title: Diagnosing bacterial peritonitis made easy by use of leukocyte esterase dipsticks.
abstract: BACKGROUND
  Spontaneous bacterial peritonitis (SBP) requires rapid diagnosis for the initiation of antibiotics. Its diagnosis is usually based on manual examination of ascitic fluid (AF) having long reporting time. AF infection is diagnosed when the fluid polymorphonuclear leukocyte (PMNL) concentration ≥250 cells/mm(3).
  
  
  OBJECTIVE
  Aim was to evaluate the diagnostic utility of leukocyte esterase (LE) reagent strip for rapid diagnosis of SBP in patients who underwent abdominal paracentesis and to calculate the sensitivity, specificity, positive, and negative predictive values.
  
  
  METHODS
  The study was carried out on 103 patients with ascites. Cell count of AF as determined by colorimetric scale of Multistix 10 SG reagent strip was compared with counting chamber method (PMNL count ≥250 cells/mm(3) was considered positive).
  
  
  RESULTS
  Of the 103 patients SBP was diagnosed in 20 patients, 83 patients were negative for SBP by manual cell count. The sensitivity and specificity of the LE test for detecting neutrocytic SBP taking grade 2 as cut off were 95% and 96.4% respectively, with a positive predictive value of 86.4% and a negative predictive value of 98.8%. Diagnostic accuracy of LE test was 96.1%.
  
  
  CONCLUSIONS
  There was a good correlation between the reagent strip result and PMNL count. The LE strip test is based on the esterase activity of activated granulocytes which reacts with an ester-releasing hydroxyphenylpyrrole causing a colour change in the azo dye of reagent strip. It is a very sensitive and specific method for the prompt detection of elevated PMNL count, and represents a convenient, inexpensive, simple, and bedside method for diagnosis of SBP. A negative LE test result excludes SBP with a high degree of certainty.
authors: Department of Biochemistry, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
authors: Kiran
authors: K
authors: Chugh
authors: Department of Biochemistry, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
authors: Yuthika
authors: Y
authors: Agrawal
authors: Department of Chest and TB, Shree Guru Gobind Singh Tricentenary Medical College, Budhera, Gurgaon, Haryana, India.
authors: Vipin
authors: V
authors: Goyal
authors: Department of Medicine, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
authors: Vinod
authors: V
authors: Khatri
authors: Department of Medicine, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
authors: Pradeep
authors: P
authors: Kumar
keywords: Bacterial; diagnosis; esterases; leukocytes; leukocytes esterases; peritonitis; reagent strips.