Peritonitis in patients with liver disease and ascites. Use of Candida albicans as a microbiological clue in differential diagnosis.

Peritonitis in patients with pre-existing liver disease and ascites may be secondary to a local abdominal condition which potentially requires surgery for cure, or alternatively, may be spontaneous in origin. For the latter, antimicrobials are therapeutic while surgery is contraindicated. An easily accessible and important clue for distinguishing these forms of peritonitis may be found in the microbiology of ascitic fluid. Visualization on gram stain smear or recovery on culture of multiple organisms and/or anaerobes favors local abdominal disease over spontaneous peritonitis. The presence of Candida species in the ascitic fluid of such patients, although less common, is highly significant. In the absence of peritoneal dialysis, recent abdominal surgery, or risk factors for disseminated candidiasis, the isolation of Candida suggests specifically gastrointestinal perforation.