Diagnosis of Spontaneous Bacterial Peritonitis by Identification of 16s rRNA Genes in Liver Cirrhosis Patients

Introduction: Spontaneous bacterial peritonitis (SBP) is a common and severe complication in patients with cirrhosis and ascites occurring in 10-25% of patients, with in-hospital mortality rate ranging from 20 to 40%. Rapid detection of bacteria in the ascitic fluid is the key to improve the survival of cirrhotic patients with ascitic fluid infection. This aim might be fulfilled by molecular diagnosis which played an increasingly important role in the rapid detection of pathogenic organisms in clinical samples. Aim of Work: Evaluate the value of ascitic bacterial 16S rRNA gene determination in the rapid diagnosis of SBP. Methods: 100 patients known to have liver cirrhosis suspecting to have SBP by clinical manifestations or ascitic fluid neutrophil count is 250/mm³. All were subjected to thorough clinical evaluation, laboratory investigations including complete blood count, liver and kidney function tests. Ascitic fluid samples examined for total leucocytic count (TLC) and polymorphnuclear leucocytes (PMN), culture and sensitivity of ascitic fluid as well as 16s rRNA genes by polymerase chain reaction quantitative method was performed. Results: 16s rRNA gene expression in ascitic fluid was positive in all 100 patients suspected to have SBP even in CNNNA (culture-negative non-neutrocytic ascites), culture negative or patients had PMN 250 cells/mm³. There was correlation between 16s rRNA levels and the results of ascitic fluid culture where its levels was higher in culture positive compared to those with culture negative. Conclusion: Identification of bacterial 16s rRNA in ascitic fluid has its significant clinical and diagnostic relevance in suspicion of SBP and its prompt therapy especially in CNNNA. It might be an alternative diagnostic tool to ascitic fluid bacterial culture and PMN in early diagnosis and prompt treatment with subsequent improvement of survival which needs further investigations.