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Rapid diagnosis of infected ascitic fluid using leukocyte esterase dipstick testing
Raj C Butani1, Richard T Shaffer, Ronald D Szyjkowski
1Division of Gastroenterology, Department of Medicine, Brooke Army Medical Center, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA.
Objectives:
Ascitic fluid infection is presumptively diagnosed when the fluid polymorphonuclear leukocyte (PMN) concentration equals or exceeds 250 cells/microl. The leukocyte esterase (LE) test has been shown to be a good predictor of the presence of PMNs and bacteria in urine and other body fluids. This study examines the value of the Multistix 10 SG LE Dipstick test for the rapid diagnosis of infected ascitic fluid.
Methods:
One hundred thirty-six ascitic fluid samples were evaluated by PMN count, culture, and LE Dipstick testing. LE dipstick values of "small" or greater were considered positive. For each sample, the LE test result was compared to the corresponding PMN count and culture result.
Results:
Ten of the 11 LE-positive samples had PMN >/=250 cells/microl, while 10 of 12 samples with PMN >/=250 cells/microl were also LE-positive. Of the 125 LE-negative samples, 123 were also negative by PMN count. One hundred twenty-three of the 124 samples with PMN <250 cells/microl had negative LE tests. There was a less concordant relationship between the LE test and culture results. The sensitivity and specificity of the LE test for detecting ascitic fluid PMN >/=250 cells/microl were 83% and 99%, respectively, with a positive predictive value of 91% and a negative predictive value of 98%.
Conclusions:
The Multistix leukocyte esterase test is useful for the prompt detection of an elevated ascitic fluid PMN count, and represents a convenient new method for the rapid diagnosis of infected ascitic fluid.
Insights
The Multistix leukocyte esterase (LE) test rapidly diagnoses infected ascitic fluid by detecting elevated polymorphonuclear leukocyte (PMN) counts. This dipstick test offers high accuracy, aiding in prompt clinical decisions for ascitic fluid infections.
Area of Science:
- Clinical diagnostics
- Microbiology
- Gastroenterology
Background:
- Ascitic fluid infection diagnosis relies on polymorphonuclear leukocyte (PMN) counts (≥250 cells/µL).
- Leukocyte esterase (LE) tests show promise for detecting PMNs in various body fluids.
Purpose of the Study:
- To evaluate the Multistix 10 SG LE Dipstick test for rapid diagnosis of infected ascitic fluid.
- To compare LE test results with ascitic fluid PMN counts and cultures.
Main Methods:
- 136 ascitic fluid samples were analyzed.
- Methods included PMN count, bacterial culture, and LE Dipstick testing.
- LE Dipstick results of "small" or greater were considered positive.
Main Results:
- The LE test demonstrated 83% sensitivity and 99% specificity for detecting PMN counts ≥250 cells/µL.
- Positive and negative predictive values were 91% and 98%, respectively.
- High concordance was observed between LE test and PMN counts, but less so with cultures.
Conclusions:
- The Multistix LE test is a valuable tool for quickly identifying elevated ascitic fluid PMN counts.
- It offers a convenient and rapid method for diagnosing infected ascitic fluid.
