Editorial - (2017) Volume 1, Issue 1
Marco Fiore1*, Sebastiano Leone2 and Maria Caterina Pace1
1Department of Anesthesiological, Surgical and Emergency Sciences, University of Campania “Luigi Vanvitelli, Naples, Italy
2Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino AV, Italy
*Corresponding Author:
Marco Fiore
Department of Anesthesiological
Surgical and Emergency Sciences
University of Campania “Luigi Vanvitelli”
Naples 80138, Italy
Tel: +39 0815665180
E-mail: marco.fiore@hotmail.it
Received date: January 07, 2017; Accepted date: February 09, 2017; Published date: February 11, 2017
Citation: Fiore M, Leone S, Pace MC. Treatment of Patients and Cirrhosis. J Clin Gastroenterol Hepatol 2017, 1:1. doi: 10.21767/2575-7733.1000005
Several influential authors in their recent review on the treatment of patients with cirrhosis [1-3] did not mention spontaneous fungal peritonitis (SFP) as a severe complication of liver cirrhosis. Spontaneous peritonitis (SP) is an infection of ascitic fluid of cirrhotics without an alternative intraabdominal source of infection. If an ascitic fluid culture is performed, the growth of bacteria makes diagnosis of spontaneous bacterial peritonitis (SBP), instead the growth of fungi makes diagnosis of SFP4.
Editorial
Several influential authors in their recent review on the treatment of patients with cirrhosis [1-3] did not mention spontaneous fungal peritonitis (SFP) as a severe complication of liver cirrhosis. Spontaneous peritonitis (SP) is an infection of ascitic fluid of cirrhotics without an alternative intraabdominal source of infection. If an ascitic fluid culture is performed, the growth of bacteria makes diagnosis of spontaneous bacterial peritonitis (SBP), instead the growth of fungi makes diagnosis of SFP4. SFP prevalence varies from 3.6% to 41% of patients with a positive ascitic fluid culture; Candida spp. is the most common fungus isolated [4-6]. SFP mortality is very high ranging from 90% to 100% of patients [4,5]. Hospitalization seems to be a SFP risk factor [4,5]. In a randomized controlled trial, an antifungal agent was added in hospital-acquired SBP with no response to broad-spectrum antibacterial agents: the results of this study showed that addon of an antifungal agent are more effective than antibacterial alone as empirical antimicrobial treatment of SBP [7]. The available literature suggests that SFP should be considered in patients with SP non-responders to initial antibacterial therapy and/or at risk for fungal infections.
Serum Procalcitonin (PCT) test is quite sensitive and specific for the SBP diagnosis but it is not sufficient for the diagnosis without other clinical findings [8].
Ascitic calprotectin should to be an alternative method for SBP diagnosis in ESLD patients [9], so in the near future the association of serum PCT and ascitic calprotectin seems to be satisfactory for the diagnosis of SBP [10].
Unfortunately, these novel biomarkers purposed by literature do not discern the etiology of SP. Recently, label-free bimodal waveguide immunosensor (BiMW biosensor) demonstrated that the detection limits of the biosensor could reach few bacteria per milliliter. Based on the results obtained, we consider that the BiMW biosensor is positioned as a promising new clinical tool for user-friendly, cost-effective and real-time microbiological analysis [11].
Studies are needed to further evaluate the accuracy of ascitic fluid label-free bimodal waveguide immunosensor for the early diagnosis and follow-up of SFP.
