Spontaneous Bacterial Peritonitis In Patients With Liver Disease And Ascites As Seen At Kenyatta National Hospital.

Abstract

A prospective study was carried out on 100 consecutive in patients with ascites and liver disease at Kenyatta National Hospital (KNH) over a period of one year with a view of finding cases of spontaneously infected ascites. 76 of the patients studied were males and 24 females with mean ages of 46 and 43 years respectively. 10 patients (10%) (7 males and 3 females) were found to have symptomatic spontaneOU5 bacterial peritonitis (SSBP) on culture while 5 patients (5%) (3 males and 2 females) were found to have positive ascitic fluid culture without clinical signs and symptoms of peritonitis. 10 (10%) patients (9 males and 1 female) were considered as possible cases of spontaneous bacterial peritonitis on clinical grounds. The mean fluid total white blood cell (WBC) count among patients with asymptomatic sterile ascites (ASA) was 122.8 leukocytes/mm3 (standard deviation (s.d) 122.8 vmC/mm3) while the mean for patients with culture positive SSBP was 179.6 WBC/mm3 (s.d 196.9 WBC/mm3). This difference was not significant ( P> 0.20). The mean ascitic fluid polymorph count among patients with culture positive SSEP was 62% {s.d 33% of the total fluid WBC count while the mean among patients with ASA was 29.7% (s.d 23.1%)... The difference was significant at P < 0.001. There was no patient among the ASA group with polymorph count greater than 85% but 40% of patients with culture positive SSEP had fluid polymorph count greater than 85% of total WEC count. There was a high association of generalized abdominal pain (100%), generalized abdominal tenderness (100%) abnormal (low and high) body temperature (80%) and significant ascitic fluid polymorphonuclear count with infected ascities. Hypothermia, hepatic encephalopathy and presence of enteric organisms on culture were factors associated with poor outcome while hyperpyrexia was associated with a better outcome.