The high prevalence of Listeria monocytogenes peritonitis in cirrhotic patients of an Egyptian Medical Center

Zaki, Maysaa El Sayed; Shabrawy, Walaa Othman El; El-Eshmawy, Mervat M; Eletreby, Shahera

doi:10.1016/j.jiph.2011.06.002

Cited by 20 publications

(9 citation statements)

References 18 publications

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“…Interestingly, the majority of bactDNA-positive samples (79%) showed a total leukocyte count in ascites below or equal to 500 cells mm Ϫ3 , a fact that has already been described in context with culture-negative, bactDNA-positive ascites in outpatients and hospitalized patients (6,13,14). However, bactDNA detection rates in nonneutrocytic ascites were considerably lower in these studies, ranging from 10% to 35% (4,6), which might be due to the larger sample volume used in this study in combination with a DNA isolation kit that enhances the bactDNA yield from intact bacterial cells by degrading human DNA prior to nucleic acid purification. Samples with low bactDNA contents could be detected by running a higher number of PCR cycles for the detection of low DNA copy numbers, resulting in a real-time PCR assay with increased sensitivity (detection limit, 2.72 log copies ml Ϫ1 ).…”

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confidence: 54%

“…As evidenced by culture-based diagnosis, Gram-negative bacteria of the genera Escherichia and Klebsiella are the most frequent cause for SBP (2,3). However, recent data reveal that also Grampositive bacteria such as Staphylococcus and Enterococcus species may be responsible for bacterial peritonitis, especially in hospitalized patients (4,5). Since detection rates of classical culture techniques are low in the routine setting, the causative agent remains unknown in many cases of SBP (3).…”

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confidence: 99%

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Application of Qualitative and Quantitative Real-Time PCR, Direct Sequencing, and Terminal Restriction Fragment Length Polymorphism Analysis for Detection and Identification of Polymicrobial 16S rRNA Genes in Ascites

Krohn¹,

Böhm²,

Engelmann³

et al. 2014

J Clin Microbiol

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Qualitative and quantitative 16S rRNA gene-based real-time PCR and direct sequencing were applied for rapid detection and identification of bacterial DNA (bactDNA) in 356 ascites samples. bactDNA was detected in 35% of samples, with a mean of 3.24 log copies ml ؊1 . Direct sequencing of PCR products revealed 62% mixed chromatograms predominantly belonging to Grampositive bacteria. Terminal restriction fragment length polymorphism (T-RFLP) results of a sample subset confirmed sequence data showing polymicrobial DNA contents in 67% of bactDNA-positive ascites samples. Spontaneous bacterial peritonitis (SBP) is the most severe bacterial infection in patients with decompensated liver disease (1). As evidenced by culture-based diagnosis, Gram-negative bacteria of the genera Escherichia and Klebsiella are the most frequent cause for SBP (2, 3). However, recent data reveal that also Grampositive bacteria such as Staphylococcus and Enterococcus species may be responsible for bacterial peritonitis, especially in hospitalized patients (4, 5). Since detection rates of classical culture techniques are low in the routine setting, the causative agent remains unknown in many cases of SBP (3).Application of culture-independent PCR-based methods for the detection of bacterial DNA (bactDNA) in ascites has been proposed as a suitable tool to improve pathogen identification in patients at risk for SBP (6) and has indicated that bactDNA derives in most cases from a single pathogen (7-9). However, recent studies using 16S rRNA-based fingerprinting analyses have shown that ascites may also be polymicrobial (10,11) and that the bacterial spectrum is broader than that previously reported in context with SBP (11).Based on these findings, we analyzed a set of ascites samples using primers targeting the 16S rRNA gene for qualitative and quantitative PCR and further characterized bactDNA-positive samples by direct sequencing and terminal restriction fragment length polymorphism (T-RFLP) analysis in order to determine the frequency of detectable bactDNA in ascites from patients with end-stage liver disease and to identify the corresponding bacterial agents.A total of 356 ascites samples from 174 patients with liver cirrhosis (77.6% alcoholic, 11.5% cryptogenic, 2.9% viral hepatitis, 1.7% genetic disorders or metabolic diseases, 1.7% autoimmune hepatitis, 0.6% primary biliary cirrhosis, 3.5% nonalcoholic fatty liver disease, and 0.6% cardiac) were obtained at the University Hospital Leipzig, between February 2011 and December 2012. Thirty-seven percent of the patients (n ϭ 61) underwent several diagnostic paracenteses (mean number of paracenteses, 3.9; range, 2 to 11). All patients gave full written informed consent to the study protocol, which was approved by the local ethics committee.Ascitic fluid samples were routinely analyzed for total leukocyte count using an automated blood cell counter and for the presence of bacterial and fungal pathogens by routine microbiological culture with direct inoculation of agar plates.For culture-independe...

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confidence: 54%

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confidence: 99%

Application of Qualitative and Quantitative Real-Time PCR, Direct Sequencing, and Terminal Restriction Fragment Length Polymorphism Analysis for Detection and Identification of Polymicrobial 16S rRNA Genes in Ascites

Krohn¹,

Böhm²,

Engelmann³

et al. 2014

J Clin Microbiol

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“…The isolation rates of L. monocytogenes from different localities in Egypt were 8% in beef burger, 4% in minced meat and 4% in luncheon meat; while sausage samples were all negative [ 77 ]. In humans, L. monocytogenes is considered the most common lethal complication in Egyptian patients with liver cirrhosis associated with ascites [ 78 ]. Detection of the organism in stool samples of hospitalized Egyptians was reported in different localities [ 71 , 79 ].…”

Section: Bacterial Zoonosismentioning

confidence: 99%

A Comprehensive Review of Common Bacterial, Parasitic and Viral Zoonoses at the Human-Animal Interface in Egypt

2017

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Egypt has a unique geographical location connecting the three old-world continents Africa, Asia and Europe. It is the country with the highest population density in the Middle East, Northern Africa and the Mediterranean basin. This review summarizes the prevalence, reservoirs, sources of human infection and control regimes of common bacterial, parasitic and viral zoonoses in animals and humans in Egypt. There is a gap of knowledge conerning the epidemiology of zoonotic diseases at the human-animal interface in different localities in Egypt. Some zoonotic agents are “exotic” for Egypt (e.g., MERS-CoV and Crimean-Congo hemorrhagic fever virus), others are endemic (e.g., Brucellosis, Schistosomiasis and Avian influenza). Transboundary transmission of emerging pathogens from and to Egypt occurred via different routes, mainly importation/exportation of apparently healthy animals or migratory birds. Control of the infectious agents and multidrug resistant bacteria in the veterinary sector is on the frontline for infection control in humans. The implementation of control programs significantly decreased the prevalence of some zoonoses, such as schistosomiasis and fascioliasis, in some localities within the country. Sustainable awareness, education and training targeting groups at high risk (veterinarians, farmers, abattoir workers, nurses, etc.) are important to lessen the burden of zoonotic diseases among Egyptians. There is an urgent need for collaborative surveillance and intervention plans for the control of these diseases in Egypt.

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“…In an Egyptian prospective cohort, the burden of GPB turned out to be as high as 73.2%, namely 30 out of 41 episodes, including 10 cases by Listeria monocytogenes [ 23 ]. In contrast, a retrospective study conducted in Nigeria, which reviewed medical records from August 2009 to July 2010, showed a much smaller proportion of GBP, which although not marginal was equal to 31.8% (7/22)[ 24 ].…”

Section: Epidemiology Of Sbp: Change Of Paradigmmentioning

confidence: 99%

Current concepts and future strategies in the antimicrobial therapy of emerging Gram-positive spontaneous bacterial peritonitis

Fiore¹,

Maraolo²,

Gentile³

et al. 2017

WJH

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Spontaneous bacterial peritonitis (SBP) is the most common infection in end-stage liver disease patients. SBP is defined as an ascitic fluid infection with a polymorphonuclear leucocyte count ≥ 250/mm3 without an evident intra-abdominal surgically treatable source. Several mechanisms contribute to SBP occurrence, including translocation of gut bacteria and their products, reduced intestinal motility provoking bacterial overgrowth, alteration of the gut’s barrier function and local immune responses. Historically, Gram-negative enteric bacteria have been the main causative agents of SBP, thereby guiding the empirical therapeutic choice. However, over the last decade, a worryingly increasing prevalence of Gram-positive and multi-drug resistant (MDR) SBP has been seen. Recently, the microbiological spectrum of SBP seems to have changed in Europe due to a high prevalence of Gram-positive bacteria (48%-62%). The overall proportion of MDR bacteria is up to 22%-73% of cases. Consequently, empirical therapy based on third-generation cephalosporins or amoxicillin/clavulanic acid, can no longer be considered the standard of care, as these drugs are associated with poor outcomes. The aim of this review is to describe, with an epidemiological focus, the evidence behind this rise in Gram-positive and MDR SBP from 2000 to present, and illustrate potential targeted therapeutic strategies. An appropriate treatment protocol should include daptomycin plus ceftaroline and meropenem, with prompt stepdown to a narrower spectrum when cultures and sensitivity data are available in order to reduce both cost and potential antibiotic resistance development.

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The high prevalence of Listeria monocytogenes peritonitis in cirrhotic patients of an Egyptian Medical Center

Cited by 20 publications

References 18 publications

Application of Qualitative and Quantitative Real-Time PCR, Direct Sequencing, and Terminal Restriction Fragment Length Polymorphism Analysis for Detection and Identification of Polymicrobial 16S rRNA Genes in Ascites

Application of Qualitative and Quantitative Real-Time PCR, Direct Sequencing, and Terminal Restriction Fragment Length Polymorphism Analysis for Detection and Identification of Polymicrobial 16S rRNA Genes in Ascites

A Comprehensive Review of Common Bacterial, Parasitic and Viral Zoonoses at the Human-Animal Interface in Egypt

Current concepts and future strategies in the antimicrobial therapy of emerging Gram-positive spontaneous bacterial peritonitis

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