What is bacterascites?
Bacterascites is defined by an ascitic fluid polymorphonuclear neutrophil (PMN) count below 250/μL and a positive ascitic fluid culture results in the absence of an evident intra‐abdominal, surgically treatable source of infection.1 It is a different clinical entity than spontaneous bacterial peritonitis (SBP), which …
What is culture negative neutrocytic ascites?
Culture-negative neutrocytic ascites (probable SBP) is established when the ascitic fluid culture results are negative but the PMN count is 250 cells/µL or greater. This may happen in as many as 50% of patients with SBP and may not actually represent a distinctly different disease entity.
How is PMN count calculated?
The PMN count is calculated by multiplying the white cells/mm3 by the percentage of neutrophils in the differential. In a bloody sample, which contains a high concentration of red blood cells, the PMN count must be corrected: 1 PMN is subtracted from the absolute PMN count for every 250 red cells/mm3 in the sample.
Can SBP be asymptomatic?
Typically, it is suspected when patients present with signs or symptoms of SBP (eg, fever, abdominal pain). It may also be detected in patients who are asymptomatic who undergo paracentesis when admitted to the hospital for another reason.
How is SBP diagnosed?
The diagnosis of SBP is established based on positive ascitic fluid bacterial cultures and the detection of an elevated absolute fluid polymorphonuclear neutrophil (PMN) count in the ascites (>250/mm3) without an evident intra-abdominal surgically treatable source of infection [1, 9].
Can you have SBP without cirrhosis?
SBP almost always occurs in patients with cirrhosis and large-volume ascites. Table I summarizes possible clinical presentations for SBP; however, approximately 13% of patients will have no sign or symptom of infection.
What is secondary bacterial peritonitis?
Secondary bacterial peritonitis is infected ascites in the setting of an underlying intra-abdominal source of infection. The distinction of spontaneous from secondary bacterial peritonitis is based upon ascitic fluid analysis, imaging studies, and response to treatment.
What is a PMN?
A type of immune cell that has granules (small particles) with enzymes that are released during infections, allergic reactions, and asthma. Neutrophils, eosinophils, and basophils are PMNs. A PMN is a type of white blood cell. Also called granular leukocyte, granulocyte, and polymorphonuclear leukocyte.
What is PMN on CBC?
Polymorphonuclear leukocytes (PMNs) are a type of white blood cell (WBC) that include neutrophils, eosinophils, basophils, and mast cells.
Does SBP cause diarrhea?
For clinical diagnosis, patients with SBP may present signs of peritoneal irritation and pain, together with changes in gastrointestinal motility, sometimes with nausea, vomiting, diarrhea or ileus. Many patients, however, may not present any symptoms or signs as a result of the presence of SBP.
What are the symptoms of SBP?
What are the signs and symptoms of spontaneous bacterial peritonitis (SBP)?
- Fever and chills (as many as 80% of patients)
- Abdominal pain or discomfort (found in as many as 70% of patients)
- Worsening or unexplained encephalopathy.
- Diarrhea.
- Ascites that does not improve following administration of diuretic medication.
How do you treat SBP?
Any person with cirrhosis and ascites who has signs or symptoms concerning for SBP should be treated with antibiotic therapy regardless of ascitic fluid PMN count. Recommended therapy for SBP consists of intravenous cefotaxime 2 grams every 8 hours (or a similar third-generation cephalosporin) for a duration of 5 days.
