Tuberculous peritonitis in cirrhotic patients: comparison of spontaneous bacterial peritonitis caused by Escherichia coli with tuberculous peritonitis.

The aim of this study was to compare the characteristics of tuberculous peritonitis (TP) and spontaneous bacterial peritonitis (SBP) in cirrhotic patients. In a retrospective review of the medical records of a single tertiary hospital between 1988 and 2006, 15 patients met the diagnostic criteria TP and liver cirrhosis. For comparison, we randomly selected 3 cirrhotic patients with SBP caused by Escherichia coli for each cirrhotic patient with TP. Compared to SBP, TP in cirrhotic patients was more frequently associated with extra-peritoneal tuberculosis (TP vs SBP: 53.3% vs 0%), an insidious onset (> or =2 weeks; 60% vs 2.2%), and Child-Pugh classification class B at onset (80% vs 8.9%) (p<0.05). Compared to SBP, TP was associated with lower white blood cell count in ascites (TP vs SBP: 2.0+/-2.2 x 10(3)/mm(3) vs 7.2+/-7.5 x 10(3)/mm(3)), a higher proportion of mononuclear leukocytes (lymphocytes and monocytes) in ascites (88.9+/-9.5% vs 16.6+/-15.3%), higher protein concentration in ascites (3.1+/-1.7 g/dl vs 1.2+/-0.3 g/dl), and higher adenosine deaminase activity in ascites (62.3+/-31.8 U/l vs 6.9+/-3.1 U/l) (p<0.05). TP should be suspected in cirrhotic patients with relevant clinical manifestations and characteristics of ascites.