Spontaneous Bacterial Peritonitis Differential Diagnoses
- Author: Thomas E Green, DO, MPH, FACOEP, FACEP; Chief Editor: Rick Kulkarni, MD more...
Diagnostic Considerations
- Secondary bacterial peritonitis
- Perforated viscus
- Pyelonephritis
Clinical features do not distinguish secondary bacterial peritonitis from spontaneous bacterial peritonitis. However, patients with secondary bacterial peritonitis have a surgically treatable source of infection (eg, perforated duodenal ulcer, perinephric abscess).
In secondary bacterial peritonitis from free perforation of a viscus, the peritoneal fluid analysis characteristically shows an extremely elevated polymorphonuclear neutrophil count, multiple organisms (often including fungi and Enterococcus) on Gram stain and culture, and at least two of the following criteria[4] :
- Total protein greater than 1 g/dL
- Lactate dehydrogenase above the upper limit of normal for serum
- Glucose less than 50 mg/dL
Differential Diagnoses
Lata J, Stiburek O, Kopacova M. Spontaneous bacterial peritonitis: a severe complication of liver cirrhosis. World J Gastroenterol. Nov 28 2009;15(44):5505-10. [Medline]. [Full Text].
Bert F, Noussair L, Lambert-Zechovsky N, Valla D. Viridans group streptococci: an underestimated cause of spontaneous bacterial peritonitis in cirrhotic patients with ascites. Eur J Gastroenterol Hepatol. Sep 2005;17(9):929-33. [Medline].
Cholongitas E, Papatheodoridis GV, Lahanas A, Xanthaki A, Kontou-Kastellanou C, Archimandritis AJ. Increasing frequency of Gram-positive bacteria in spontaneous bacterial peritonitis. Liver Int. Feb 2005;25(1):57-61. [Medline].
[Guideline] Runyon BA. Management of adult patients with ascites due to cirrhosis: an update. Hepatology. Jun 2009;49(6):2087-107. [Medline].
Riggio O, Angeloni S. Ascitic fluid analysis for diagnosis and monitoring of spontaneous bacterial peritonitis. World J Gastroenterol. Aug 21 2009;15(31):3845-50. [Medline]. [Full Text].
Chinnock B, Gomez R, Hendey GW. Peritoneal fluid cultures rarely alter management in patients with ascites. J Emerg Med. Jan 2011;40(1):21-4. [Medline].
Gaya DR, David B Lyon T, Clarke J, Jamdar S, Inverarity D, Forrest EH, et al. Bedside leucocyte esterase reagent strips with spectrophotometric analysis to rapidly exclude spontaneous bacterial peritonitis: a pilot study. Eur J Gastroenterol Hepatol. Apr 2007;19(4):289-95. [Medline].
Runyon BA. Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis. Hepatology. Oct 1990;12(4 Pt 1):710-5. [Medline].

