This causes peritonitis by inducing translocation through the compromised gastrointestinal tract mucosa into peritoneal cavity. Immunosuppression and malnutrition, both of which are widespread in ESLD, intensify this impact. Since fungi are much larger than bacteria, a higher gut permeability is expected for fungal translocation. This is why SFP is most likely limited to those who have had the most damage to their innate immunity and who have advanced cirrhosis.
Due to the high mortality rate associated with SFP, early diagnosis and treatment are critical for optimizing patient outcomes. New tests, such as the pan- fungal PCR assay and 1,3 beta-D-Glucan, are not only more sensitive in identifying fungi in peritoneal fluid, but they also aid in the early detection of SFP by reducing the time to diagnosis. It is recommended to test peritoneal fluid of patients with risk factors for SFP early with these assays.
This study aimed to know the frequency of spontaneous fungal peritonitis in patients |
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ISSN: | 1460-2725 1460-2393 |
DOI: | 10.1093/qjmed/hcae175.992 |