Manifestations and Treatment of Spontaneous Bacterial Peritonitis

Spontaneous bacterial peritonitis is the infection of fluid that builds up within the abdominal cavity. The infection occurs in the peritoneum. The peritoneum is the membrane that lines the abdomen and covers all of the organs inside the abdomen.

How does a person get spontaneous bacterial peritonitis?

A person who has cirrhosis of the liver is at risk for bacterial peritonitis. Some researchers suggest that as many as 15-30% of people with cirrhosis experience this infection. As many as 20-70% of the people who experience spontaneous bacterial peritonitis die from it. This is typically because it often occurs without warning and without doctors knowing why the infection began.

How is spontaneous bacterial peritonitis related to hepatitis C?

When a person is infected with hepatitis C, their body may not show signs or symptoms of the infection for weeks, months, or even years. This allows the virus to grow and cause bodily damage when it goes untreated for so long. This is no one’s fault, as many do not believe they have reason to be tested for hepatitis C, and this test is not typically done at a routine check-up. Often, this means that doctors do not perform this test until or unless the patient complains of symptoms related to hepatitis C or unless the patient is undergoing an extensive battery of blood tests for some other reason.

When the hepatitis C virus is detected, doctors may not know how long the virus has been active. In some cases, a long-term infection can cause extensive liver damage called cirrhosis. However, in other cases, those who have had the hepatitis C infection for a short time can also have cirrhosis, as this type of permanent liver damage is not always a sign of the length or intensity of the infection. A person with cirrhosis of the liver will likely have their liver monitored throughout the hepatitis C treatment process. Even so, the liver damage may be permanent, and this cirrhosis leaves the patient susceptible to spontaneous bacterial peritonitis.

How does a person know if they have spontaneous bacterial peritonitis?

Because spontaneous bacterial peritonitis occurs without warning, the symptoms may not necessarily appear to be obvious indicators of this illness. These symptoms may be mistaken for a cold or flu, as they include fever, nausea, chills, vomiting, tenderness of the abdomen, and feeling generally uncomfortable and unwell. In some cases, though, patients may experience no symptoms at all. The combination of non-specific symptoms and sometimes a total lack of symptoms is why spontaneous bacterial peritonitis can be so difficult to diagnose or so difficult to diagnose before death.

How can it be diagnosed?

When a doctor suspects this infection to be the cause of the patient’s symptoms, they will likely act very quickly. A doctor can diagnose spontaneous bacterial peritonitis using a medical test called a paracentesis. This is a test in which a needle is inserted into the abdominal cavity. A sample of the fluid in the cavity is removed from the peritoneum and is then tested by a laboratory. The laboratory tests will tell the doctors first whether there is an infection in the peritoneum. This is based on the white blood cell count, which increases when an infection is present. If there is an infection, the sample can be cultured. This is a type of test which tells the doctor what specific strain of the infection is present. This information allows the doctor to both confirm the diagnosis and to know which exact strain of the infection to treat.

How can spontaneous bacterial peritonitis be treated?

Spontaneous bacterial peritonitis is treated using antibiotics. Because the infection is so serious, the treatment occurs in a hospital setting. There, the patient will receive intravenous (IV) antibiotics. This is because the hospital setting not only allows professionals to handle IV set-up, but also to allow for additional testing or to alter medication, as needed. These tests may include re-tests to observe whether the drug is working to lower the infection levels. Additional medication may include albumin or prokinetics to help the body fight the infection, as well as medications to manage any side effects of the infection or the drugs being used to treat the infection.

How can someone prevent it from occurring?

Some professionals believe that anyone with cirrhosis of the liver should receive regular antibiotics, in hopes that any infections (including spontaneous bacterial peritonitis) would be preemptively prevented. Other professionals believe that consistently introducing antibiotics into the body without the immediate need for them would simply be trading one set of risks for another. At the present time, there is no clear way to prevent spontaneous bacterial peritonitis other than for patients with cirrhosis of the liver to seek medical treatment quickly if they experience any of the symptoms of spontaneous bacterial peritonitis and to speak with their medical treatment provider if they have fears or questions about whether they may be infected or at high risk of infection.^1-4