Prevalence of spontaneous fungal peritonitis in Egyptian cirrhotic patients with ascites

Abstract Background Spontaneous bacterial peritonitis (SBP) is a common complication in cirrhotic patients with ascites, whereas spontaneous fungal peritonitis (SFP) is a less recognized but serious entity. Data on the frequency and predisposing factors of SFP in cirrhosis remain limited. We aimed to evaluate the prevalence, risk factors, and clinical features of SFP in patients with cirrhotic ascites. Methods This multicenter cross-sectional study enrolled 267 Egyptian adults with cirrhotic ascites. All patients underwent history taking, clinical examination, and routine laboratory testing. Ascitic fluid analysis included direct microscopic examination and bacterial and fungal cultures. Results The prevalence of SFP was 2.62%, whereas 56.55% of patients were diagnosed with SBP. Among SFP cases, the most frequent presentations were abdominal distension (42.85%), abdominal pain (42.85%), and abdominal pain with fever (14.28%). Hepatorenal syndrome was present in 28.57% and hepatocellular carcinoma in 14.28% of SFP cases. Most SFP patients (85.71%) had received antibiotics during hospitalization. According to the Child–Pugh classification, 57.1% of patients were class C, and the remainder were class B (42.9%). The mean Model for End-Stage Liver Disease (MELD) score among SFP patients was 18.3 ± 8.99. Conclusion A high index of suspicion for SFP is required in cirrhotic patients with ascites, particularly in those presenting with a higher MELD score and Child–Pugh class C who fail to improve after antibiotic treatment.