Journal article
Cirrhosis, gastrointestinal bleed, and cryptococcal peritonitis
Proceedings - Baylor University. Medical Center, Vol.33(2), pp.195-198
04/02/2020
DOI: 10.1080/08998280.2020.1723361
PMCID: PMC7155978
PMID: 32313460
Abstract
Disseminated Cryptococcus neoformans infection rarely causes peritonitis in non–HIV-infected patients but does affect cirrhotic patients. Diagnostic challenges delay treatment, and mortality is high. We performed a literature search of proven cryptococcal peritonitis cases in HIV-negative adults with underlying cirrhosis, included our own case, and collected demographic, infection risk factor, diagnostic, treatment, and outcomes data. We identified 16 articles and 21 cases. Most patients were men. Alcohol abuse was the leading cause of underlying cirrhosis (n = 10, 48%). Eight (38%) patients experienced an upper gastrointestinal bleed (UGIB) within a month before peritonitis presentation. Peritoneal fluid analysis was abnormal and lymphocytic predominant. Half the patients were fungemic. When performed, peritoneal fluid cryptococcal antigen (CrAg) test results were positive. Amphotericin B was the primary treatment. Mortality was high at 76%. In conclusion, C. neoformans is an opportunistic pathogen that causes peritonitis in non-HIV, cirrhotic patients. People with recent UGIB seem to be at risk. Cryptococcus species infection should be suspected in patients with clinical signs and symptoms of spontaneous bacterial peritonitis whose lymphocytic-predominant peritoneal fluid and cultures are negative for bacterial growth. Peritoneal CrAg testing expedites diagnosis because growth on fungal media is slow. Mortality remains high, despite standard therapy with amphotericin B.
Details
- Title: Subtitle
- Cirrhosis, gastrointestinal bleed, and cryptococcal peritonitis
- Creators
- Amy E. Barnett - Baylor Scott & White Medical Center - TempleKaren B. Brust - Baylor Scott & White Medical Center - Temple
- Resource Type
- Journal article
- Publication Details
- Proceedings - Baylor University. Medical Center, Vol.33(2), pp.195-198
- DOI
- 10.1080/08998280.2020.1723361
- PMID
- 32313460
- PMCID
- PMC7155978
- ISSN
- 0899-8280
- eISSN
- 1525-3252
- Language
- English
- Date published
- 04/02/2020
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984360153402771
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