Spontaneous Colon Bacillus Bacteremia in Laennec's Cirrhosis

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Summary Four cases have been described that illustrate the coincidence of Laennec's cirrhosis and spontaneous or primary Escherichia coli bacteremia. In 3 patients the clinical onset of bacteremia was acute, with chills, fever, and impaired mental function; in a fourth, the illness was subacute. Although 1 patient died with vasomotor collapse and diffuse gastrointestinal hemorrhage, 3 recovered after appropriate antibiotic therapy. In no case was a localized E. coli tissue infection demonstrated. Clinically inapparent local sites of bacterial growth, impaired hepatic blood flow and reticuloendothelial cell function, and defective humoral defenses against infection, all potential consequences of chronic liver disease, may account for the frequency of spontaneous coliform bacteremia in cirrhosis.