Related Experiment Videos
Fungal peritonitis in patients on continuous ambulatory peritoneal dialysis
1Department of Nephrology, University Medical Centre, Ljubljana, Slovenia.
Abstract:
The purpose of this study was to analyze the microbiological and clinical features of fungal peritonitis in patients with endstage renal failure treated with continuous ambulatory peritoneal dialysis (CAPD). The diagnosis of peritonitis was based on abdominal discomfort or pain, cloudy peritoneal effluent with an elevated leukocyte count and isolation of fungi from the peritoneal effluent. Amphotericin B, flucytosine, ketoconazole, miconazole and more recently fluconazole were used for antifungal therapy. From 1983 to 1997 13 patients experienced 14 episodes of fungal peritonitis, comprising 3.1% of all episodes of peritonitis in the dialysis centre. Isolates from the peritoneal effluent comprised Candida tropicalis in two cases, Candida parapsilosis in two cases, Candida albicans in one case, Candida lusitaniae in one case,Cephalosporium spp. in three cases, Aspergillus fumigatus in two cases, and an Aspergillus sp., a Trichoderma sp. and a yeast in one case each. In eight cases bacterial infection shortly before the episode of fungal peritonitis was documented. In 12 (86%) cases the peritoneal catheter had to be removed. Four patients died during the treatment, and one patient died 2 months after the end of treatment due to intra-abdominal bleeding from peritoneal adhesions. Only two patients continued CAPD later; the other patients were switched to hemodialysis. It is concluded that fungal peritonitis is a rare but serious complication in CAPD patients with high rates of morbidity, mortality and drop-out from the CAPD programme (85%). The most frequent isolates were Candida spp. A predisposing factor for fungal peritonitis could be a recent bacterial infection treated with antibiotics. Early peritoneal catheter removal is recommended.
Insights
Fungal peritonitis is a rare but serious complication in patients on continuous ambulatory peritoneal dialysis (CAPD), often linked to prior bacterial infections. High rates of morbidity, mortality, and program dropout necessitate early catheter removal.
Area of Science:
- Nephrology
- Infectious Diseases
- Mycology
Background:
- Fungal peritonitis is a rare complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Understanding its microbiological and clinical spectrum is crucial for managing end-stage renal failure patients on CAPD.
Purpose of the Study:
- To analyze the microbiological and clinical features of fungal peritonitis in end-stage renal failure patients on CAPD.
- To identify risk factors and outcomes associated with fungal peritonitis in this population.
Main Methods:
- Retrospective analysis of 14 episodes of fungal peritonitis in 13 CAPD patients from 1983 to 1997.
- Diagnosis based on clinical signs, elevated leukocyte count in peritoneal effluent, and fungal isolation.
- Antifungal therapies included Amphotericin B, flucytosine, ketoconazole, miconazole, and fluconazole.
Main Results:
- Fungal peritonitis accounted for 3.1% of all peritonitis episodes.
- Common isolates included Candida spp. (tropicalis, parapsilosis, albicans, lusitaniae), Cephalosporium spp., and Aspergillus spp.
- Recent bacterial infection preceded fungal peritonitis in 8 cases; 86% required catheter removal.
- Mortality was 31% during treatment, with 85% overall dropout from CAPD.
Conclusions:
- Fungal peritonitis is a severe complication in CAPD patients, characterized by high morbidity, mortality, and CAPD program abandonment.
- Candida species are the most frequent fungal isolates.
- Recent bacterial infections treated with antibiotics may predispose patients to fungal peritonitis, underscoring the need for early catheter removal.