Spontaneous bacterial peritonitis due to Brucella species versus peritoneal dialysis-related peritonitis: a systematic review.

Introduction: Brucella-associated primary peritonitis is an exceptionally rare condition that may present as spontaneous bacterial peritonitis (SBP) or peritoneal dialysis-related peritonitis (PDrP). We investigated demographic and clinical characteristics of these two entities caused by Brucella species.

Methods: A systematic review of the literature was undertaken to identify published cases of primary peritonitis caused by Brucella species and perform comparative analysis. Cases were categorized as SBP or PDrP and analyzed for demographics, clinical features, microbiology, treatment regimens and outcomes.

Results: A total of 33 cases were identified: 22 of SBP and 11 of PDrP. Among these, SBP cases occurred predominantly in older cirrhotic males (mean age 55.2 years), with Brucella isolated mainly from blood cultures (72.7%) and an associated mortality rate of 13.6%. In contrast, PDrP cases involved younger, generally healthier individuals on PD (mean age 47.5 years), where Brucella was universally isolated from peritoneal fluid and mortality was 0%. Catheter removal was required in 36.4% of PDrP cases. Epidemiological risk factors were more common in PDrP (81.8% vs. 45.5%). Blood culture positivity was significantly higher in SBP (p=0.016), while peritoneal fluid cultures were more often diagnostic in PDrP (p=0.028). Most patients received combination therapy with doxycycline and rifampicin, while treatment duration tended to be longer in PDrP.

Conclusion: Brucella peritonitis shows differing patterns in SBP and PDrP. Early identification and appropriate intervention are essential for favorable clinical results.