Ascitic fluid analysis for diagnosis and monitoring of spontaneous bacterial peritonitis

Abstract

Polymorphonuclear (PMN) cell count in the ascitic fluid is essential for the diagnosis and management of spontaneous bacterial peritonitis (SBP). To date, PMN cell count is routinely performed by traditional manual counting. However, this method is time-consuming, costly, and not always timely available. Therefore, considerable efforts have been made in recent years to develop an alternative test for a more rapid diagnosis and monitoring of SBP. The use of urinary reagent strips was proposed to achieve an "instant" bedside diagnosis of SBP. A series of reports evaluated the urine strip test for SBP diagnosis and reported promising results. However, a recent large multicenter study revealed a surprising lack of diagnostic efficacy of the urine screening test for SBP diagnosis. Another method, more recently proposed as an alternative to the manual PMN count, is the measurement of lactoferrin in ascitic fluid, but the data available on the diagnostic value of this test are limited to a single study. However, both urinary reagent strips and ascitic lactoferrin tests are qualitative methods and need, therefore, to be further confirmed by standard cytology of the ascitic fluid. To date, the only quantitative method proposed as a valid alternative to manual PMN counting is automated blood cell counters, commonly used in all laboratories for blood cell counting. Data available in the literature on the diagnostic performance of this method are limited but very promising, and this tool seems to have the potential to replace the manual counting method.

Bacterial Profile and their Antimicrobial Resistance Patterns from Body Fluids at Tikur Anbesa Specialized Hopital, Addis Ababa, Ethiopia

“…Bacterial invasion of body fluids cause severe diseases leading to morbidity and mortality unless identified early and treated [1,2]. Though isolation and identification of bacterial etiologies are critical for patient mangment [13] developing resistance against commonly used antibiotics are becoming a challenge for treatment success [14]. There are very limited data on the bacterial profiles and their antimicrobial susceptibility patterns from body fluids in Ethiopia in general and in this study site in particular.…”

Fluorescence in-situ hybridization as a novel technique for rapid and sensitive detection of ascitic fluid infection

“…Diagnosis should be prompt and treatment must not be delayed until the microbiological results are available. In contrast, lymphocytes, which have a long lifespan, increase in concentration during diuresis [27]. Owing to the short lifespan of PMNs, their ascitic count is independent of diuretic intake and/or other modulations in ascites volume.…”

Toward reliable and rapid bedside diagnosis of spontaneous bacterial peritonitis in cirrhotic patients

“…However, even automated cell counts suffer generally from similar constraints to those described above for manual techniques. Therefore, any alternative test that may provide or, more importantly, exclude a diagnosis of SBP at the bedside and reduce the 'tap-to-first shot' time is considered welcome [12,[14][15][16].…”