An Unusual Cause of Massive Intraperitoneal Bleeding in CAPD

A 73-year-old man, who had been on CAPD for two years, presented with massive intraperitoneal hemorrhage. On laparotomy the peritoneal catheter was situated in a large pouch that was lined by fibrous tissue. The hemorrhage arose from erosion of the pouch wall -an unusual cause of intraperitoneal bleeding in the CAPD patient. Massive intraperitoneal bleeding is a rare complication of continuous ambulatory peritoneal dialysis (CAPD). Mild to moderate bleeding, which is more common in CAPD, usually is related to disintegration of small blood vessels. In most patients the bleeding is self-limited. This paper describes an unusual cause of massive bleeding in a CAPD patient.

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Scanning Electron Microscopy of Staphylococcus Epidermidis Adherence to Continuous Ambulatory Peritoneal Dialysis Catheters

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100119429 ◽

1985 ◽

Vol 43 ◽

pp. 520-521

Author(s):

William J. Lamoreaux ◽

David L. Smalley ◽

Larry M. Baddour ◽

Alfred P. Kraus

Keyword(s):

Electron Microscopy ◽

Scanning Electron Microscopy ◽

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Staphylococcus Epidermidis ◽

Sterile Saline ◽

Intravascular Devices ◽

Capd Patient ◽

Scanning Electron

Infections associated with the use of intravascular devices have been documented and have been reported to be related to duration of catheter usage. Recently, Eaton et al. reported that Staphylococcus epidermidis may attach to silastic catheters used in continuous ambulatory peritoneal dialysis (CAPD) treatment. The following study presents findings using scanning electron microscopy (SEM) of S. epidermidis adherence to silastic catheters in an in vitro model. In addition, sections of polyvinyl chloride (PVC) dialysis bags were also evaluated by SEM.The S. epidermidis strain RP62A which had been obtained in a previous outbreak of coagulase-negative staphylococcal sepsis at local hospitals was used in these experiments. The strain produced surface slime on exposure to glucose, whereas a nonadherent variant RP62A-NA, which was also used in these studies, failed to produce slime. Strains were grown overnight on blood agar plates at 37°C, harvested from the surface and resuspended in sterile saline (0.85%), centrifuged (3,000 rpm for 10 minutes) and then washed twice in 0.1 M phosphate-buffered saline at pH 7.0. Organisms were resuspended at a concentration of ca. 106 CFU/ml in: a) sterile unused dianeal at 4.25% dextrose, b) sterile unused dianeal at 1.5% dextrose, c) sterile used dialysate previously containing 4.25% dextrose taken from a CAPD patient, and d) sterile used dialysate previously containing 1.5% dextrose taken from a CAPD patient.

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New Strategy following Peritoneal Catheter Implantation in Continuous Ambulatory Peritoneal Dialysis

Ambulatory Peritoneal Dialysis ◽

10.1007/978-1-4615-9555-7_73 ◽

1990 ◽

pp. 280-282

Author(s):

L. De Clerck ◽

P. Ruedin ◽

H. Favre

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Peritoneal Catheter ◽

New Strategy ◽

Catheter Implantation

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CAPD Catheter Exit-Site and Tunnel Infection with Fungal Etiology—Treatment and Catheter Reinsertion for an Extremely Rare Complication

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00031 ◽

2017 ◽

Vol 37 (2) ◽

pp. 237-239

Author(s):

Manmeet Singh Jhawar ◽

Jasmin Das ◽

Pratish George ◽

Anil Luther

Keyword(s):

Candida Albicans ◽

Peritoneal Dialysis ◽

Case Report ◽

Fungal Infection ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Rare Complication ◽

Exit Site ◽

Duration Of Therapy ◽

Tunnel Infection ◽

Few Data

Fungal infection is an extremely rare etiology of exit-site and tunnel infection in patients on continuous ambulatory peritoneal dialysis (CAPD). There are few data available regarding its management—especially choice of antifungals, duration of therapy, and removal of catheter. There are no guidelines pertaining to reinsertion of the CAPD catheter following fungal exit-site and tunnel infection. This case report highlights Candida albicans as a rare cause of exit-site and tunnel infection of the CAPD catheter. The catheter was removed and the patient received appropriate antifungal therapy followed by reinsertion of the CAPD catheter and re-initiation on CAPD.

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Continuous ambulatory peritoneal dialysis-associated Histoplasma capsulatum peritonitis: a case report and literature review

BMC Infectious Diseases ◽

10.1186/s12879-020-05441-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Thanat Ounsinman ◽

Piriyaporn Chongtrakool ◽

Nasikarn Angkasekwinai

Keyword(s):

Peritoneal Dialysis ◽

Amphotericin B ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Histoplasma Capsulatum ◽

Rare Complication ◽

Clinical Specimen ◽

Rare Condition ◽

High Morbidity ◽

High Grade Fever ◽

Fungal Peritonitis

Abstract Background Fungal peritonitis (FP) is a rare complication of peritoneal dialysis. We herein describe the second case in Asia of Histoplasma capsulatum peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). Case presentation An 85-year-old woman with end-stage renal disease (ESRD) who had been on CAPD for 3 years and who had a history of 3 prior episodes of peritonitis presented with intermittent abdominal pain for 2 weeks and high-grade fever for 3 days. Elevated white blood cell (WBC) count and rare small oval budding yeasts were found in her peritoneal dialysis (PD) fluid. From this fluid, a white mold colony was observed macroscopically after 7 days of incubation, and numerous large, round with rough-walled tuberculate macroconidia along with small smooth-walled microconidia were observed microscopically upon tease slide preparation, which is consistent with H. capsulatum. The peritoneal dialysis (PD) catheter was then removed, and it also grew H. capsulatum after 20 days of incubation. The patient was switched from CAPD to hemodialysis. The patient was successfully treated with intravenous amphotericin B deoxycholate (AmBD) for 2 weeks, followed by oral itraconazole for 6 months with satisfactory result. The patient remains on hemodialysis and continues to be clinically stable. Conclusion H. capsulatum peritonitis is an extremely rare condition that is associated with high morbidity and mortality. Demonstration of small yeasts upon staining of PD fluid, and isolation of slow growing mold in the culture of clinical specimen should provide important clues for diagnosis of H. capsulatum peritonitis. Prompt removal of the PD catheter and empirical treatment with amphotericin B or itraconazole is recommended until the culture results are known.

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Fungal Peritonitis Caused by Rhodotorula mucilaginosa in a CAPD Patient Treated with Liposomal Amphotericin B: A Case Report and Literature Review

Peritoneal Dialysis International ◽

10.3747/pdi.2017.00096 ◽

2018 ◽

Vol 38 (1) ◽

pp. 69-73 ◽

Cited By ~ 4

Author(s):

Frederic Franconieri ◽

Julie Bonhomme ◽

Aline Doriot ◽

Cecile Bonnamy ◽

Maxence Ficheux ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Amphotericin B ◽

Liposomal Amphotericin ◽

Inhibitory Concentration ◽

Liposomal Amphotericin B ◽

Rhodotorula Mucilaginosa ◽

Peritoneal Catheter ◽

Fungal Peritonitis ◽

Capd Patient

Rhodotorula mucilaginosa is a ubiquitous yeast that may cause serious peritoneal dialysis (PD) infections. A 70-year-old man receiving continuous ambulatory peritoneal dialysis (CAPD) for 6 months presented with a PD infection caused by Rhodotorula mucilaginosa. The patient was treated with intravenous liposomal amphotericin B. His peritoneal catheter was simultaneously removed and reinserted. To date, only 10 cases of Rhodotorula CAPD infections have been reported. Catheters, corticoids, cancer, and previous antibiotic therapy were the main risk factors for these infections. For most patients, the peritoneal catheter was removed, leading to a definitive transfer to hemodialysis. Along with flucytosine, amphotericin B is the main antifungal that is used. Both have a lower minimal inhibitory concentration (MIC), whereas fluconazole and caspofungin have the highest MICs. We highlighted the efficacy of liposomal amphotericin B associated with simultaneous withdrawal and reinsertion of a peritoneal catheter in a case of Rhodotorula peritonitis in a CAPD patient. Further studies are needed to evaluate the treatment of this condition.

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Splenic Abscess and Peritonitis in a Continuous Ambulatory Peritoneal Dialysis (CAPD) Patient

Peritoneal Dialysis International ◽

10.1177/089686088900900115 ◽

1989 ◽

Vol 9 (1) ◽

pp. 73-74 ◽

Cited By ~ 5

Author(s):

Peter Blake ◽

Georgi Abraham ◽

Joanne Bargman ◽

Stephen Vas ◽

Raymond Mathews ◽

...

Keyword(s):

Myocardial Infarction ◽

Renal Failure ◽

Peritoneal Dialysis ◽

Antibiotic Treatment ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Splenic Abscess ◽

Endstage Renal Failure ◽

Autopsy Findings ◽

Acute Peritonitis ◽

Capd Patient

A 26-year-old female was on continuous ambulatory peritoneal dialysis (CAPD) because of diabetic endstage renal failure. She developed an acute peritonitis that relapsed repeatedly despite appropriate antibiotic treatment. Investigations showed the presence of a splenic abscess, and splenectomy and peritoneal cannula removal were required. The patient died of myocardial infarction two weeks postoperatively. This is the first recorded case of peritonitis secondary to splenic abscess in a CAPD patient. Autopsy findings suggest that the abscess developed from infection of a splenic infarct.

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Peritonitis-Related Deaths in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients

Peritoneal Dialysis International ◽

10.1177/089686089001000112 ◽

1990 ◽

Vol 10 (1) ◽

pp. 45-47 ◽

Cited By ~ 37

Author(s):

George E. Digenis ◽

Georgi Abraham ◽

Eugene Savin ◽

Peter Blake ◽

Nicholas Dombros ◽

...

Keyword(s):

Cardiovascular Disease ◽

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Serum Proteins ◽

Total Serum ◽

Contributing Factors ◽

Peritoneal Catheter ◽

Staph Aureus ◽

Artery Disease ◽

Present On Admission

A total of 636 episodes of peritonitis occurred in 440 patients who entered our continuous ambulatory peritoneal dialysis (CAPD) program from September 1977 to February 1988. Sixteen patients (8 male and 8 female, aged 37–77 years) died during an episode of peritonitis (fatality rate 2.5%). They had been on CAPD for 3 to 105 (average 39) months. Six of them were diabetics. The peritonitis rate among these 16 patients were 1 episode per 12 patient months, while the corresponding figure for the whole (440) CAPD population was 14 patient months. Risk factors present in the 16 patients were: cardiovascular disease (12), cerebrovascular accident (2) peripheral artery disease (1) and pulmonary fibrosis (1). Fever and leukocytosis were present on admission in 11 patients, while total serum proteins and albumin were significantly lower (p < 0.001) than the corresponding values before peritonitis (56 ± 8 vs. 65 ± 5). Staph. aureus was isolated in 8 patients (50%), multiple organisms in 6, Pseudomonas and Candida albicans in 1 each. An abdominal abscess was found in 4 (25%) patients. The peritoneal catheter was removed between the 5th and 10th day in 6 and after the 10th day in 7 patients. Peritonitis with sepsis was the cause of death in 13 patients. Contributing factors were cardiovascular accident in 9, uremic coma in 2, extensive GI bleeding in 2, GI performation in 2, intestinal infarction in 1, and pneumonia in 2 patients. We conclude that the risk of peritonitis-related death in CAPD patients is increased with Staph. aureus or multibacterial peritonitis. Contributing factors are concomitant cardiovascular disease and delayed (>5 days) catheter removal.

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