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Spontaneous Bacterial Infection in Empyema Fluid in Cases with
Cirrhosis
Wasfi E S A(1),
Asal F E(1), Farrag A. (1), El Kassas G(1),
Fouad H A(2) & Edrees A(1)
Departments of Tropical Medicine(1)
and Microbiology(2)),
Faculty of Medicine, Tanta University, Egypt
Tanta Med. Sc. J 2008; 3(4):70-76
Article type: Original article
Background/Aim: Spontaneous bacterial empyema is an infection of a
preexisting hydrothorax in a cirrhotic patient that cannot be
attributed to chest condition. It is associated with a bad prognosis
and mortality rate may reach over 20%. Infection is usually by
enteric bacteria which reach pleural cavity by hematogenous spread;
though transfer through bowel wall can occur. The aim of the present
work is to throw some light on the spontaneous bacterial empyema in
cirrhotic patients with hepatic hydrothorax and its relation to
ascetic fluid. Patients and Methods: The present study was performed
on 40 patients with hepatic hydrothorax from Tropical Medicine
Dept., Tanta University. All patients were subjected to full history
taking, thorough clinical examination, routine laboratory
investigations, abdominal US. Tuberculin testing and ZN examination
of sputum were done to exclude TB. Examination of pleural fluid of
all cases was done including Adenosine Deaminase (ADA) and LDH.
Pleural fluid was examined bacteriologically for Gram stain and
Ziehl Neelsen staining. Cultures were done using the conventional
method and modified method. According to these data, cases were
further divided into two groups: Group I: Thirteen patients (13)
with cirrhosis, hepatic hydrothorax with Spontaneous bacterial
empyema. Group II: Twenty seven patients (27) with cirrhosis and
hepatic hydrothorax. Ascitic fluid analysis macroscopically,
biochemically and bacteriologically was done for all cases. Results:
There were no significant differences as regards Child score,
hemoglobin, white cell count, Serum bilirubin and transaminases, but
there was a significant deterioration in group I compared to group
II. Comparison of pleural and ascitic fluid in the two groups proved
significant differences as regards total leucocytes, PMN, LDH and pH
in group I compared to group II. Main bacterial pathogen in pleural
fluid was E. coli followed by Pseudomonas aeroginosa. Culture was
negative in 46.2% of ascitic fluid and 30.7% in pleural fluid.
Conclusion: Spontaneous bacterial empyema is a relatively common
complication of cirrhotic patients with hydrothorax. Diagnostic
thoracocentesis is mandatory in cases with hepatic hydrothorax
regardless the presence or absence of ascites. E. coli is the most
common pathogen, and hematogenous spread may play a main role.
Modified method of culture is the method of choice to increase
sensitivity.
ICID 881851 |