Leukocyte esterase reagent strips for diagnosis of spontaneous bacterial peritonitis in pediatric patients with chronic liver disease / Marwa Shaaban Abdo Ali ; Supervised Engy Adel Mogahed , Caroline Morkos Ghobrial , Noha Salah

Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Introduction: Spontaneous bacterial peritonitis (SBP) is a common problem in patients with chronic liver disease (CLD). Aim of work: To assess the accuracy of leukocyte esterase reagent strips (LERS) as a bedside test for rapid diagnosis of SBP in pediatric liver patients with ascites. Patients and methods: This was a cross-sectional study conducted on 39 children of both sexes with CLD and ascites with a total of 47 paracentesis procedures performed. All patients were subjected for proper history taking and clinical examination for symptoms and signs of ascitic fluid infection (AFI). Ascitic fluid examination was performed including cells, culture and LERS. Results: The age of our patients ranged between 2 months to 16 years. Thirty-four paracentesis procedures were diagnostic (72.3%), 8 were therapeutic (17%). Biliary atresia constituted the main cause of CLD (55.3%). The most common symptoms of AFI were fever, abdominal pain and dyspnea. Seven patients had SBP with PMNL>250 and LERS were positive in 13 patients. Positive LERS, ascitic fluid culture, high TLC and absolute staff count, were significant predictors of AFI. The diagnostic accuracy of LERS for AFI compared to PMNL >250 was 95%, sensitivity 100% and specificity 92.3%. Conclusion: LERS is a rapid, accurate and sensitive method for diagnosis of SBP. It is recommended as a bedside test for diagnosis of SBP to allow early and proper management

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