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Mononuclear phagocyte thromboplastin and endotoxin in patients with secondary bacterial peritonitis
S M Almdahl1, J H Brox, B Osterud
1Surgical Dept., University Hospital of Tromsø, Norway.
Abstract:
Endotoxin levels and mononuclear phagocyte thromboplastin activities in samples from peripheral blood and peritoneal fluid were determined in nine patients with secondary bacterial peritonitis (appendicitis with perforation, or diverticulitis) and in five control patients (uncomplicated duodenal ulcer or gallbladder stones). None or only negligible amounts of endotoxin, always less than 0.01 ng/dl (contamination), and no growth of bacteria were detected in controls. In the patients with peritonitis, peritoneal fluid samples always contained gram-negative bacteria, and large amounts (mean, 31.6 ng/dl) of endotoxin were seen. Plasma from these patients also contained endotoxin (mean, 0.56 ng/dl) despite negative blood cultures. Mononuclear phagocytes from controls had low thromboplastin values, whereas both circulating monocytes and peritoneal macrophages from peritonitis patients showed a substantial increase (multifold) of thromboplastin.
Insights
Bacterial peritonitis significantly elevates endotoxin and thromboplastin levels in patients. Mononuclear phagocytes, including monocytes and macrophages, show increased thromboplastin activity during infection, indicating a heightened procoagulant state.
Area of Science:
- Microbiology
- Immunology
- Pathophysiology
Background:
- Secondary bacterial peritonitis is a severe condition often involving gram-negative bacteria.
- Endotoxins are potent inflammatory mediators released by gram-negative bacteria.
- Mononuclear phagocytes play a crucial role in innate immunity and inflammation.
Purpose of the Study:
- To investigate endotoxin levels in peripheral blood and peritoneal fluid of patients with secondary bacterial peritonitis.
- To assess the thromboplastin activity of mononuclear phagocytes (monocytes and macrophages) in these patients.
- To compare these findings with control subjects having uncomplicated gastrointestinal conditions.
Main Methods:
- Analysis of endotoxin levels using standardized assays.
- Measurement of mononuclear phagocyte thromboplastin activity.
- Comparison between peritonitis patients and control groups.
Main Results:
- Peritoneal fluid in peritonitis patients contained high endotoxin levels (mean 31.6 ng/dl) and gram-negative bacteria.
- Plasma endotoxin was detected in peritonitis patients (mean 0.56 ng/dl) even with negative blood cultures.
- Mononuclear phagocytes from peritonitis patients exhibited significantly increased thromboplastin activity compared to controls.
Conclusions:
- Secondary bacterial peritonitis is characterized by significant endotoxinemia and peritoneal endotoxin presence.
- Circulating and peritoneal mononuclear phagocytes demonstrate enhanced thromboplastin activity in peritonitis.
- These findings suggest a link between bacterial peritonitis, endotoxin exposure, and altered mononuclear phagocyte procoagulant function.