WordNet

able to make fine distinctions; "a subtle mind"
happening or arising without apparent external cause; "spontaneous laughter"; "spontaneous combustion"; "a spontaneous abortion" (同)self-generated
(microbiology) single-celled or noncellular spherical or spiral or rod-shaped organisms lacking chlorophyll that reproduce by fission; important as pathogens and for biochemical properties; taxonomy is difficult; often considered to be plants (同)bacterium
relating to or caused by bacteria; "bacterial infection"
inflammation of the peritoneum (同)peritoneal inflammation

PrepTutorEJDIC

(知覚しにくいほど)『かすかな』,ほのかな,微妙な / (頭脳・感覚などが)鋭い / ずるい,こうかつな / 難解な / 巧みな,精巧な
(行動などが)『自然に起こる』,自発的な / (現象などが)自然[発生]の;(植物などが)天然の,自生の
『バクテリア』,細菌
バクテリアの,細菌の
腹膜炎

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/02/04 13:20:53」(JST)

wiki en

Spontaneous bacterial peritonitis (SBP) is the development of a bacterial infection in the peritoneum causing peritonitis, despite the absence of an obvious source for the infection.^[1] It occurs almost exclusively in people with portal hypertension (increased pressure over the portal vein), usually as a result of cirrhosis of the liver.^[1] It can also occur in patients with nephrotic syndrome.^[2]^[3]

The diagnosis of SBP requires paracentesis (aspiration of fluid with a needle) from the abdominal cavity.^[4] If the fluid contains bacteria or large numbers of neutrophil granulocytes (>250 cells/µL) (a type of white blood cells), infection is confirmed and antibiotics are required to avoid complications. In addition to antibiotics, infusions of albumin are usually administered.

Signs and symptomsEdit

Symptoms include fevers, chills, nausea, vomiting, abdominal tenderness and general malaise.^[1] Patients may complain of abdominal pain and worsening ascites.^[1] Thirteen percent of patients have no signs or symptoms.^[5] Hepatic encephalopathy may be the only manifestation of SBP; in the absence of a clear precipitant for the encephalopathy, all patients should undergo paracentesis, or sampling of the ascites fluid, in order to assess for SBP.

PathogenesisEdit

SBP is thought to result from a combination of factors inherent in cirrhosis and ascites, such as prolonged bacteremia secondary to compromised host defenses, intrahepatic shunting of colonized blood, and defective bactericidal activity within the ascitic fluid.^[6] Pharmacologic acid suppression has also been associated with SBP in patients with advanced cirrhosis.^[7]^[8]^[9] Contrary to earlier theories, transmucosal migration of bacteria from the gut to the ascitic fluid is no longer considered to play a major role in the etiology of SBP.^[10]

With respect to compromised host defenses, patients with severe acute or chronic liver disease are often deficient in complement and may also have malfunctioning of the neutrophilic and reticuloendothelial systems.^[11]

As for the significance of ascitic fluid proteins, it was demonstrated that cirrhotic patients with ascitic protein concentrations below 1 g/dL were 10 times more likely to develop SBP than individuals with higher concentrations.^[12] It is thought that the antibacterial, or opsonic, activity of ascitic fluid is closely correlated with the protein concentration.^[13] Additional studies have confirmed the validity of the ascitic fluid protein concentration as the best predictor of the first episode of SBP.^[11]

DiagnosisEdit

Diagnosis is made by paracentesis (needle aspiration of the ascitic fluid). SBP is diagnosed if the fluid contains neutrophils (a type of white blood cell) at greater than 250 cells per mm³ (equals a cell count of 250 x10⁶/L) fluid in the absence of another reason for this (such as inflammation of one of the internal organs or a perforation).^[1]^[14] The fluid is also cultured to identify bacteria. If the sample is sent in a plain sterile container 40% of samples will identify an organism, while if the sample is sent in a bottle with culture medium the sensitivity increases to 72-90%.^[14]

PreventionEdit

All people with cirrhosis might benefit from antibiotics (oral fluoroquinolone norfloxacin) if:

Ascitic fluid protein <1.0 g/dL.^[12] Patients with fluid protein <15 g/L and either Child-Pugh score of at least 9 or impaired renal function may also benefit.^[15]
Previous SBP^[16]

People with cirrhosis admitted to the hospital should receive prophylactic antibiotics if:

They have bleeding esophageal varices^[17]

TreatmentEdit

AntibioticsEdit

After confirmation of SBP, patients need hospital admission for intravenous antibiotics. They will often also receive intravenous albumin. A repeat paracentesis in 48 hours is sometimes performed to ensure control of infection. Once patients have recovered from SBP, they require regular prophylactic antibiotics as long as they still have ascites.^{[citation needed]}

ProkineticsEdit

The addition of a prokinetic drug to an antibiotic regime reduces the incidence of spontaneous bacterial peritonitis possibly via decreasing small intestinal bacterial overgrowth.^[18]

Intravenous albuminEdit

A randomized controlled trial found that intravenous albumin on the day of admission and on hospital day 3 can reduce renal impairment.^[19]

EpidemiologyEdit

Patients with ascites underwent routine paracentesis, the incidence of active SBP ranged from 10% to 27% at the time of hospital admission.^[20]

HistoryEdit

SBP was first described in 1964 by Prof Harold O. Conn.^[21]

ReferencesEdit

^ ^a ^b ^c ^d ^e Lata J, Stiburek O, Kopacova M (November 2009). "Spontaneous bacterial peritonitis: a severe complication of liver cirrhosis". World J. Gastroenterol. 15 (44): 5505–10. doi:10.3748/wjg.15.5505. PMC 2785051. PMID 19938187.
^ Hingorani SR, Weiss NS, Watkins SL (August 2002). "Predictors of peritonitis in children with nephrotic syndrome". Pediatr. Nephrol. 17 (8): 678–82. doi:10.1007/s00467-002-0890-6. PMID 12185481.
^ Chuang TF, Kao SC, Tsai CJ, Lee CC, Chen KS (January 1999). "Spontaneous bacterial peritonitis as the presenting feature in an adult with nephrotic syndrome". Nephrol. Dial. Transplant. 14 (1): 181–2. doi:10.1093/ndt/14.1.181. PMID 10052502.
^ Rimola A, García-Tsao G, Navasa M, et al. (January 2000). "Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club". J. Hepatol. 32 (1): 142–53. doi:10.1016/S0168-8278(00)80201-9. PMID 10673079.
^ Koulaouzidis A, Bhat S, Saeed AA (March 2009). "Spontaneous bacterial peritonitis". World J. Gastroenterol. 15 (9): 1042–9. doi:10.3748/wjg.15.1042. PMC 2655193. PMID 19266595.
^ Runyon BA, Hoefs JC (1984). "Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis". Hepatology 4 (6): 1209–11. doi:10.1002/hep.1840040619. PMID 6500513.
^ Gati GA, Deshpande A (2012). "Increased rate of spontaneous bacterial peritonitis among cirrhotic patients receiving pharmacologic acid suppression". Clinical Gastroenterology and Hepatology 4 (4): 422–27. doi:10.1016/j.cgh.2011.11.019. PMID 22155557.
^ Deshpande A, Pasupuleti V (2012). "Acid suppressive therapy is associated with spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis". Journal of Gastroenterology and Hepatology 28 (2): 235–42. doi:10.1111/jgh.12065. PMID 23190338.
^ Bajaj JS, Zadvornova Y (2009). "Association of Proton Pump Inhibitor Therapy With Spontaneous Bacterial Peritonitis in Cirrhotic Patients With Ascites". American Journal of Gastroenterology 104 (5): 1130–34. doi:10.1038/ajg.2009.80. PMID 19337238.
^ Runyon BA (1988). "Patients with deficient ascitic fluid opsonic activity are predisposed to spontaneous bacterial peritonitis". Hepatology 8 (3): 632–5. doi:10.1002/hep.1840080332. PMID 3371881.
^ ^a ^b Alaniz C, Regal RE (April 2009). "Spontaneous Bacterial Peritonitis: A Review of Treatment Options". P T 34 (4): 204–210. PMC 2697093. PMID 19561863.
^ ^a ^b Runyon BA (December 1986). "Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis". Gastroenterology 91 (6): 1343–6. PMID 3770358.
^ Runyon BA, Morrissey RL, Hoefs JC, Wyle FA (1985). "Opsonic activity of human ascitic fluid: a potentially important protective mechanism against spontaneous bacterial peritonitis". Hepatology 5 (4): 634–7. doi:10.1002/hep.1840050419. PMID 4018735.
^ ^a ^b Moore KP, Aithal GP (October 2006). "Guidelines on the management of ascites in cirrhosis". Gut. 55 Suppl 6: vi1–12. doi:10.1136/gut.2006.099580. PMC 1860002. PMID 16966752.
^ Fernández J, Navasa M, Planas R, et al. (2007). "Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis". Gastroenterology 133 (3): 818–24. doi:10.1053/j.gastro.2007.06.065. PMID 17854593.
^ Grangé JD, Roulot D, Pelletier G, et al. (1998). "Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites: a double-blind randomized trial". J. Hepatol. 29 (3): 430–6. doi:10.1016/S0168-8278(98)80061-5. PMID 9764990.
^ Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L (2002). Soares-Weiser, Karla, ed. "Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding". Cochrane database of systematic reviews (Online) (2): CD002907. doi:10.1002/14651858.CD002907. PMID 12076458.
^ Hiyama, T.; Yoshihara, M.; Tanaka, S.; Haruma, K.; Chayama, K. (Apr 2009). "Effectiveness of prokinetic agents against diseases external to the gastrointestinal tract.". J Gastroenterol Hepatol 24 (4): 537–46. doi:10.1111/j.1440-1746.2009.05780.x. PMID 19220673.
^ Sort P, Navasa M, Arroyo V, et al. (1999). "Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis". N. Engl. J. Med. 341 (6): 403–9. doi:10.1056/NEJM199908053410603. PMID 10432325.
^ Runyon BA (1988). "Spontaneous bacterial peritonitis: an explosion of information". Hepatology 8 (1): 171–5. doi:10.1002/hep.1840080131. PMID 3338704.
^ CONN HO (April 1964). "Spontaneous peritonitis and bacteremia in Laennec's cirrhosis caused by enteric organisms. A relatively common but rarely recognized syndrome" (PDF). Ann. Intern. Med. 60 (4): 568–80. doi:10.7326/0003-4819-60-4-568. PMID 14138877.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 特発性細菌性腹膜炎の治療および予防 treatment and prophylaxis of spontaneous bacterial peritonitis
2. 特発性細菌性腹膜炎の診断 diagnosis of spontaneous bacterial peritonitis
3. 特発性細菌性腹膜炎の臨床症状 clinical manifestations of spontaneous bacterial peritonitis
4. 特発性細菌性腹膜炎の病因 pathogenesis of spontaneous bacterial peritonitis
5. 特発性細菌性腹膜炎の亜種 spontaneous bacterial peritonitis variants

English Journal

Letter: possible association of PPI use and spontaneous bacterial peritonitis - authors' reply.

Raizada A1, Dever JB2.
Alimentary pharmacology & therapeutics.Aliment Pharmacol Ther.2015 Sep;42(6):779-80. doi: 10.1111/apt.13340.
PMID 26278566

Letter: possible association between PPI use and spontaneous bacterial peritonitis.

Ali Khan M1, Howden CW2.
Alimentary pharmacology & therapeutics.Aliment Pharmacol Ther.2015 Sep;42(6):778-9. doi: 10.1111/apt.13311.
PMID 26278565

Diagnostic utility of interferon gamma-induced protein 10 kDa in spontaneous bacterial peritonitis: single-center study.

Abdel-Razik A1, Mousa N, Elbaz S, Eissa M, Elhelaly R, Eldars W.
European journal of gastroenterology & hepatology.Eur J Gastroenterol Hepatol.2015 Sep;27(9):1087-93. doi: 10.1097/MEG.0000000000000400.
BACKGROUND AND AIMS: Spontaneous bacterial peritonitis (SBP) is an important cause of mortality and morbidity in cirrhotic patients with ascites. The diagnosis of SBP is mainly made on the basis of a polymorphonuclear leukocyte cell count exceeding 250/μl in ascitic fluid. However, this procedure i
PMID 26020377

Japanese Journal

Rapid detection of spontaneous bacterial peritonitis by granulocyte elastase latex immunoassay and reagent strip

Yamazaki Masaharu,Sano Reiko,Kuramoto Chizuko [他]
臨床病理 59(6), 549-558, 2011-06
NAID 40018921158

劇症型A群溶血性連鎖球菌感染症に対し, ポリメチルメタクリレート膜血液濾過器を用いた持続的血液濾過透析を2系列同時施行した特発性細菌性腹膜炎の1救命例

松村洋輔,織田成人,貞広智仁,仲村将高,安部隆三,中田孝明,平澤博之
日本集中治療医学会雑誌 = Journal of the Japanese Society of Intensive Care Medicine 17(4), 505-512, 2010-10-01
NAID 10027854265

Related Pictures

★リンクテーブル★

リンク元	「特発性細菌性腹膜炎」「subtle」「SBP」
関連記事	「spontaneous」「bacterial」

「特発性細菌性腹膜炎」

Spontaneous bacterial peritonitis
Classification and external resources
ICD-9-CM	567.23
eMedicine	emerg/882
	[edit on Wikidata]

　　[★]

英: spontaneous bacterial peritonitis SBP
関: 腹膜炎、肝硬変

概念

腹水を有する肝硬変における感染症。

病因

門脈圧亢進により腸管壁の細菌透過性が亢進するため、らしい。
腸内細菌の過剰増殖(腸管の運動低下による)、PPI使用による低胃酸症、肝硬変による腸管透過性亢進(uptodate.2)

病原体

IRE.704

小児：肺炎球菌、A群β溶連菌＞黄色ブドウ球菌・グラム陰性桿菌
成人：大腸菌＞クレブシエラ属＞肺炎球菌＞＞＞黄色ブドウ球菌

症状

uptodate.3

発熱、腹痛 and/or 圧痛、精神状態の変化。なかには好中球増多、アシドーシス、あるいは腎機能の低下しか示さない例もある。

症候	(%)
発熱	69
腹痛	59
精神状態の変化	54
腹部圧痛	49
下痢	32
麻痺性イレウス	30
低血圧	21
低体温	17

検査

腹水白血球：500個/ul以上 (YN.A-112)

診断

腹水中好中球が診断に重要 (YN.A-112)
腹水中の細菌培養(+)で、かつ多形核白血球の絶対的増加(250/ul以上) (uptodate.4)

参考

uptodate

1. [charged] 特発性細菌性腹膜炎の亜種 - uptodate [1]
2. [charged] 特発性細菌性腹膜炎の病因 - uptodate [2]
3. [charged] 特発性細菌性腹膜炎の臨床症状 - uptodate [3]
4. [charged] 特発性細菌性腹膜炎の診断 - uptodate [4]
5. [charged] 特発性細菌性腹膜炎の治療および予防 - uptodate [5]

国試

102D041

「subtle」

　　[★]

adj.

繊細な。微妙な、とらえにくい、かすかな、ほのかな

These changes may be diagnostically useful and appear as increased FLAIR and T2 signal intensity in the posterior limb of the internal capsule, descending motor tracts of the brainstem, and spinal cord, all of which are subtle and may be missed.

CT scanning is used to detect intracranial calcifications and MRI to detect subtle abnormalities in myelinization.

The signs and symptoms of spontaneous bacterial peritonitis are subtle compared with those of patients who have surgical peritonitis in the absence of ascites.

ex.

subtle sign

(a subtle sign)かすかな兆し/兆候/前兆

関: a fraction of, dim, faint, faintly, few, insignificant, little, marginally, modest, modestly, only, scant, slight, slightly, subtly

「SBP」

　　[★]

「spontaneous」

　　[★]

adj.

自発性の、自発的な、自然発症の、自然な

関: autochthonous、native、natural、naturally、nature、spontaneity、spontaneously、voluntarily、voluntary、willing

「bacterial」

　　[★]

adj.

細菌性の、細菌の、細菌的な

関: bacteria、bacterially、bacterio、bacterium

[pmid19938187-1] Lata J, Stiburek O, Kopacova M (November 2009). "Spontaneous bacterial peritonitis: a severe complication of liver cirrhosis". World J. Gastroenterol. 15 (44): 5505–10. doi:10.3748/wjg.15.5505. PMC 2785051. PMID 19938187.

[pmid12185481-2] Hingorani SR, Weiss NS, Watkins SL (August 2002). "Predictors of peritonitis in children with nephrotic syndrome". Pediatr. Nephrol. 17 (8): 678–82. doi:10.1007/s00467-002-0890-6. PMID 12185481.

[pmid10052502-3] Chuang TF, Kao SC, Tsai CJ, Lee CC, Chen KS (January 1999). "Spontaneous bacterial peritonitis as the presenting feature in an adult with nephrotic syndrome". Nephrol. Dial. Transplant. 14 (1): 181–2. doi:10.1093/ndt/14.1.181. PMID 10052502.

[pmid10673079-4] Rimola A, García-Tsao G, Navasa M, et al. (January 2000). "Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club". J. Hepatol. 32 (1): 142–53. doi:10.1016/S0168-8278(00)80201-9. PMID 10673079.

[pmid19266595-5] Koulaouzidis A, Bhat S, Saeed AA (March 2009). "Spontaneous bacterial peritonitis". World J. Gastroenterol. 15 (9): 1042–9. doi:10.3748/wjg.15.1042. PMC 2655193. PMID 19266595.

[pmid6500513-6] Runyon BA, Hoefs JC (1984). "Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis". Hepatology 4 (6): 1209–11. doi:10.1002/hep.1840040619. PMID 6500513.

[pmid22155557-7] Gati GA, Deshpande A (2012). "Increased rate of spontaneous bacterial peritonitis among cirrhotic patients receiving pharmacologic acid suppression". Clinical Gastroenterology and Hepatology 4 (4): 422–27. doi:10.1016/j.cgh.2011.11.019. PMID 22155557.

[pmid23190338-8] Deshpande A, Pasupuleti V (2012). "Acid suppressive therapy is associated with spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis". Journal of Gastroenterology and Hepatology 28 (2): 235–42. doi:10.1111/jgh.12065. PMID 23190338.

[pmid19337238-9] Bajaj JS, Zadvornova Y (2009). "Association of Proton Pump Inhibitor Therapy With Spontaneous Bacterial Peritonitis in Cirrhotic Patients With Ascites". American Journal of Gastroenterology 104 (5): 1130–34. doi:10.1038/ajg.2009.80. PMID 19337238.

[pmid3371881-10] Runyon BA (1988). "Patients with deficient ascitic fluid opsonic activity are predisposed to spontaneous bacterial peritonitis". Hepatology 8 (3): 632–5. doi:10.1002/hep.1840080332. PMID 3371881.

[pmid19561863-11] Alaniz C, Regal RE (April 2009). "Spontaneous Bacterial Peritonitis: A Review of Treatment Options". P T 34 (4): 204–210. PMC 2697093. PMID 19561863.

[pmid3770358-12] Runyon BA (December 1986). "Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis". Gastroenterology 91 (6): 1343–6. PMID 3770358.

[pmid4018735-13] Runyon BA, Morrissey RL, Hoefs JC, Wyle FA (1985). "Opsonic activity of human ascitic fluid: a potentially important protective mechanism against spontaneous bacterial peritonitis". Hepatology 5 (4): 634–7. doi:10.1002/hep.1840050419. PMID 4018735.

[AithalMoore-14] Moore KP, Aithal GP (October 2006). "Guidelines on the management of ascites in cirrhosis". Gut. 55 Suppl 6: vi1–12. doi:10.1136/gut.2006.099580. PMC 1860002. PMID 16966752.

[pmid17854593-15] Fernández J, Navasa M, Planas R, et al. (2007). "Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis". Gastroenterology 133 (3): 818–24. doi:10.1053/j.gastro.2007.06.065. PMID 17854593.

[pmid9764990-16] Grangé JD, Roulot D, Pelletier G, et al. (1998). "Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites: a double-blind randomized trial". J. Hepatol. 29 (3): 430–6. doi:10.1016/S0168-8278(98)80061-5. PMID 9764990.

[pmid12076458-17] Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L (2002). Soares-Weiser, Karla, ed. "Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding". Cochrane database of systematic reviews (Online) (2): CD002907. doi:10.1002/14651858.CD002907. PMID 12076458.

[Hiyama-2009-18] Hiyama, T.; Yoshihara, M.; Tanaka, S.; Haruma, K.; Chayama, K. (Apr 2009). "Effectiveness of prokinetic agents against diseases external to the gastrointestinal tract.". J Gastroenterol Hepatol 24 (4): 537–46. doi:10.1111/j.1440-1746.2009.05780.x. PMID 19220673.

[pmid10432325-19] Sort P, Navasa M, Arroyo V, et al. (1999). "Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis". N. Engl. J. Med. 341 (6): 403–9. doi:10.1056/NEJM199908053410603. PMID 10432325.

[pmid3338704-20] Runyon BA (1988). "Spontaneous bacterial peritonitis: an explosion of information". Hepatology 8 (1): 171–5. doi:10.1002/hep.1840080131. PMID 3338704.

[21] CONN HO (April 1964). "Spontaneous peritonitis and bacteremia in Laennec's cirrhosis caused by enteric organisms. A relatively common but rarely recognized syndrome" (PDF). Ann. Intern. Med. 60 (4): 568–80. doi:10.7326/0003-4819-60-4-568. PMID 14138877.

匿名

検索

案内

spontaneous bacterial peritonitis