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      Spontaneous Bacterial Peritonitis in Cardiac Ascites: A Rare but Deadly Occurrence

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          Abstract

          Patient: Male, 85

          Final Diagnosis: Spontaneous bacterial peritonitis

          Symptoms: Abdomen distension • confusion • lethargy

          Medication: —

          Clinical Procedure: Paracentesis

          Specialty: Gastroenterology and Hepatology

          Objective:

          Unusual clinical course

          Background:

          Spontaneous bacterial peritonitis is frequently described in cirrhotic patients who develop infected ascitic fluid. However, ascites can be cardiac in origin. The phenomenon of spontaneous bacterial peritonitis in cardiac as-cites is an extremely rare but deadly occurrence.

          Case Report:

          Here we present a unique case of a patient who was admitted for advanced cardiorenal syndrome in the setting of a viral colitis that likely promoted a bacterial translocation resulting in spontaneous bacterial peritonitis.

          Conclusions:

          This case tends to shed light on a few quintessential points for clinicians to be aware of, including the potential intersection between the microbiota and metabolic effects of congestive heart failure and the necessity to lower the diagnostic threshold for spontaneous bacterial peritonitis cardiac ascites in patient’s presenting for a congestive heart failure exacerbation.

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          Most cited references7

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          Studies on intragastric PCO2 at rest and during exercise as a marker of intestinal perfusion in patients with chronic heart failure.

          The aim of this study was to investigate mesenteric ischaemia by determining intragastric PCO(2) (iPCO(2)) with gastric tonometry during rest and exercise stress testing in patients with chronic heart failure (CHF). In CHF inflammatory immune activation is hypothesized to result from a chronic endotoxin challenge due to bacterial translocation of hypoperfused intestinal mucosa. In 10 patients with CHF and ten healthy controls a tonometry catheter was inserted into the stomach. IPCO(2) was measured at rest and during bicycle exercise every 5 min. At rest arterial pCO(2) (aPCO(2)), intragastric pCO(2) (iPCO(2)) and the intragastric/arterial gap did not differ between patients and controls. During low level exercise (25 W), patients showed an increase in iPCO(2) compared to resting iPCO(2), whereas controls did not show an increase in iPCO(2) (change in iPCO(2): 12+/-2% vs. 1+/-0.4%, P<0.001). In CHF, iPCO(2) during peak exercise was 25+/-3% higher than at rest, compared to controls (increase 2+/-1, P<0.0001). Patients with CHF already at low level exercise develop an increase in iPCO(2). This is likely to reflect hypoperfusion of the intestinal mucosa, which may contribute to the development of bacterial translocation.
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            The diagnostic work-up in patients with ascites: current guidelines and future prospects.

            Accumulation of fluid in the peritoneal cavity - ascites - is commonly encountered in clinical practice. Ascites can originate from hepatic, malignant, cardiac, renal, and infectious diseases. This review discusses the current recommended diagnostic approach towards the patient with ascites and summarises future diagnostic targets.
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              Spontaneous bacterial peritonitis associated with cardiac ascites.

              B A Runyon (1984)
              A patient who developed fatal spontaneous bacterial peritonitis associated with cardiac ascites is reported. Spontaneous bacterial peritonitis most frequently occurs in patients with decompensated cirrhosis of alcoholic or nonalcoholic type. Although there are reports of spontaneous bacterial peritonitis occurring in patients with nephrotic syndrome, or with acute or chronic hepatitis, there appear to be no reports of spontaneous bacterial infection developing in cardiac ascites.
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                Author and article information

                Journal
                Am J Case Rep
                Am J Case Rep
                amjcaserep
                The American Journal of Case Reports
                International Scientific Literature, Inc.
                1941-5923
                2019
                01 October 2019
                : 20
                : 1446-1448
                Affiliations
                [1 ]Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, U.S.A.
                [2 ]Philadelphia College of Osteopathic Medicine, Philadelphia, PA, U.S.A.
                Author notes

                Authors’ Contribution:

                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                Conflict of interest: None declared

                Corresponding Author: Andrew Canakis, e-mail: Andrew.Canakis@ 123456bmc.org
                Article
                915944
                10.12659/AJCR.915944
                6788488
                31570687
                aa9dc7de-1f79-46b5-9dc0-14b512fdf0af
                © Am J Case Rep, 2019

                This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International ( CC BY-NC-ND 4.0)

                History
                : 27 February 2019
                : 02 August 2019
                Categories
                Articles

                ascites,bacterial translocation,heart failure,microbiota

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