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Spontaneous non-typhoidal Salmonella peritonitis in patients with serious underlying disorders
J de la Fuente-Aguado1, J Bordón, A R Esteban
1Unit of Infectious Diseases, Hospital Xeral, E-Vigo, Spain.
Abstract:
Non-typhoidal Salmonella is a rare cause of spontaneous bacterial peritonitis (SBP). Non-typhoidal Salmonella SBP has been reported in patients with relatively normal ascitic fluid protein levels. Five patients with non-typhoidal Salmonella SBP and a review of the literature are reported. These patients had chronic underlying disorders, such as malignancy, or other conditions causing immunosuppression. In previous reports, an ascitic fluid protein level above 1.5 g/dl was present in six patients, and under 1.5 g/dl in two. In the present report, ascitic fluid protein is above 2.5 g/dl in three patients and under 1.5 g/dl in one. Immunosuppression and the virulence of the organism seem to play a major role in non-typhoidal Salmonella SBP. Physicians should be alert to the possibility of non-typhoidal Salmonella infection in patients with SBP and normal protein levels in ascitic fluid.
Insights
Non-typhoidal Salmonella is a rare cause of spontaneous bacterial peritonitis (SBP). Immunosuppression and organism virulence are key factors, prompting vigilance in patients with SBP and normal ascitic fluid protein.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Clinical Medicine
Background:
- Spontaneous bacterial peritonitis (SBP) is typically caused by Gram-negative enteric pathogens.
- Non-typhoidal Salmonella is an uncommon etiology of SBP, particularly in patients without significant liver disease.
Observation:
- This study reports five cases of non-typhoidal Salmonella SBP and reviews existing literature.
- Patients often present with underlying conditions leading to immunosuppression, such as malignancy.
Findings:
- Ascitic fluid protein levels in non-typhoidal Salmonella SBP cases can vary, with some patients exhibiting levels below 1.5 g/dl and others above 2.5 g/dl.
- Both patient immunosuppression and Salmonella virulence appear critical in the pathogenesis of this infection.
Implications:
- Physicians should consider non-typhoidal Salmonella in the differential diagnosis of SBP, especially in immunocompromised patients.
- The possibility of SBP with normal ascitic fluid protein levels necessitates a high index of suspicion for unusual pathogens.