Nisan 2021
Spontan bakteriyel peritonit: Etken ne? Olgu sunumu
Spontaneous bacterial peritonitis: What is the causative agent? A case report
- Ana Sayfa
- Sayılar
- Nisan 2021
- Spontan bakteriyel peritonit: Etken ne? Olgu sunumu...
Özet
Spontan bakteriyel peritonit intra-abdominal cerrahi öyküsü olmaksizinasit sivisinda bakteriyel enfeksiyon görülmesidir ve asitin ölümcül birkomplikasyonudur. Spontan bakteriyel peritonit tanisi genelde sirozluhastada, karin agrisi, hepatorenal sendrom gibi dekompanzasyon oldugunda ya da rutin yapilan parasentezde nötrofil sayisinin 250/mm3ve üzerinde olmasi ile konur. Siklikla etken mikroorganizmalar enterikgram negatif bakterilerdir. Tedaviye bu mikroorganizmalara yönelik ampirik olarak baslanir ve kültür sonucuna göre revize edilebilir. Listeriamonocytogenes spontan bakteriyel peritonitin nadir görülen etkenidir.Gram pozitif, fakültatif anaerob basildir ve özellikle neonatallerde, yaslive immünsuprese kisilerde enfeksiyona yol açar. Diger enfeksiyonlaringenel bir bulgusu olan ates, spontan bakteriyel peritonitli hastada genellikle görülmez. Biz bu yazimizda asit ve periferik ödem sikayetiyleyatirilan, kriptojenik karaciger sirozu tanisi konulan, altmis yedi yasindabayan hastada ampirik olarak tedavi edilirken karin agrisi ve atesi olmasinedeniyle alinan asit sivisinda Listeria monocytogenes üreyen vakamizisunduk. Spontan bakteriyel peritonit ampirik olarak tedavi edilirken ate-si çikan hastanin alinan asit kültüründe ve kan kültüründe Listeria monocytogenes üredi. Listeria monocytogenes’in nadir görülen bir patojenoldugu bilinmesine ragmen bizim vakamizda oldugu gibi yas ve kronikhastalik gibi faktörler görülme sikligini arttirabilir. Ampirik tedaviye yanitvermeyen veya tedavi sirasinda ates gibi sistemik belirti gösteren spontan bakteriyel peritonitli hastalarda çok nadir olmasina ragmen Listeriamonocytogenes akla gelmelidir
Abstract
Spontaneous bacterial peritonitis is a bacterial infection in ascitic fluidwithout a history of intra-abdominal surgery and is a fatal complicationof ascites. Spontaneous bacterial peritonitis is usually diagnosed whena cirrhotic patient has abdominal pain or when a patient with cirrhosisdecompensates, such as hepatorenal syndrome, or when routine paracentesis is performed. The diagnosis is established when the neutrophilcount is ?250/mm3. The causative microorganisms are often entericGram-negative bacteria. Spontaneous bacterial peritonitis is treatedempirically, and the treatment can be revised according to the cultureresult. Listeria monocytogenes is a rare cause of spontaneous bacterialperitonitis. It is a Gram-positive facultative anaerobe bacillus that causesinfections, particularly in neonates, the elderly, and immunocompromised individuals. Fever, a common finding of other infections, is notusually seen in patients with spontaneous bacterial peritonitis. In thiscase report, we present a case of a 67-year-old female hospitalized withcomplaints of ascites and peripheral edema and who was diagnosedwith cryptogenic liver cirrhosis. Listeria monocytogenes grew in ascitic fluid recovered during empirical treatment due to fever. While thespontaneous bacterial peritonitis was being treated empirically, Listeriamonocytogenes grew in ascites and blood cultures of the patient, whodeveloped fever and recovered after a change in treatment. AlthoughListeria monocytogenes is a rare pathogen, factors, such as age andchronic disease, may increase its incidence, as in our case. Listeriamonocytogenes should be considered in patients with spontaneousbacterial peritonitis who do not respond to empirical treatment or whoshow systemic symptoms, such as fever, during treatment.
