Abstract
Six episodes of pneumococcal peritonitis in five patients with postnecrotic cirrhosis, portal hypertension and ascites are reported. This diagnosis must be considered when fever or abdominal complaints, especially with leukocytosis, occur in patients with postnecrotic cirrhosis with ascites. Onset may be insidious.
Physical examination and gross characterization of ascitic fluid were not diagnostic. Cell counts and Gram-stained smears of ascitic fluid provided first evidence of bacterial peritonitis. Adequate bacteriologic studies of blood and ascitic fluid established definitive diagnosis. Bactericidal levels of penicillin were demonstrated in ascitic fluid after a relatively small intravenous dose.
Therapeutic responses to parenteral penicillin were prompt and successful with respect to the pneumococcal peritonitis. However, in four patients the peritonitis occurred as a preterminal event or was followed by other complications that caused death.
THREE episodes of pneumococcal peritonitis involving two children with postnecrotic cirrhosis and ascites were observed at our hospital during a 12-month period. This experience stimulated a review of the medical records of 217 patients admitted to Cleveland Metropolitan General Hospital during a 10-year period with diagnoses of peritonitis. The review disclosed three additional patients with pneumococcal peritonitis, a seven-year-old girl, and two men 35 and 65 years of age. Each of these also had postnecrotic cirrhosis and ascites. This coincidence of pneumococcal peritonitis and postnecrotic cirrhosis suggests an association between the two diseases.
Clinical Features
The clinical and laboratory findings . . .
