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

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.

Peritonitis Caused by Monilia sitophila in a Patient Undergoing Peritoneal Dialysis

1996 ◽  
Vol 19 (4) ◽  
pp. 218-220 ◽  
Author(s):  
A.E. Radix ◽  
V.M. Bieluch ◽  
C.W. Graeber
Keyword(s):  
Peritoneal Dialysis ◽  
Amphotericin B ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Fungal Peritonitis ◽  
Common Cause ◽  
Tenckhoff Catheter ◽  
First Case ◽  
Etiologic Agents ◽  
Oral Itraconazole

Fungi have become an increasingly important cause of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. The most common cause of fungal peritonitis is Candida. However, in recent years unusual and “nonpathogenic” fungi have been reported as etiologic agents of CAPD-associated peritonitis. We are reporting the first case of CAPD-associated peritonitis caused by Monilia sitophila. This organism had previously been considered to be non-pathogenic, and a troublesome laboratory contaminant. Our patient was successfully managed with intravenous and intraperitoneal amphotericin B, followed by oral itraconazole, without removal of her Tenckhoff catheter.

scholarly journals Histoplasma Peritonitis: An Extremely Rare Complication of Peritoneal Dialysis

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Asjad Sardar ◽  
Bijin Thajudeen ◽  
Pradeep V. Kadambi
Keyword(s):  
Peritoneal Dialysis ◽  
Histoplasma Capsulatum ◽  
Rare Complication ◽  
Altered Mental Status ◽  
Response To Treatment ◽  
Fungal Peritonitis ◽  
Bacterial Peritonitis ◽  
Peritoneal Dialysis Fluid ◽  
Stage Renal Disease ◽  
End Stage

Bacterial peritonitis is a common complication of peritoneal dialysis, but fungal peritonitis is unusual and is mostly due to Candida species. Peritonitis due to Histoplasma capsulatum is rare and we report one such case. A 63-year-old female presented with progressively worsening abdominal pain, fever, and altered mental status. She had end-stage renal disease and had been on peritoneal dialysis for 4 years. She had abdominal tenderness without rebound or guarding. Laboratory studies and CT of abdomen were significant for leukocytosis and peritoneal membrane thickening, respectively. Peritoneal dialysis fluid study was consistent with peritonitis and culture of the fluid grew Histoplasma capsulatum. Treatment recommendations include removal of catheter and initiation of antifungal therapy. With the availability of newer antifungals, medical management without removal of PD catheter is possible, but at the same time if there is no response to treatment within a week, PD catheter should be removed promptly.

Ketoconazole Pharmacokinetics in Continuous Ambulatory Peritoneal Dialysis

1984 ◽  
Vol 4 (4) ◽  
pp. 199-201 ◽  
Author(s):  
Nancy M. McGuire ◽  
Friedrich K. Port ◽  
Carol A. Kauffman
Keyword(s):  
Peritoneal Dialysis ◽  
Amphotericin B ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Peritoneal Fluid ◽  
Serum Levels ◽  
Oral Drug ◽  
Attractive Alternative ◽  
Pharmacokinetic Studies ◽  
Major Drawback ◽  
Fungal Peritonitis

Ketoconazole, a new oral drug, has minimal toxicity and a broad spectrum of antifungal activity. To determine its usefulness in fungal peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD), we carried out nine pharmacokinetic studies in five patients on CAPD. Serum levels of ketoconazole in CAPD patients were lower than in normal controls, and some patients did not appear to absorb the drug. We did not detect ketoconazole in the peritoneal fluid of any patient, even in the presence of peritoneal inflammation. One should not use this agent in the treatment of fungal peritonitis at daily doses of 400 mg or less because such a dose achieves only poor peritoneal fluid concentrations. Continuous ambulatory peritoneal dialysis (CAPD) has become an attractive alternative to hemodialysis for many patients with chronic renal failure. However, a major drawback with this technique is peritonitis (1). Although most of these infections are due to staphylococci (I), fungal peritonitis appears to be increasing as experience with CAPD grows (2,3). The treatment of such peritonitis is hampered by the poor penetration of amphotericin B into the peritoneal fluid (2), chemical peritonitis when amphotericin B is instilled directly into the cavity (3), and the limited spectrum of activity of flucytosine -a drug which readily penetrates into the peritoneal fluid (4). Ketoconazole is less toxic than amphotericin B and easier to administer and it has a much broader antifungal spectrum than flucytosine. The value of ketoconazole in fungal peritonitis remains to be established, and we have only limited data concerning its penetration into the peritonal cavity (2, 5). In this study we assessed the serum and peritoneal-fluid levels of ketoconazole in patients on CAPD.

Stability of Amphotericin B in CAPD Fluid

1990 ◽  
Vol 10 (4) ◽  
pp. 287-289 ◽  
Author(s):  
Robert Janknegt ◽  
Ans Paulissen ◽  
Piet M. Hooymans ◽  
Joseph J. H. M. Lohman ◽  
Walter A. J. J. Hermens
Keyword(s):  
Peritoneal Dialysis ◽  
Amphotericin B ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Chemical Compatibility ◽  
Fungal Peritonitis ◽  
Drug Of Choice ◽  
Physical And Chemical

Amphotericin B is the drug of choice in continuous ambulatory peritoneal dialysis (CAPD) associated fungal peritonitis and is usually administered intra peritoneally. The drug is stated to be incompatible with anions. All CAPD fluids contain chloride and lactate anions. Therefore, the physical and chemical compatibility of amphotericin B with dextrose 5%, Dianeal 1.36% CAPD fluid, and Dianeal 1.36% peritoneal effluent was studied at amphotericin B concentrations of 1, 2, and 5 mg/L. Amphotericin B was most stable in Dianeal CAPD fluid. The rate of degradation was concentration dependent in dextrose 5% and peritoneal effluent. The higher the concentration, the lower the rate of degradation. After an incubation of 6 h at 37°C, no significant decomposition was found at all concentrations studied in Dianeal CAPD fluid whereas 12–18% decomposition was found in effluent. No physical incompatibility with any solution was observed.

scholarly journals THE RISK FACTORS AND OUTCOME OF FUNGAL PERITONITIS IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS

2009 ◽  
Vol 27 (1) ◽  
pp. 59-61
Author(s):  
E Indhumathi ◽  
V Chandrasekaran ◽  
D Jagadeswaran ◽  
M Varadarajan ◽  
G Abraham ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Fungal Peritonitis

Rectal Stenosis Associated with Fungal Peritonitis: A Complication of Continuous Ambulatory Peritoneal Dialysis

Nephron ◽  
1989 ◽  
Vol 53 (3) ◽  
pp. 288-289 ◽  
Author(s):  
Masako Uchida ◽  
Takanobu Sakemi ◽  
Yoshiro Nagano ◽  
Masanobu Mizuguchi
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Rectal Stenosis ◽  
Fungal Peritonitis

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

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.

Treatment of Fungal Peritonitis with a Combination of Intravenous Amphotericin B and Oral Flucytosine, and Delayed Catheter Replacement in Continuous Ambulatory Peritoneal Dialysis

2008 ◽  
Vol 28 (2) ◽  
pp. 155-162 ◽  
Author(s):  
Ping-Nam Wong ◽  
Kin-Yee Lo ◽  
Gensy M.W. Tong ◽  
Shuk-Fan Chan ◽  
Man-Wai Lo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Amphotericin B ◽  
Clinical Course ◽  
Control Group ◽  
Study Group ◽  
Fungal Peritonitis ◽  
Antifungal Chemotherapy ◽  
Intravenous Amphotericin ◽  
Technique Failure ◽  
Catheter Replacement

Background Fungal peritonitis (FP) is associated with significant mortality and high risk of peritoneal failure. The optimum treatment for peritoneal dialysis (PD)-associated FP remains unclear. Since January 2000 we have been treating FP with a combination of intravenous amphotericin B and oral flucytosine, together with deferred catheter replacement. We examined the clinical course and outcome of the FP patients treated with this approach (study group). An outcome comparison was also made to an alternatively treated historic cohort (control group). Methods This was a single-center retrospective study. The clinical course and outcome of 13 consecutive episodes of FP occurring in 13 patients treated between January 2000 and April 2005 with the study approach were examined. The patients were treated with an incremental dose of intravenous amphotericin B to a target dose of 0.75 – 1 mg/kg body weight/day, and oral flucytosine 1 g/day upon a diagnosis of FP at 3.77 ± 0.93 days from presentation. Replacement of the peritoneal catheter was intended after complete clearing of effluent, after which, antifungal chemotherapy was continued for another 1 – 2 weeks. Their outcome was compared with 14 historic controls that were treated between April 1995 and December 1999. Results Mean age of the study group was 58.7 ± 13.2 years; male-to-female ratio was 2:11; 6 (46.1%) were diabetic. All FP were caused by Candida species ( C. albicans, 2; C. parapsilosis, 8; C. glabrata, 3). Two (15.4%) patients died before resolution of the peritonitis. The dialysate effluent cleared in 11 patients (84.6%) after 13.2 ± 3.3 days of treatment, but 2 patients died of acute myocardial infarction before catheter replacement. Nine patients had their catheters replaced at day 26.7 ± 7.7 of treatment; all 9 returned to PD after a total of 31 ± 12.2 days of antifungal chemotherapy. Reversible liver dysfunction was common with this regimen. When compared with the 14 cases in the historic control group ( Candida species, 13; Trichosporon, 1), who were treated with amphotericin B, fluconazole, or a combination of the two, and the majority (78.6%) of whose catheters were removed before day 10 of presentation, the study group appeared to have a lower technique failure rate (30.8% vs 78.6%, p = 0.013) and similar all-cause mortality (30.7% vs 28.5%, p = NS), FP-related mortality (15.4% vs 28.5%, p = NS), and length of hospitalization (48.5 ± 30.2 vs 57.0 ± 37.7 days, p = NS). However, a significantly earlier commencement of antifungal treatment in the study group (3.8 ± 0.9 vs 5.8 ± 2.4 days, p = 0.012) could be an important confounder of outcome. Conclusions Combination of intravenous amphotericin B and oral flucytosine with deferred catheter replacement appears to be associated with a relatively low incidence of PD technique failure, without affecting mortality in patients suffering from FP due to yeasts in this preliminary study. Nonetheless, drug-induced hepatic dysfunction was common; close monitoring during treatment is of paramount importance. The reasons accounting for the observed distinctive outcome remain unclear and further study is required to confirm the results and to investigate for the underlying mechanism.

Tuberculous and Fungal Peritonitis in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 263-266
Author(s):  
Lui Sing Leung ◽  
Chan Tak Mao ◽  
Lai Kar Neng ◽  
Wai Kei Lo
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Features ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Fungal Infections ◽  
Fungal Peritonitis ◽  
Diagnosis And Management

Tuberculous and fungal infections are two relatively uncommon but important causes of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The clinical features, diagnosis, and management of these two special forms of CAPD-related peritonitis are highlighted in this article.

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

2018 ◽  
Vol 38 (1) ◽  
pp. 69-73 ◽  
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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