title: Laboratory diagnostics of spontaneous bacterial peritonitis.
abstract: The term peritonitis indicates an inflammatory process involving the peritoneum that is most frequently infectious in nature. Primary or spontaneous bacterial peritonitis (SBP) typically occurs when a bacterial infection spreads to the peritoneum across the gut wall or mesenteric lymphatics or, less frequently, from hematogenous transmission in combination with impaired immune system and in absence of an identified intra-abdominal source of infection or malignancy. The clinical presentation of SBP is variable. The condition may manifest as a relatively insidious colonization, without signs and symptoms, or may suddenly occur as a septic syndrome. Laboratory diagnostics play a pivotal role for timely and appropriate management of patients with bacterial peritonitis. It is now clearly established that polymorphonuclear leukocyte (PMN) in peritoneal fluid is the mainstay for the diagnosis, whereas the role of additional biochemical tests is rather controversial. Recent evidence also suggests that automatic cell counting in peritoneal fluid may be a reliable approach for early screening of patients. According to available clinical and laboratory data, we have developed a tentative algorithm for efficient diagnosis of SBP, which is based on a reasonable integration between optimization of human/economical resources and gradually increasing use of invasive and expensive testing. The proposed strategy entails, in sequential steps, serum procalcitonin testing, automated cell count in peritoneal fluid, manual cell count in peritoneal fluid, peritoneal fluid culture and bacterial DNA testing in peritoneal fluid.
authors: Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy. Electronic address: glippi@ao.pr.it.
authors: Giuseppe
authors: G
authors: Lippi
authors: Laboratory of Clinical Chemistry and Hematology, University of Verona, Verona, Italy.
authors: Elisa
authors: E
authors: Danese
authors: Emergency Department, Academic Hospital of Parma, Parma, Italy.
authors: Gianfranco
authors: G
authors: Cervellin
authors: Laboratory of Clinical Chemistry and Hematology, University of Verona, Verona, Italy.
authors: Martina
authors: M
authors: Montagnana
mesh_terms: D000465:Algorithms; D001202:Ascitic Fluid / Q000382:microbiology; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D002452:Cell Count; D019411:Clinical Laboratory Techniques; D006801:Humans; D010538:Peritonitis / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D011498:Protein Precursors / Q000097:blood
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
keywords: Laboratory diagnostics; Peritoneal fluid; Peritonitis; Procalcitonin; Spontaneous bacterial peritonitis