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.     

Vitamins and continuous ambulatory peritoneal dialysis (CAPD)

The authors assessed vitamin A, and its protein carriers vitamins C and E in serum and dialysis fluid of 10 patients with chronic renal failure during 6–12 months of continuous ambulatory peritoneal dialysis.Vitamin A and its protein carriers and serum vitamin E were elevated throughout the long-term investigation of continuous ambulatory peritoneal dialysis despite the fact that vitamin A and its protein carriers have a relatively great peritoneal transfer and loss into the dialysis fluid. The oral dose of 200 mg of vitamin C per day, despite the great peritoneal transfer and loss into the dialysis fluid, prevented the development of hypovitaminosis C. Assessment of vitamins B₁, B₂ and B₆ revealed that the supplementation with these vitamins is adequate for patients during continuous ambulatory peritoneal dialysis.     

Group B Streptococcus (Streptococcus agalactiae) peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD)

Streptococcus agalactiae typically induces serious infections in pregnant women and newborns. Nonpregnant adult patients can also be infected and mortality rate exceeds 40%. CAPD peritonitis is very rarely induced by S. agalactiae. Seven cases have been described previously and all had a very severe course, which included bacteremia, septic shock and death. A 27-year-old male with end-stage renal disease due to membranoprolipherative glomerulonephritis type I, who was on CAPD for 17 months, was admitted with the clinical and laboratory picture of CAPD peritonitis. Severe abdominal pain, shaking chills and fever 38.5 microC were also observed at presentation. Streptococcus agalactiae was isolated from the peritoneal fluid and blood culture was sterile. Under treatment with ceftazidime and tobramycin (i.p.) and vancomycin (i.v.) cultures became negative after 48 hours, abdominal symptoms resolved after 12 days and WBC count in the dialysate normalized after 14 days. As a possible source of infection the patient's partner was shown to be a vaginal carrier of a clone of S. agalactiae identical to that isolated in the peritoneal fluid. S. agalactiae is a rare cause of CAPD peritonitis with potentially very serious consequences. Anal or genital tract colonization is, in general, the source of contamination with S. agalactiae. The microbiological findings in the case presented here suggest that colonization of the patient or of his close environment may be important in the pathogenesis of S. agalactiae-induced CAPD peritonitis.     

Relapsing Bacillus licheniformis peritonitis in a continuous ambulatory peritoneal dialysis patient

Bacillus licheniformis is a rare pathogen in continuous ambulatory peritoneal dialysis (CAPD) peritonitis. Only one case of B. licheniformis peritonitis has been previously reported but relapsing peritonitis by same species has not been reported. A 31-year-old man undergoing CAPD was admitted to our hospital with diarrhoea and turbid peritoneal effluent. Although B. licheniformis was cultured at his previous admission, we did not consider the species as a pathogen. After the same species was cultured twice consecutively at the subsequent admission, we confirmed that B. licheniformis was a pathogen of CAPD peritonitis. After appropriate intraperitoneal antibiotics therapy, the patient improved. He is currently undergoing CAPD without catheter removal.     

Laparoscopic repositioning of a continuous ambulatory peritoneal dialysis (CAPD) catheter

We describe a laparoscopic technique for relieving obstruction of a continuous ambulatory peritoneal dialysis (CAPD) catheter. Laparoscopic repositioning of the catheter and omentectomy obviated the need for laparotomy in a patient with end-stage renal disease.     

Mycobacterium avium complex-associated peritonitis in a patient on continuous ambulatory peritoneal dialysis

Continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis remains a major cause of morbidity in the dialysis population. Typically, infection is caused by gram positive bacteria and treated with empiric antibiotics. A subset of patients, however, develop culture negative peritonitis and may be infected with fungal or mycobacterial organisms. We present a case of Mycobacterium avium complex-associated peritonitis in a HIV negative patient on CAPD. Our patient suffered from technique failure and died from unrelated causes before treatment could be completed.     

Sclerosing peritonitis following continuous ambulatory peritoneal dialysis

Sclerosing peritonitis is a severe complication after CAPD treatment. The visceral peritoneum is thickened and interenteric adhesive parts are found. Myofibroblasts are proliferated and the collageneous tissue is hyperplastic. The mean clinical symptom is the mechanical obstruction of the small bowel. We observed this illness in three out of sixty patients under CAPD. These patients had higher incidence of bacterial peritonitis. In the ascites high concentrations of PG E2 and Thromboxan B2 were observed. After treatment of the infection the concentrations fell down to normal values. Electronoptical observations from peritoneal biopsies showed a proliferation of myofibroblasts and extracellular lysosomes. It is known from these lysosomes that they are able to set free proteasis. These lead to degredation of fibrin and fibrinogen. These splits are mitogen to myofibroblasts. release from HIT cells could also be evoked by the sulphonylureas glibenclamide and tolbutamide and by an increase in concentration of extracellular K+ to 40 mmol/l. The content of cyclic AMP in HIT cells was increased modestly by glucose but not by an increase in extracellular K+. Forskolin elicited a 4-fold increase in cyclic AMP content. We conclude that HIT cells retain the essential features of the insulin secretory response of normal B cells and represent an important tool for further biochemical characterisation of the secretory system.     

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

Key words: Bacillus cereus; CAPD peritonitis; lysis centrifugation      

Algal peritonitis complicating continuous ambulatory peritoneal dialysis

A 41-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) presented with algal peritonitis. Prototheca wickerhamii was isolated from multiple dialysate effluent cultures. Despite treatment with amphotericin B, catheter removal was required. An attempt to reinsert a Tenckhoff catheter 3 months later was unsuccessful because of dense intraperitoneal adhesions. Prototheca sp are a rare cause of human disease, this being the first reported case of algal peritonitis complicating CAPD.     

An interracial study of continuous ambulatory peritoneal dialysis (CAPD) in Natal

This study analyses our experience with continuous ambulatory peritoneal dialysis (CAPD) over a period of 2 1/2 years. Twenty-six patients are continuing on CAPD. Of the 31 Whites, 19 Asians, 5 Coloureds and 3 Blacks who began treatment, 15 Whites, 8 Asians, and 3 Coloureds but no Black patients are continuing treatment. Peritonitis was the most important limiting factor and occurred once in every 28,5 weeks in Coloureds, once in 19,5 weeks in Whites, once every 16 weeks in Asiatics and once every 11 weeks in Blacks. Twenty-eight per cent of the patients had 70% of the episodes of peritonitis. Advantages of CAPD were personal freedom, control of blood pressure and fluid balance, and a greater latitude in acceptance of more patients into a chronic renal dialysis programme. The value of CAPD should be assessed further in time and should not be regarded as the final solution to the management of patients with chronic renal failure.     

Neutral-pH peritoneal dialysis solution improves peritoneal function and decreases matrix metalloproteinase-2 (MMP-2) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD)

Background Conventional lactate-buffered peritoneal dialysis (PD) solutions have several bioincompatible characteristics, including acidic pH, lactate buffer, and the presence of glucose degradation products (GDPs), and these characteristics contribute to membrane dysfunction in PD patients. The formation of GDPs can be reduced by separating the glucose component of the solution from the lactate component during sterilization. This study was carried out to evaluate the clinical effect of dual-chambered neutral-pH PD solution in patients on continuous ambulatory peritoneal dialysis (CAPD).Methods Thirteen CAPD patients using conventional PD solution were enrolled in this study. The fast peritoneal equilibration test (fast PET) was performed periodically before and after treatment with neutral PD solution. The concentration of matrix metalloproteinase-2 (MMP-2) in dialysate effluent was measured using 4-h dwelling 2.5% glucose dialysis solution. The patients were categorized into two groups, according to the value of the initial dialysate/plasma (D/P) creatinine ratio: i.e., lower transporters (group L, D/PCr < 0.65) and higher transporters (group H, D/PCr 0.65).Results The mean D/P creatinine ratio measured by fast PET, was significantly decreased (0.72 ± 0.09 to 0.60 ± 0.06; P < 0.03) after treatment with neutral PD solution in group H. The mean glucose level in 4-h dwelling dialysate effluent was elevated (824.6 ± 195.9mg/dl to 942.6 ± 147.8mg/dl; P < 0.022) in all subjects. In group H, a significant decrease of MMP-2 in the dialysate effluent was recognized from 15 months after the beginning of treatment with the neutral PD solution (141.4 ± 52.5ng/ml to 91.3 ± 15.1ng/ml; P < 0.05), with the lowest value being shown at 21 months (80.0 ± 31.8ng/ml; P < 0.03).Conclusions Neutral-pH peritoneal dialysis solution decreased the MMP-2 level in dialysate and improved peritoneal function in high-transporter patients with CAPD treatment.     

Brucella peritonitis in a patient on continuous ambulatory peritoneal dialysis with acute brucellosis

Peritonitis is an uncommon complication of brucellosis. Brucella peritonitis in chronic ambulatory peritoneal dialysis (CAPD) patients has not been reported before. A male patient is presented with peritonitis caused by Brucella melitensis who was on CAPD. The source of infection was thought to be unpasteurized, unsalted cheese eaten a month before the onset of symptoms. At the beginning, antibiotic therapy with doxycyline and rifampicin led to a rapid clinical improvement, with disappearance of the organism in the peritoneal fluid. However, peritonitis relapsed after discontinuation of antimicrobial therapy. Successful management required a combination of medical therapy and removal of the Tenckhoff catheter.     

Successful maintenance of continuous ambulatory peritoneal dialysis in a patient after fungal peritonitis and dialysate leakage

Fungal peritonitis (FP) and dialysate leakage have often been reported in association with continuous ambulatory peritoneal dialysis (CAPD), which has to be discontinued in many cases due to these complications. This report describes the first case of dialysate leakage into the urinary bladder of a 70-year-old male patient, after the area of the left ureteral ostium had been very deeply resected. The leakage probably led to severe fungal peritonitis developing 1 day after the ostium resection. The ostium resection was performed in November 2003 after detection of a carcinoma in situ (Cis) in this area and after previous bilateral nephroureterectomies due to multifocal urothelial carcinoma in the kidneys, ureters and bladder. In spite of prior fungal peritonitis and dialysate leakage, CAPD could be successfully initiated 41 days after biochemical manifestation of peritonitis and could be maintained in the patient because of the following reasons: early and effective treatment of FP with fluconazole and voriconazole, spontaneous occlusion of the slitted ostium area, allowance of enough healing time after 2 major abdominal surgeries, during which the patient was placed on extracorporal hemodialysis (which had been started 1 day after nephroureterectomy and ended after the antimycotic treatment) and thorough monitoring of the patient after starting CAPD. In January 2004, the patient could be placed on a cycler peritoneal dialysis and was fully rehabilitated 1 year later.     

Lymphocytes subsets in the course of continuous ambulatory peritoneal dialysis (CAPD)

BACKGROUND: We studied lymphocyte subset counts in comparison with normal subjects in order to clarify the abnormalities of cellular immune responses in uremic patients undergoing continuous ambulatory peritoneal dialysis (CAPD). METHODS: The study included 37 CAPD patients and 45 normal individuals, as the control group. For the study, CAPD patients were divided into four groups depending on duration of replacement therapy. Group I consisted of patients treated for 0-6 months (n=6), group II for 6-12 months (n=6), group III for 13-24 months (n=16), and group IV for more than 25 months (n=9). Flow cytometry was used for estimation of lymphocyte subsets (determination of CD2, CD3, CD3+/CD4+, CD3+/CD8+, CD3-/16+56+, CD19, CD4/CD8). RESULTS: Our patients started CAPD with decreased lymphocyte subset counts, slightly above the normal range (excluding CD3 -/16+56+, CD2). After 6 months of CAPD therapy, an increase in CD4/CD8 ratio was observed and all examined lymphocyte subset counts decreased (excluding CD2). In patients on CAPD for more than 25 months, CD3+/CD4+, CD19 counts were below the normal range, CD3 -/16+56+ exceeded the upper limit of normal range and at the same time mean total lymphocyte count (TLC) was maintained in the normal range. CONCLUSIONS: We recommend lymphocyte subset determinations for detection of immune abnormalities in the course of CAPD treatment.     

Aspergillus peritonitis in continuous ambulatory peritoneal dialysis patients

Aspergillus peritonitis is a rare and serious cause of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. We report 3 cases of aspergillus peritonitis in CAPD which were successfully treated by catheter removal and amphotericin. Two of the 3 patients returned temporarily to CAPD, but were subsequently transferred to hemodialysis because of membrane failure. A novel finding in 2 of the 3 cases was a positive Limulus amebocyte lysate test, despite negative bacterial cultures. We discuss the possible relevance of this finding to the diagnosis of aspergillus infections and emphasize the importance of early catheter removal for successful treatment of this condition.