Assessment of Fungal Infection of Peritoneal Fluid in Cirrhotic Ascites

Abstract

Background and study aim: Spontaneous peritonitis (SP) is the most important infectious complication of cirrhotic patients. The aim of this study is to evaluate the occurrence of fungal infection of peritoneal fluid in cirrhotic patients with ascites. Patients and Methods: Between September 2016 and April 2017, 50 Patients were classified into (SP group) and (non SP group) all patients were subjected to history taking, clinical examination, complete blood count, ESR,CRP, liver profile, kidney function tests, serological tests for viral hepatitis markers, abdominal ultrasonography and diagnostic abdominal paracentesis. The ascitic fluid was subjected to the following: microscobic examination, biochemical examination and microbiological cultures (bacterial and fungal). Results: MELD score was higher in SP group with Mean ± SD 23.08 ± 3.85. Analysis of the results showed that abdominal pain, hepatic encephalopathy and melena were the only significant clinical presentations (chief complaint) in patients with SP compared to non SP group (52%, 40% and 8% respectively). As regard risk factors of ascitic fluid infection, 40% had previous episodes of SP. In SP patients, mean PMN count in ascitic fluid was 675.20 ± 420.02 at the time of diagnosis. Ascitic fluid bacterial culture was positive in only 40% of SP patients. Ascitic fluid fungal culture was positive in only 2 patient (8%) of SP group and negative in all patients of non SP group. The isolated organism was Candida albicans. These 2 patient had proven spontaneous fungal peritonitis owing to the presence of Candida albicans as evidenced by clinical picture of spontaneous peritonitis, high ascitic fluid PMN count and. Conclusion: Spontaneous fungal peritonitis is less common than SBP but usually presented as a severe disease, so, clinical prediction and early detection helps in proper treatment and better prognosis.