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Spontaneous bacterial peritonitis: variant syndromes.

H O Conn1

  • 1Yale University School of Medicine, New Haven, Conn.

Southern Medical Journal
|November 1, 1987
PubMed
Summary

Spontaneous bacterial peritonitis (SBP) is increasingly recognized across various liver diseases and conditions. This nosocomial infection often presents silently, with a broad spectrum of clinical signs and causative bacteria.

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Area of Science:

  • Hepatology and Infectious Diseases
  • Gastroenterology
  • Internal Medicine

Background:

  • Spontaneous bacterial peritonitis (SBP) was initially recognized in the 1960s, primarily associated with alcoholic cirrhosis.
  • The disease spectrum has expanded to include posthepatitic, cryptogenic, biliary, and cardiac cirrhosis, as well as alcoholic hepatitis, viral hepatitis, malignant ascites, pancreatitis, and disseminated lupus.
  • A similar syndrome, primary peritonitis, is observed in children with nephrotic ascites.

Purpose of the Study:

  • To describe the evolving spectrum and clinical presentation of spontaneous bacterial peritonitis.
  • To highlight the broadening range of associated conditions and causative organisms.
  • To emphasize the critical differentiation between spontaneous and non-spontaneous bacterial peritonitis.

Main Methods:

  • Review of historical and contemporary case reports and clinical observations of spontaneous bacterial peritonitis.
  • Analysis of the expanding list of associated liver diseases and clinical conditions.
  • Examination of the changing patterns of causative bacteria and clinical manifestations.

Main Results:

  • SBP is now associated with a wider array of conditions beyond alcoholic cirrhosis, including other liver diseases and non-hepatic conditions like lupus.
  • The clinical presentation of SBP has become more variable, ranging from classic symptoms to a completely silent presentation.
  • The range of identified causative bacteria has significantly broadened, though anaerobes remain rare.

Conclusions:

  • Spontaneous bacterial peritonitis is a complex nosocomial disease with an expanding clinical and etiological profile.
  • Accurate differentiation between spontaneous and non-spontaneous bacterial peritonitis is crucial for patient management.
  • The disease often occurs in hospitalized patients with low ascitic fluid protein and severe portal-systemic shunting.

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