scholarly journals Refractory Spontaneous Bacterial Empyema in Cirrhotic Patient

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Erica Chow ◽  
Bashar Khiatah ◽  
Amanda Frugoli
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Relevant Literature ◽  
High Rate ◽  
Case Vignette ◽  
Timely Initiation ◽  
Mortality And Morbidity ◽  
Bacterial Peritonitis ◽  
High Clinical Suspicion ◽  
History Of ◽  
Spontaneous Bacterial Empyema

Spontaneous bacterial empyema (SBEM), also called spontaneous bacterial pleuritis, is an infection of the pleural space that arises in the setting of cirrhosis and, by definition, the absence of pneumonia. It is likely underdiagnosed as its symptoms are nonspecific and it lacks standardized diagnostic and therapeutic recommendations. SBEM represents a distinct complication of hepatic hydrothorax with different pathogenesis, presentation, and treatment strategy from those of empyema secondary to pneumonia. Surprisingly, nearly 40% of episodes of spontaneous empyema are not associated with spontaneous bacterial peritonitis. Although SBEM is amenable to prompt antibiotic therapy, it has a high rate of mortality and morbidity. A high clinical suspicion is crucial for patient survival and timely initiation of appropriate antibiotics. Increased understanding, recognition, and standardization of treatment would help alleviate the relatively high burden of SBEM. In this case vignette, we provide a review of the relevant literature, and we describe a rare case of SBEM in a patient with a history of alcohol-associated liver cirrhosis and prior episode of spontaneous bacterial peritonitis (SBP). SBEM was diagnosed with thoracentesis and analysis of the aspirate, and he was treated with ceftriaxone with resolution of his presenting abdominal pain and leukocytosis.

scholarly journals Clinical Presentation and Prevalence of Spontaneous Bacterial Peritonitis in Patients with Cryptogenic Cirrhosis and Features of Metabolic Syndrome

2004 ◽  
Vol 18 (6) ◽  
pp. 381-386 ◽  
Author(s):  
P Sorrentino ◽  
G Tarantino ◽  
P Conca ◽  
A Perrella ◽  
O Perrella
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Case Control Study ◽  
Laboratory Data ◽  
Control Group ◽  
Cryptogenic Cirrhosis ◽  
Bacterial Peritonitis ◽  
Prevalence Of Obesity ◽  
History Of ◽  
Juvenile Obesity ◽  
Control Study

BACKGROUND:Nonalcoholic steatohepatitis (NASH) may progress to cirrhosis. The prevalence and clinical relevance that spontaneous bacterial peritonitis may have in complicating ascites due to NASH-related cirrhosis have yet to be defined.METHODS:Among 611 cases of cirrhosis-associated ascites, 45 patients with cryptogenic cirrhosis were retrospectively identified. Of these, 36 patients and a control group of subjects with viral-associated ascites were followed up and compared in a case control study. Information on the onset of ascites, with or without spontaneous bacterial peritonitis, history of risk factors for multimetabolic syndrome, and serological and ascitic laboratory data were compared between groups.RESULTS:Spontaneous bacterial peritonitis occurred significantly more often in patients with cryptogenic cirrhosis than in equally symptomatic viral controls. The prevalence of obesity, diabetes and spontaneous bacterial peritonitis was significantly higher in patients with cryptogenic cirrhosis. Although liver function was similar in both groups, cryptogenic cirrhosis patients had lower aminotransferase levels. Multivariate analysis identified diabetes, juvenile obesity and spontaneous bacterial peritonitis as independent factors associated with ascites due to cryptogenic cirrhosis.CONCLUSIONS:Features suggestive of NASH are more frequently observed in patients with ascites and cryptogenic cirrhosis than in age- and sex-matched ascitic patients with well-defined viral etiology. Ascites may be a presenting symptom of NASH-related cirrhosis, and affected patients have a twofold greater risk of spontaneous bacterial peritonitis.

51Cr-EDTA permeability test in ascitic cirrhotic patients with and without history of spontaneous bacterial peritonitis

2009 ◽  
Vol 41 (3) ◽  
pp. A3
Author(s):  
E. Scarpellini ◽  
G. Merra ◽  
A. Dal Lago ◽  
L. Zileri Dal Verme ◽  
C. Lauritano ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Permeability Test ◽  
Bacterial Peritonitis ◽  
51Cr Edta ◽  
History Of ◽  
Cirrhotic Patients

scholarly journals Determining the Risk of Spontaneous Bacterial Peritonitisdue to increase use of Proton Pump Inhibitors among cirrhotic patients with ascites

2021 ◽  
Vol 37 (4) ◽  
Author(s):  
Bashir Ahmed Shaikh ◽  
Zahid Ali Shaikh ◽  
Aftab Hussain Shah ◽  
Aneel Kumar
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Spontaneous Bacterial Peritonitis ◽  
Polymorphonuclear Neutrophil ◽  
Retrospective Case ◽  
Medical College ◽  
Creative Commons ◽  
Bacterial Peritonitis ◽  
History Of ◽  
Cirrhotic Patients

Objectives: The current study aimed to determine the Spontaneous Bacterial Peritonitis (SBP) risk due to increased use of Proton Pump Inhibitors (PPIs) among cirrhotic patients with ascites. Methods: This retrospective case-control study was conducted at Chandka Medical College & Hospital, Larkana from March 2013 to February 2014, involving 215 cirrhotic patients with ascites. Paracentesis was performed to distinguish cirrhotic patients with SBP and Polymorphonuclear Neutrophil (PMN) count ≥ 250 neutrophils/mm3 (cases) and non-SBP with PMN count < 250 neutrophils/mm3 (controls). The demographic details, history of PPIs use before admission and duration of Chronic Liver Disease (CLD) were inquired and statistical analysis was carried through SPSS Version 23.0. Results: Increased pre-hospital PPI intake was observed among cirrhotic patients with SBP (69.8%) as compared to those without SBP (48.8%; p = 0.014). The mean duration of PPI use was 19.16 ± 4.772 days, and it was more significant among older cirrhotic patients (p < 0.05). Increased duration of CLD was observed among PPI users, i.e. 20.47 ± 6.305 months vs. 18.95 ± 5.527 months among non-PPI users (p < 0.05). Conclusions: Our results show that cirrhotic patients with ascites consuming PPIs are more likely to develop SBP as compared to non-PPI users. doi: https://doi.org/10.12669/pjms.37.4.3476 How to cite this:Shaikh BA, Shaikh ZA, Shah AH, Kumar A. Determining the Risk of Spontaneous Bacterial Peritonitis due to increase use of Proton Pump Inhibitors among cirrhotic patients with ascites. Pak J Med Sci. 2021;37(4):---------.   doi: https://doi.org/10.12669/pjms.37.4.3476 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

261 51CR-EDTA PERMEABILITY TEST IN ASCITIC CIRRHOTIC PATIENTS WITH AND WITHOUT HISTORY OF SPONTANEOUS BACTERIAL PERITONITIS

2008 ◽  
Vol 48 ◽  
pp. S105
Author(s):  
E. Scarpellini ◽  
G. Merra ◽  
A. Dal Lago ◽  
L. Zileri Dal Verme ◽  
C. Lauritano ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Permeability Test ◽  
Bacterial Peritonitis ◽  
51Cr Edta ◽  
History Of ◽  
Cirrhotic Patients

scholarly journals Infective Endocarditis: A Case with Prolonged Fever

2021 ◽  
Vol 2 (2) ◽  
pp. 84
Author(s):  
Maulia Prismadani ◽  
Agus Subagjo
Keyword(s):  
Infective Endocarditis ◽  
Heart Valves ◽  
High Rate ◽  
Structural Abnormality ◽  
Severe Mitral Regurgitation ◽  
Mortality And Morbidity ◽  
Prolonged Fever ◽  
Duke Criteria ◽  
History Of ◽  
Major Criterion

Infective endocarditis (IE) is associated with a high rate of mortality and morbidity in patients with anomalies of heart valves. We present a case of a 23-year-old male known to have severe mitral regurgitation (MR) with a history of prolonged fever for 5 months. According to The Modified Duke Criteria, clinical sign and symptoms fulfilled one major criterion (echocardiography finding of vegetation on mitral valve) and three minor (fever of at least 380 Celsius, valvular heart disease as a predisposing heart condition, and positive blood culture for Lactococcus sp. and Pediococcus sp.) considered as definite IE. Fever is one of the most common symptoms of IE (>90% of cases). Patient with prolonged fever and structural abnormality of heart valve should be considered for acute or subacute of IE. Establishing an diagnosis of IE and appropriate antibiotic therapy will improve the patient's clinical condition, and reduce morbidity and mortality.

scholarly journals A70 ASSOCIATION BETWEEN PROTON PUMP INHIBITOR USE IN HOSPITALIZED CIRRHOTICS AND DEVELOPMENT OF HEPATIC ENCEPHALOPATHY AND SPONTANEOUS BACTERIAL PERITONITIS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 83-84
Author(s):  
P Tan ◽  
M Ukos ◽  
C Miller ◽  
J Lombardi ◽  
E M Kelly
Keyword(s):  
Hepatic Encephalopathy ◽  
Proton Pump ◽  
Variceal Bleeding ◽  
Spontaneous Bacterial Peritonitis ◽  
Relevant Information ◽  
Prescribing Patterns ◽  
Ulcer Disease ◽  
Bacterial Peritonitis ◽  
Significant Difference ◽  
History Of

Abstract Background Proton pump inhibitors (PPI) are commonly prescribed medications which are indicated in various different gastrointestinal (GI) diseases, including peptic ulcer disease, gastroesophageal reflux disorder and upper GI bleeding. There is some evidence to suggest that PPI use in cirrhosis may predispose to the development of hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP), albeit with some controversy. Aims We aim to conduct a retrospective epidemiological analysis of the association between PPI use in hospitalized patients with cirrhosis, and prevalence of HE and SBP. Methods This was a retrospective cohort study of 600 adult patients (mean age 61.4 (SD=12.2)) admitted the Ottawa Hospital between January 1, 2011 and December 31, 2015 with cirrhosis. A chart review was conducted and relevant information extracted. Results Average MELD-Na on admission was 16.2 (sd=6.7). 14.8% of patients had a history of HE, 5.0% SBP, 7.8% with history of hepatocellular carcinoma and 1.0% with history of hepatorenal syndrome. 28.5% of patients had a history of varices, of which 11.0% had previous variceal bleeding. 69.3% of patients were on a PPI during their hospitalization. Not surprisingly, patients admitted with variceal bleeding were more likely to be exposed to PPI in hospital (97.2% vs 63.2%, p&lt;0.01) Patients with a diagnosis of cirrhosis prior to index admission were more likely to be on a PPI in hospital (p=0.001) and on discharge (p=0.001). Patients with ascites were less likely to be on a PPI than those without ascites (64.1% vs 77.6%, p&lt;0.01). There was no significant correlation between in hospital PPI use and MELD score (p=0.42). Amongst patients on PPI in hospital, 85.9% remained on a PPI at discharge. Although numerically greater, no statistically significant differences were observed in terms of prevalence of HE (21.3% in patients on PPI vs 8.3% in those not on PPI (p=0.37)), nor SBP (5.7% on PPI vs. 3.7% in those not on PPI (p=0.29)). Conclusions We did not observe a significant difference in HE and SBP among this cohort of cirrhotic patients by in-hospital PPI use. We did however note significantly higher PPI use in patients with previous diagnosis of cirrhosis as compared to those who were newly diagnosed, as well as those whose admissions were related to bleeding. Patients with ascites had lower prevalence of PPI use. Prescribing patterns for PPIs in patients with cirrhosis warrant further attention, including clinical utility and longer-term risks and benefits of this therapy. Funding Agencies None

S1959 51cr-EDTA Permeability Test in Ascitic Cirrhotic Patients with and Without History of Spontaneous Bacterial Peritonitis

2008 ◽  
Vol 134 (4) ◽  
pp. A-792
Author(s):  
Giuseppe Merra ◽  
Emidio Scarpellini ◽  
Antonio Dal Lago ◽  
Lorenzo Zileri Dal Verme ◽  
Maria Grazia Spitilli ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Permeability Test ◽  
Bacterial Peritonitis ◽  
51Cr Edta ◽  
History Of ◽  
Cirrhotic Patients

51Cr-EDTA Permeability Test in Ascitic Cirrhotic Patients with and without History of Spontaneous Bacterial Peritonitis

2008 ◽  
Vol 103 ◽  
pp. S120
Author(s):  
Emidio Scarpellini ◽  
Giuseppe Merra ◽  
Antonio Dal Lago ◽  
Venanzio Valenza ◽  
Antonio Gasbarrini ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Permeability Test ◽  
Bacterial Peritonitis ◽  
51Cr Edta ◽  
History Of ◽  
Cirrhotic Patients
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