Kamath Sangita D, Kumar Umesh, Sarkar Nilanjan, Shrivastava Vikki
Internal Medicine, Tata Main Hospital, Jamshedpur, IND.
General Medicine, Tata Main Hospital, Jamshedpur, IND.
Cureus. 2024 Jul 19;16(7):e64953. doi: 10.7759/cureus.64953. eCollection 2024 Jul.
The incidence of bacterial infections is high in patients with liver cirrhosis (LC) due to compromised immune systems. They are associated with acute hepatic decompensation, multiorgan dysfunction, high morbidity, and mortality and account for 25-46% of all hospitalizations. The mortality rate is about 30% after one month and increases to 63% at one-year follow-up. While spontaneous bacterial peritonitis (SBP), urinary tract infections, soft tissue infections, and respiratory tract infections (pneumonia) are some of the common infections, SBP accounts for 25-31% of the cases and is the most frequent bacterial infection. Impaired activity of the phagocytes of the reticuloendothelial system, decreased production of the complement, and bacteria gaining access into the systemic circulation through the porto-systemic shunts are some of the causes of high-risk bacterial infection in patients with LC. The diagnosis of bacterial infection may be challenging as the typical symptoms like fever may not always be evident. We present a very challenging, middle-aged patient of cirrhosis with diabetes mellitus (DM) who presented with infections at multiple sites like SBP due to Serratia ficaria, multiple pyemic liver abscesses, left peri-nephric abscess with septicaemia, further complicated by portal vein thrombosis - all during single hospital admission. SBP was unique in the sense that no case of SBP due to Serratia ficaria has been published in the literature to date. The stormy clinical course, management, and outcome of the patient are described here.
由于免疫系统受损，肝硬化（LC）患者的细菌感染发生率很高。它们与急性肝失代偿、多器官功能障碍、高发病率和死亡率相关，占所有住院病例的25%-46%。一个月后的死亡率约为30%，在一年的随访中升至63%。虽然自发性细菌性腹膜炎（SBP）、尿路感染、软组织感染和呼吸道感染（肺炎）是一些常见感染，但SBP占病例的25%-31%，是最常见的细菌感染。网状内皮系统吞噬细胞活性受损、补体产生减少以及细菌通过门体分流进入体循环是LC患者发生高危细菌感染的一些原因。由于发热等典型症状可能并不总是明显，细菌感染的诊断可能具有挑战性。我们报告了一名极具挑战性的中年肝硬化合并糖尿病（DM）患者，在单次住院期间出现了多个部位的感染，如费氏沙雷菌引起的SBP、多发性脓性肝脓肿、左肾周脓肿伴败血症，并进一步并发门静脉血栓形成。SBP的独特之处在于，迄今为止，文献中尚未发表过费氏沙雷菌引起SBP的病例。本文描述了该患者的凶险临床过程、治疗及转归。
