Types of ascites fluid infections:
(1) spontaneous bacterial peritonitis
(2) culture-negative neutrocytic ascites
(3) mono-microbial nonneutrocytic bacterascites
(4) secondary bacterial peritonitis
(5) polymicrobial bacterascites
Findings:
(1) white blood cell count of ascitic fluid
(2) culture of ascites fluid
(3) source
|
Type
|
PMN count per µL
|
Bacterial Cultures
|
Other Findings
|
|
spontaneous bacterial peritonitis
|
>= 250
|
positive (usually 1 organism)
|
no surgically treatable intra-abdominal source
|
|
secondary bacterial peritonitis
|
>= 250
|
positive, poly-microbic
|
surgically treatable intra-abdominal source
|
|
culture-negative neutrocytic ascites (CNNA)
|
>= 250
|
negative
|
no surgically treatable intra-abdominal source
|
|
mono-microbial nonneutrocytic bacterascites
|
< 250
|
positive (1 organism)
|
|
|
polymicrobial bacterascites
|
< 250
|
positive, poly-microbic
|
iatrogenic, following inadvertent puncture of the intestines
|
from Table 1, page 670
where:
• The Gram stain appearance can be used prior to culture results.
Additional findings in secondary bacterial peritonitis – 2 of the following:
(1) total protein > 1 g/dL
(2) glucose concentration < 50 mg/dL
(3) LDH greater than the upper limit of normal for serum
The differential diagnosis of culture-negative neutrocytic ascites includes:
(1) pancreatitis
(2) tuberculous peritonitis
(3) peritoneal carcinomatosis
