Rhodococcus peritonitis in a patient treated with peritoneal dialysis

This report is of a patient treated with continuous ambulatory peritoneal dialysis who developed peritonitis attributed to a Rhodococcus species. The rhodococci are rarely pathogenic to humans, and there are no previous reports of peritonitis associated with these organisms. It is important for clinicians to be aware of these bacteria because they can be acid-fast and can be confused with mycobacteria. They are often reported as "diphtheroids" but should not be considered contaminants.     

Aspergillus Niger peritonitis in a peritoneal dialysis patient treated with eculizumab

The complement system plays a vital role in preventing life-threatening infections by ensuring optimal functioning of the host immune system. Its dysregulation has been implicated in causing glomerular, hematological, and transplant-related disorders. Eculizumab a novel monoclonal antibody against complement component C5 has emerged in the recent past as the standard of care offering an effective rescue and maintenance therapy against many of these disorders. Its use has been associated with increased risk of infections predominantly with encapsulated organisms. There is no data in the literature on its effects in end-stage kidney disease (ESKD) or dialysis patients. We describe here a very rare case of Aspergillus Niger peritonitis in an ESKD patient on peritoneal dialysis (PD) receiving maintenance eculizumab therapy for atypical hemolytic uremic syndrome. Given that murine models with the same defect as that induced by eculizumab is vulnerable to invasive Aspergillosis, it is suggested that the fungal peritonitis in this patient was the result of the eculizumab therapy.     

Bacillus cereus peritonitis in a patient being treated with continuous ambulatory peritoneal dialysis

Key words: Bacillus cereus; CAPD peritonitis; lysis centrifugation      

A peritoneal dialysis patient with fatal culture-negative peritonitis

SUMMARY: Culture-negative peritoneal inflammation accounts for between 5 and 20% of cases of peritonitis in peritoneal dialysis patients. Diagnostic yields may be enhanced considerably by reculturing dialysate effluents using appropriate collection methods and optimal laboratory techniques (including prolonged low-temperature and anaerobic incubations). In patients with persistent culture-negative peritonitis, consideration should be given to the possibilities of unusual or fastidious microorganisms (especially fungi and mycobacteria) and non-infective causes (especially drug reactions, malignancy, visceral inflammation and retroperitoneal inflammation). In this paper, an illustrative case of persistent culture-negative peritonitis is presented followed by a discussion of the investigative approach to such patients, with particular emphasis on differential diagnosis and the limitations of currently available tests.     

Gemella morbillorum peritonitis in a patient being treated with continuous ambulatory peritoneal dialysis.

Sir, Peritonitis is a serious problem for peritoneal dialysis (PD)patients, and is a major cause of hospitalization, catheterloss and transfer to haemodialysis [1]. We present a peritonitisepisode caused by an unusual pathogen, Gemella morbillorum.A 55-year-old man was admitted to hospital after noticing     

Takotsubo cardiomyopathy associated with peritonitis in peritoneal dialysis patient

Takotsubo cardiomyopathy (TTC) is characterized by clinical and electrocardiographic features that mimic acute myocardial infarction, normal or mildly elevated cardiac enzymes, distinctive left ventricular wall motion abnormalities, and absence of significant obstructive coronary artery disease. Often there is a history of emotional stress and usually encountered in postmenopausal women. Excessive catecholamine stimulation plays an important role in the pathogenesis of TTC. Usually, this condition is reversible within several weeks to months. Only two cases of TTC were described in patients on hemodialysis. To our knowledge, we report the first case of TTC in peritoneal dialysis and the first case associated with peritonitis.     

Gonococcal peritonitis in a patient treated with continuous ambulatory peritoneal dialysis (CAPD)

We report a case of gonococcal peritonitis in a sexually active female on continuous ambulatory peritoneal dialysis. The presumed route of entry into the peritoneal cavity was via the Fallopian tube. The episode responded rapidly to a standard antibiotic treatment protocol. Some episodes of culture-negative peritonitis may be caused by genital tract organisms which are not cultured by routine methods.     

Pasteurella multocida peritonitis in an HIV-positive patient on continuous cycling peritoneal dialysis

Pasteurella multocida has been reported only once previously as a cause of peritonitis in a patient undergoing chronic peritoneal dialysis. The present report describes findings associated with a case of P. multocida peritonitis in a human immunodeficiency virus (HIV)-positive patient in which renal replacement therapy consisted of continuous cycling peritoneal dialysis. To our knowledge this is the first report of this unique infection in an HIV-positive end-stage renal disease patient. In addition, the recent literature on this unusual organism is reviewed in detail. These findings emphasize the potential for increased susceptibility to zoonoses in immunocompromised patients, particularly with indwelling intraperitoneal catheters which may serve as a portal of entry for unusual organisms.     

Fungal peritonitis in children treated with peritoneal dialysis and gastrostomy feeding

Feeding gastrostomies were placed in three children treated with chronic peritoneal dialysis at our center because of persistent, severe malnutrition and inadequate growth. Two had frequent fungal infections of the gastrostomy site and all three developedCandida peritonitis which occurred at 1 month, 2 months and 2 years after insertion of gastrostomy. Complications included multiple intra-abdominal adhesions, abscess formation and loss of peritoneal function necessitating transfer to hemodialysis. The presence of a gastrostomy may predispose to the development of fungal peritonitis with its high morbidity and should be avoided in children on chronic peritoneal dialysis.     

Recent peritonitis associates with mortality among patients treated with peritoneal dialysis

Peritonitis is a major complication of peritoneal dialysis, but the relationship between peritonitis and mortality among these patients is not well understood. In this case-crossover study, we included the 1316 patients who received peritoneal dialysis in Australia and New Zealand from May 2004 through December 2009 and either died on peritoneal dialysis or within 30 days of transfer to hemodialysis. Each patient served as his or her own control. The mean age was 70 years, and the mean time receiving peritoneal dialysis was 3 years. In total, there were 1446 reported episodes of peritonitis with 27% of patients having ≥ 2 episodes. Compared with the rest of the year, there were significantly increased odds of peritonitis during the 120 days before death, although the magnitude of this association was much greater during the 30 days before death. Compared with a 30-day window 6 months before death, the odds for peritonitis was six-fold higher during the 30 days immediately before death (odds ratio, 6.2; 95% confidence interval, 4.4-8.7). In conclusion, peritonitis significantly associates with mortality in peritoneal dialysis patients. The increased odds extend up to 120 days after an episode of peritonitis but the magnitude is greater during the initial 30 days.     

Capnocytophaga canimorsus peritonitis in a pediatric peritoneal dialysis patient

Capnocytophaga canimorsus, a bacterium rarely encountered by clinicians, was responsible for the development of peritonitis in an 18-year-old white male on automated peritoneal dialysis following the puncture of his dialysis tubing by a domestic cat. Although more than 100 cases of septicemia caused by C. canimorsus have been reported, this is the first report of the organism causing peritonitis in a patient receiving peritoneal dialysis. Of interest, the patient had a prior episode of peritonitis secondary to Pasteurella multocida, also following transmission from the same cat. Received: 20 November 1998 / Revised: 13 January 1999 / Accepted: 13 January 1999     

Mycobacterium chelonae peritonitis in a patient on peritoneal dialysis

Non-tuberculous mycobacteria peritonitis is uncommon with the majority of cases reported in patients on peritoneal dialysis with diagnostic and therapeutic challenges. Here we present a case of Mycobacterium chelonae peritonitis and review other cases in the literature to discuss the clinical spectrum, diagnostics, regimens and duration of treatment, and outcome.     

Encapsulating peritoneal sclerosis in a peritoneal dialysis patient presenting with complicated Mycobacterium fortuitum peritonitis

Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication seen in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysisAPD after prolonged duration on dialysis. Patients usally present with vague complaints of abdominal pain, vomitting, diarrhea, weight loss and change in peritoneal transport characte-ristics. High degree of suspicion is needed in PD patients who have been on dialysis for prolonged duration and have been using high-concentrated dialysis fluid. Mycobacterium fortuitum (MF) is a rapidly growing, non-tuberculous mycobacterium that has rarely been reported as a pathogen causing peritonits in patients on PD. We report a case of CAPD presenting with culture-negative peritonits, which, on specific culture, grew MF and, on radiological evaluation, showed diagnostic features of EPS.     

Successful treatment of Aspergillus peritonitis in a peritoneal dialysis patient

Aspergillus peritonitis is a rare, potentially fatal complication of continuous ambulatory peritoneal dialysis (CAPD). We report the successful treatment of refractory fungal peritonitis in an 8-year-old girl treated by peritoneal dialysis for 3.3 years. This is the second report of Aspergillus thermomutatus (telemorph: Neosartorya pseudofischeri) in humans. Comprehensive treatment included early removal of the CAPD catheter, the use of liposomal amphotericin B, and the use of itraconazole. Received: 21 August 2001 / Revised: 17 December 2001 / Accepted: 18 December 2001     

Pantoea peritonitis in a patient receiving chronic ambulatory peritoneal dialysis

Pantoea agglomerans is usually the most common organism transmitted through plant thorn injuries. This report is of a female patient maintained on chronic ambulatory peritoneal dialysis (CAPD) who developed peritonitis attributed to P. agglomerans. Peritonitis is an uncommon complication of P. agglomerans and there is no previous report of peritonitis associated with this organism in a CAPD patient. The source of infection was thought to be due to rose-thorn injury. Antibiotic therapy with ceftazidime and amikacin i.p. led to a clinical improvement, with disappearance of the organism in the peritoneal fluid.