Spontaneous fungal peritonitis in cirrhotic Egyptian patients with ascites: a single-center study

Abstract

Background Spontaneous bacterial peritonitis (SBP) is the most common infectious complication in cirrhosis. Spontaneous fungal peritonitis (SFP) is rare but more severe. Aim To assess the occurrence of fungal infection of the ascitic fluid in Egyptian cirrhotic patients with spontaneous peritonitis (SP) in a single-center study. Patients and methods In all, 100 patients with SP were subjected to history taking, clinical examination, laboratory investigations, abdominal ultrasonography, and diagnostic abdominal paracentesis. The ascitic fluid was subjected to microscopic examination, microbiological cultures (bacterial and fungal), biochemical examination, and 1-3-β-D-glucan. Results Of the 100 patients, 4% developed SFP and 96% developed SBP. The most common organisms in SFP patients were Candida albicans (75%), followed by Cryptococcus neoformans (25%), with no bacterial growth in those patients. Ascitic fluid bacterial culture was positive in 41.67% of patients with SBP, while it was negative in 58.33%. The most isolated organisms in SBP were Gram-negative (77.5%), predominantly E. coli (57.5%) and Klebsiella (17.5%), then Gram-positive (22.5%). Upper GI bleeding and antibiotic exposure in the last month were significantly higher in SFP than SBP. Patients with SFP had higher ascitic fluid lactate dehydrogenase 202.5 (162.5–230.0) versus 105.0 (86.0–165.0) (P=0.045) and ascitic fluid 1,3-b-d-glucan 97.95 (96.96–98.78) versus 21.0 (13.0–32.50) (P<0.001). Conclusions SFP is less common than SBP but usually presented as a severe disease, so clinical prediction and early detection help in proper treatment and a better prognosis.