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1.
The authors report the first case in Manitoba of a patient undergoing continuous ambulatory peritoneal dialysis who experienced three successive infections with Pasteurella multocida and Capnocytophaga species over an eight-month period. These zoonotic infections were believed to originate from contact with the patient’s household pets. To prevent such infections, the authors recommend the development and implementation of hygiene guidelines outlining the risks associated with owning domestic pets for continuous ambulatory peritoneal dialysis patients.  相似文献   

2.
Pasteurella multocida is a Gram-negative bacterium recovered from a wide variety of wild and domestic animals and has mostly been associated with infection following animal bites. We present the first reported case of a patient who developed a postoperative sternal wound infection due to P. multocida complicated by bloodstream infection. The outcome was favorable following surgical debridement and antimicrobial therapy. We also review the literature regarding P. multocida postoperative wound infections.  相似文献   

3.
Epidemiology data predict that by the year 2025, diabetes will affect about 380 million people worldwide with a significant increase in patients with chronic renal disease progressing to hemodialysis. Diabetes-related peripheral vascular disease is a major risk factor for vascular access failure in patients on extracorporeal hemodialysis. Although peritoneal dialysis is a valid option for diabetics, peritonitis is still a main complication for these patients. We report the case of a 71-year-old type 2 diabetes patient treated by subcutaneous insulin, undergoing automated peritoneal dialysis (APD) who developed peritonitis and bloodstream infection by Ochrobactrum anthropi (O. anthropi). The patient was initially shifted to continuous ambulatory peritoneal dialysis (CAPD) and treated with intraperitoneal cefotaxime and gentamicin. According to antibiogram, cefotaxime was discontinued but lasting gentamicin. Within 48 h from admission, clear peritoneal effluent was observed with reduction in white blood cells count from 580/mm3 77.9% neutrophils to less than 10/mm3. Prompt regression of infection without catheter removal and no relapse after over 7-month follow-up allowed supposing that O. anthropi did not colonized peritoneal catheter. O. anthropi is an emerging cause of nosocomial infection in immunocompromised patients. Cases of such infection in patients undergoing CAPD and hemodialysis have been already described. However, this is the first reported case of O. anthropi in a patient undergoing APD.  相似文献   

4.
J.S.J Wong, M.I. Schousboe, S.S.L. Metcalf, Z.H. Endre, J.M. Hegarty, M.J. Maze, E.R. Keith, L.M. Seaward, R.G. Podmore. Ochroconis gallopava peritonitis in a cardiac transplant patient on continuous ambulatory peritoneal dialysis
Transpl Infect Dis 2010: 12: 455–458. All rights reserved Abstract: Ochroconis gallopava has rarely been isolated in immunosuppressed patients. We report the first case to our knowledge of O. gallopava peritonitis in a cardiac transplant patient on continuous ambulatory peritoneal dialysis. A 58‐year‐old man who had undergone cardiac transplant 8 years earlier alerted his dialysis nurses to the presence of black material in his catheter lumen. Fungal hyphae were seen on direct microscopy of the black material and from the dialysate effluent, and O. gallopava was cultured from both after 1 day. He was treated successfully with a single dose of intravenous voriconazole, followed by 2 weeks of oral voriconazole.  相似文献   

5.
Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of liver cirrhosis. Recently, rifaximin, a non-absorbable antibiotic which is used to prevent recurrent hepatic encephalopathy, has been proposed as effective prophylaxis for SBP. Here, we present an unusual case of SBP under treatment with rifaximin. A 50-year-old woman with liver cirrhosis was admitted because of tense ascites and abdominal pain. She was under long-term oral prophylaxis with rifaximin due to hepatic encephalopathy. Paracentesis revealed SBP caused by Pasteurella multocida, which was sensitive to multiple antibiotics, including rifaximin. Treatment with ceftriaxone resulted in rapid resolution of the peritonitis and restoration of the patient. Since P. multocida is usually transmitted from pets, the patient’s cat was tested and could be identified as the most likely source of infection. This case should elicit our awareness that uncommon pathogens and unusual routes of transmission may lead to SBP, despite antibacterial prophylaxis with non-absorbable antibiotics. Nevertheless, such infections may still remain sensitive to systemic therapy with conventional antibiotics.  相似文献   

6.
Icodextrin peritoneal dialysis (PD) solution has been shown to increase interleukin‐6 (IL‐6) levels in PD effluent as well as leukocyte and mesothelial cell count. Mesothelial cells release cancer antigen 125 (CA125), which is used as a marker of mesothelial cell mass. This 1‐year prospective study was designed to compare peritoneal effluent cell population, its inflammatory phenotype and biocompatibility biomarkers IL‐6 and CA125 between icodextrin (E) and glucose bicarbonate/lactate (P) based PD solutions. Using baseline peritoneal ultrafiltration capacity, 19 stable incident PD patients were allocated either to P only (N = 8) or to P plus E for the overnight dwell (N = 11). Flow cytometry was used to measure white blood cell count and differential and the expression of inflammatory molecules on peritoneal cells isolated from timed overnight peritoneal effluents. Compared to P, E effluent showed higher leukocyte (10.9 vs. 7.9), macrophages (6.1 vs. 2.5) and mesothelial cells (0.3 vs. 0.1)×106/L count, as well as expression of HLA DR on mesothelial cells and IL‐6 (320.5 vs. 141.2 pg/min) on mesothelial cells and CA125 appearance rate (159.6 vs. 84.3 IU/min), all P < 0.05. In the E group, correlation between IL‐6 and CA125 effluent levels (r = 0.503, P < 0.05) as well as appearance rates (r = 0.774, P < 0.001) was demonstrated. No effect on systemic inflammatory markers or peritoneal permeability was found. Icodextrin PD solution activates local inflammation without systemic consequences so the clinical relevance of this observation remains obscure. Correlation between effluent IL‐6 and CA125 suggests that CA125 might be upregulated due to inflammation and thus is not a reliable marker of mesothelial cell mass and/or biocompatibility.  相似文献   

7.
Zusammenfassung Die Autoren berichten über einen Säugling mit einer Meningitis durchPasteurella multocida. Ausgehend von dieser Erkrankung sowie von weiteren Fällen vonP. multocida-Infektionen wird auf die Besonderheiten der Ätiologie, Diagnostik und Therapie dieser Erkrankungen eingegangen.
Meningitis in an infant caused by pasteurella multocida. Case report and review of other manifestations
Summary The authors report on an infant with meningitis caused byPasteurella multocida. The problems of aetiology, diagnosis, and therapy of these infections are discussed with reference to this patient and other cases ofP. multocida infection.


Herrn OMR Prof. em. Dr. sc. med. Dr. med. vet. h. c. Dr. med. h. c.Georg Wildführ zum 75. Geburtstag in Verehrung gewidmet  相似文献   

8.
Abstract We describe the rare case of a patient with an isolated endocarditis of the pulmonary valve caused by Pasteurella multocida. The bacterium was cultured from blood as well as from the excised valve after pulmonary valve replacement. Risk factors were contact with animals and concurrent intravenous drug use.  相似文献   

9.
Impaired gastric myoelectrical activity has been reported in patients with chronic renal failure (CRF). The effect of peritoneal dialysis on this function has not previously been described. The aim here was to investigate the effect of peritoneal dialysis on gastric myoelectrical activity. Gastric myoelectrical activity was recorded by electrogastrography (EGG) in 23 patients with CRF (18 with dyspepsia) during peritoneal dialysis and with the peritoneal cavity empty of dialysis fluid (14 patients), and in 20 healthy controls. Two 30-min EGG recordings before and after a solid test meal were analyzed using spectral analysis methods. No significant difference in the percentage of normal 2- to 4-cpm slow waves was found in patients on peritoneal dialysis compared to those with the peritoneal cavity empty of dialysis fluid or to controls (in fasting state 83 ± 3%, 80 ± 5% and 89 ± 4%, in fed state 91 ± 3%, 86 ± 4% and 83 ± 4%, respectively). It was found that the power ratio (change in power of normal slow waves in fed state) was significantly higher in the 14 patients on peritoneal dialysis compared to the same patients with the peritoneal cavity empty of dialysis fluid (27.2 ± 10.7 vs 8.6 ± 4.8, P < 0.05). There was no significant difference in the power ratio between patients with the peritoneal cavity empty of dialysis fluid and controls (8.6 ± 4.8 vs 7.5 ± 2.2). The subgroup of patients with no dyspepsia had a significantly higher power ratio compared to those with dyspepsia both on dialysis and with the peritoneal cavity empty of dialysis fluid (39.4 ± 13.7 vs 12.4 ± 5.2 and 29.2 ± 21.5 vs 2.8 ± 0.4 respectively, P < 0.05). In conclusion, there was no significant difference in gastric myoelectrical activity between patients with the peritoneal cavity empty of dialysis fluid and controls. Dialysis fluid in the peritoneal cavity seems to enforce the gastric myoelectrical signal.  相似文献   

10.
A 58-year-old woman presented with progressive midforehead swelling and erythema with frontal headache. Investigations revealed erosion of the anterior wall of the frontal sinus with subgaleal abscess formation, establishing a diagnosis of Pott’s puffy tumour. Pasteurella multocida was isolated in pure growth from an aspirate of the abscess. P multocida is a rare cause of sinusitis. It is isolated from the respiratory tract of asymptomatic individuals and, more commonly, patients with chronic respiratory conditions. Although a cause of osteomyelitis associated with animal bites or scratches, P multocida has not previously been implicated as a cause of frontal osteomyelitis or Pott’s puffy tumour. A review of reported cases of Pott’s puffy tumour, including clinical presentation, microbiology, treatment and outcome, is provided.  相似文献   

11.
The beneficial effects of novel peritoneal dialysis solutions low in glucose degradation products regarding peritoneal cell apoptosis and necrosis are well established in vitro, however in vivo data is lacking. Cell-free DNA quantification is a possible method to determine cell damage through apoptosis and necrosis in vivo. We performed a prospective, cross-over study on 26 stable continuous ambulatory peritoneal dialysis (CAPD) patients, treating each patient for 3 months in a randomized order with a conventional, lactate-buffered, acidic solution (solution D) and a novel, bicarbonate/lactate-buffered neutral solution (solution P). The timed overnight peritoneal effluent was sampled for cell-free DNA quantification using a fluorometric assay. The effluent samples of eighteen patients were finally available for DNA quantification. The concentration range of cell-free DNA in the peritoneal effluents was 1.8–9.5 µg/L. The coefficient of intrapatient variation in overnight effluent cell-free DNA appearance was 15.6 ± 12.4%. Cell-free DNA peritoneal appearance using solutions D and P was 14.9 ± 6.8 µg and 11.8 ± 3.4 µg, respectively (P = 0.02), with the average difference of 3.1 µg (95% CI, 0.7–5.6 µg). Our results show that cell-free DNA is present in the overnight peritoneal effluent of stable CAPD patients. A significant decrease in the cell-free DNA appearance with solution P was found; however, before accepting this as an indicator of a more biocompatible profile causing less peritoneal membrane cell necrosis and apoptosis, confirmatory data on larger patient samples are needed. Our results indicate the potential future role of cell-free DNA in the diagnosis and prognosis of therapy-related peritoneal membrane degeneration.  相似文献   

12.
Pasteurella multocida is a Gram-negative short rod-shaped bacteria that has been recognized as a pathogen of hemorrhagic septicemia and fowl cholera in the veterinary medicine. Infections by this microorganism as seen in the foreign literature vary widely from local infections due to bites and scratches by animals to general infections such as infections of the respiratory tract, sepsis, and meningitis. In Japan, reported cases of P. multocida infections are predominantly local infections, followed by respiratory infection. Recently, death of diabetic patients due to septicemia by this pathogen has also been reported. In this study, we experienced a case of respiratory tract infection in which the pathogen P. multocida subsp. multocida was suggested to have been transmitted from a pet cat by the agreement of the serotype of the bacterial isolates between the patient and the cat. This case was evaluated from the zoonotic viewpoint. The patient was a 68-year-old male who had been followed up since 1982 with a diagnosis of bronchiectasis. After his referral to our hospital, P. multocida subsp. multocida was isolated from his bloody sputum and, then, from the cat kept by the patient. The tow isolates were identical in terms of the biochemical properties, drug susceptibility profile, and serotype (-:1), and the derivation of P. multocida subsp. multocida infection from cat was established for the first time in this report. The incidence of P. multocida infections is increasing in Japan, and particular attention is considered to be needed about these conditions as zoonoses as indicated in "Preventive Measures against Zoonoses Derived from Pet Animals (Dog, Cat)", an official communication from the Ministry of Health and Welfare to related institutions in 1989. Also, to check whether the patient keeps any pet at the clinical inquiry is a practice of bacteriological importance in all fields of medicine.  相似文献   

13.
Mycobacterium porcinum has been reported to cause a variety of illnesses including wound infections, respiratory tract infections, osteomyelitis and catheter-related bacteremias. We report the first case of M. porcinum peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). A 67-year-old woman on CAPD presented with three weeks of constitutional symptoms and abdominal pain. Peritoneal fluid cultures on day three grew acid-fast rods. Nocardiosis was suspected and the patient was empirically treated with amikacin and trimethoprim-sulfamethoxazole. The dialysis catheter was removed. Two weeks later final culture results revealed M. porcinum. Ciprofloxacin and trimethoprim-sulfamethoxazole were initiated with good clinical response.  相似文献   

14.
Abstract This report documents a case of peritonitis due to Mycobacterium gastri in a 28 year old woman on continuous ambulatory peritoneal dialysis. She presented with persistent abdominal pain and clear peritoneal drainage fluid which contained increased numbers of lymphocytes. The diagnosis was made by identification of acid-fast bacilli in peritoneal fluid and within a peritoneal biopsy specimen, and culture of Mycobacterium gastri from peritoneal fluid. Treatment with rifampicin and ethambutol and removal of the Tenckhoff catheter has proved effective. The case highlights the importance of searching for slow growing organisms in apparently ‘aseptic’ peritonitis in peritoneal dialysis patients.  相似文献   

15.

Background

The inevitable post-inflammatory fibrosis and adhesion often compromises future treatment in peritoneal dialysis patients. Here, we describe a patient who experienced an unusual form of peritoneal adhesion that made her give up peritoneal dialysis. However, its unique pattern also saved her from infection caused by bowel perforation.

Case presentation

The female patient discontinued peritoneal dialysis due to gradual dialysis inadequacy. Two months after shifting to hemodialysis with generally improved sense of well-being and no sign of abdominal illness, she was admitted to remove the Tenckhoff catheter. The procedure was smooth, but fever and abdominal pain not at the site of operation developed the next day. Abdominal ultrasound showed the presence of ascites and aspiration revealed slimy, green-yellowish pus that gave a negative result on bacterial culture. Abdominal computed tomography (CT) with oral contrast medium was performed, but failed to demonstrate the suspected bowel perforation. The examination, however, did show accumulation of pus inside the abdomen but outside the peritoneal cavity. We drained the pus with two 14-F Pig-tail catheters and the total amount of drainage approached 4000 ml. The second CT was performed with double dose of the contrast medium and found a leak of the contrast from the jejunum. She then received laparotomy and had the perforation site closed.

Conclusions

In summary, this uremic patient suffered from pus accumulation inside her abdomen without obvious systemic toxic effect. The bowel perforation and pus formation might be caused by repeated peritonitis, but the peritoneal adhesion itself might also isolate her peritoneal cavity from the anticipated toxic injuries of bowel perforation.  相似文献   

16.
Current concepts in the management of fungal peritonitis   总被引:1,自引:0,他引:1  
Fungal pathogens are uncommon isolates in the setting of peritonitis. Secondary peritonitis results from a breach in the gastrointestinal tract with gross contamination of the peritoneum. Peritonitis in patients undergoing peritoneal dialysis represents a unique form of secondary peritonitis often caused by nosocomial bacteria and fungi. Regardless of the clinical circumstances, most cases of fungal peritonitis are caused by Candida species, however, other yeasts and filamentous fungi have been uncommonly reported. Treatment of secondary peritonitis consists of appropriate surgical intervention and systemic antifungal therapy. Systemic antifungals such as amphotericin B or fluconazole are also essential for the treatment of fungal peritonitis in patients who are peritoneal dialysis dependent. Salvage of the peritoneal dialysis catheter may be attempted, however, removal is usually required to achieve cure. Prophylaxis with fluconazole in patients with recurrent gastrointestinal perforations or anastomotic leakages has reduced the incidence of Candida peritonitis. Benefit of nystatin for fungal peritonitis prophylaxis in peritoneal dialysis patients is questionable.  相似文献   

17.
While vascular calcification is an important factor regulating prognosis in dialysis patients, its components have not been adequately studied. We analyzed in vivo components of calcification in the coronary arteries of dialysis patients using the effective atomic number from dual‐energy computed tomography. In dialysis patients (hemodialysis, N = 10; peritoneal dialysis, N = 12), average of median effective atomic number was 13.8 in the hemodialysis group, and 13.7 in the peritoneal dialysis group. No significant differences were seen between groups, with calcium oxalate monohydrate identified as the most common component in each. To confirm the accuracy of this method, we investigated the composition of surgically removed calcified tissues using already established methods. Comparison with the effective atomic number from dual‐energy computed tomography showed that the results of calcification analysis were the same. We concluded that calcium oxalate monohydrate might be one of the major components of coronary artery calcification in dialysis patients.  相似文献   

18.
Shetty AK  Nagaraj SK  Lorentz WB  Bitzan M 《Infection》2005,33(5-6):390-392
Abstract Neisseria mucosa is part of the normal nasopharyngeal flora and rarely pathogenic in humans. Reports of serious infections associated with this pathogen are very unusual. A 17–year–old boy with end–stage renal disease due to IgA nephropathy presented with acute, spontaneous, symptomatic peritoneal dialysis–associated peritonitis without reported break in sterility or PD catheter exit site infection. β–lactamase–negative N. mucosa was isolated from the dialysate effluent. Intraperitoneal antibiotic treatment with cephalothin/gentamicin for 5 days and subsequent ceftriaxone led to complete resolution of the infection. This case demonstrates that "non–pathogenic" Neisseria species can cause clinically severe peritonitis with high intraperitoneal neutrophil counts, elevated C–reactive protein levels in the peritoneal effluent (in the presented case, 27,600/μl and 3.6 mg/l, respectively) and impaired peritoneal membrane transport function. To our knowledge, this is the first case of N. mucosa peritonitis complicating chronic peritoneal dialysis in an adolescent patient. This paper is dedicated to the founders of the Walter Marget Foundation, D. Adam and F. Daschner, in gratitude for their support of the training in infectious diseases.  相似文献   

19.
Chronic systemic inflammation, a non traditional risk factor of cardiovascular diseases, is associated with increasing mortality in chronic kidney disease, especially peritoneal dialysis patients. Periodontitis is a potential treatable source of systemic inflammation in peritoneal dialysis patients. Clinical periodontal status was evaluated in 32 stable chronic peritoneal dialysis patients by plaque index and periodontal disease index. Hematologic, blood chemical, nutritional, and dialysis‐related data as well as highly sensitive C‐reactive protein were analyzed before and after periodontal treatment. At baseline, high sensitive C‐reactive protein positively correlated with the clinical periodontal status (plaque index; r = 0.57, P < 0.01, periodontal disease index; r = 0.56, P < 0.01). After completion of periodontal therapy, clinical periodontal indexes were significantly lower and high sensitivity C‐reactive protein significantly decreased from 2.93 to 2.21 mg/L. Moreover, blood urea nitrogen increased from 47.33 to 51.8 mg/dL, reflecting nutritional status improvement. Erythropoietin dosage requirement decreased from 8000 to 6000 units/week while hemoglobin level was stable. Periodontitis is an important source of chronic systemic inflammation in peritoneal dialysis patients. Treatment of periodontal diseases can improve systemic inflammation, nutritional status and erythropoietin responsiveness in peritoneal dialysis patients.  相似文献   

20.
The COVID-19 pandemic exerted complex pressures on the nephrology community. Despite multiple prior reviews on acute peritoneal dialysis during the pandemic, the effects of COVID-19 on maintenance peritoneal dialysis patients remain underexamined. This review synthesizes and reports findings from 29 total cases of chronic peritoneal dialysis patients with COVID-19, encompassing 3 case reports, 13 case series, and 13 cohort studies. When available, data for patients with COVID-19 on maintenance hemodialysis are also discussed. Finally, we present a chronological timeline of evidence regarding the presence of SARS-CoV-2 in spent peritoneal dialysate and explore trends in telehealth as they relate to peritoneal dialysis patients during the pandemic. We conclude that the COVID-19 pandemic has underscored the efficacy, flexibility, and utility of peritoneal dialysis.  相似文献   

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