[Diagnosis of spontaneous ascites infection in patients with cirrhosis: reagent strips]. / Diagnostic des infections spontanées du liquide d'ascite chez le cirrhotique par bandelette urinaire.

AIM: To evaluate the sensitivity, specificity, and predictive values of dipstick testing (DT) for detecting spontaneous bacterial peritonitis (SBP), defined by an ascites neutrophil polymorphonuclear cell count > or = 250/mm3, in patients with cirrhosis. METHODS: The study includes all patients with cirrhosis and ascites admitted to our general hospital on the southern outskirts of the Paris metropolitan area (France) from June 2003 to May 2004 (n = 47:27 men and 20 women). Diagnostic abdominal paracentesis was performed on admission, and a Multistix SG (Bayer Pharma) reagent strip was immersed in one ascitic sample from each patient. Readings after 120 s were either negative (DT-) or positive (DT+, with 4 levels of positivity: trace, +, ++, or +++). In case of cytologically-proven SBP, patients were treated with cefotaxime, and subsequent paracentesis with DT and cytologic testing took place every 48 hours, until recovery. RESULTS: Six of the 47 patients had proven SBP, all with clinical signs of SBP (fever and/or abdominal pain); five of these patients were DT+ and one was DT-. In the five patients initially DT+, the DT became negative at the same time as the cytologic criteria for SBP disappeared. Forty-one patients did not meet the cytologic criteria for SBP: 34 were DT- and 7 were DT+ (traces: 4, ++: 2, +++:1); two of these had clinical signs suggestive of SBP. CONCLUSION: Although the sensitivity (83%), specificity (83%) and negative predictive value (97%) of DTwere satisfactory, its positive predictive value (42%) was low. Dipstick testing of ascitic fluid is easy to perform and inexpensive and may be recommended for diagnosis and follow-up of SBP, especially in emergency settings.

[Presence of anti-Yersinia pseudotuberculosis agglutinins during a flare-up of ileal Crohn's disease. Apropos of 3 cases]. / Présence d'agglutinines anti-"Yersinia pseudotuberculosis" lors d'une poussée de maladie de Crohn iléale. A propos de trois cas.

Sera of 19 patients who had been admitted with an attack of Crohn's disease were tested for agglutinins against Yersinia. The localization and the extent of the disease were highly variable. Only three patients with a subacute obstruction syndrome due to ileitis had a high circulating antibody titer directed against Yersinia pseudotuberculosis type IV (greater than or equal to 1/500). Culture of the stools did not isolate any pathogenic organisms; particularly, Yersinia pseudotuberculosis failed to grow even though specific methods were used. In one case, a strain of Yersinia enterocolitica was identified which did not prove to be pathogenic. Under corticoid and antibiotic treatment, the course was favorable in every patient. Agglutinin titers progressively decreased and serology became negative within seven to ten months. A patient had a relapse of ileitis but agglutinin titers failed to rise again. In these three patients with unquestionable Crohn's disease, it may be concluded that there was serological evidence of superinfection with Yersinia pseudotuberculosis type IV. This organism might be responsible for acute ileitis mimicking an attack of Crohn's disease.