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Paecilomyces variotii peritonitis in an infant on automated peritoneal dialysis
S Rinaldi1, E Fiscarelli, G Rizzoni
1Division of Nephrology and Dialysis, Bambino Gesù Children Research Hospital, Rome, Italy. rinaldi@opbg.net
Abstract:
Fungal peritonitis is a serious complication of chronic peritoneal dialysis (CPD) and is frequently associated with CPD drop-out. Paecilomyces variotii, a common saprophytic fungus, rarely causes human infection. To date, only nine adult or adolescent patients with P. variotii peritonitis during continuous ambulatory peritoneal dialysis have been reported. In all patients, successful treatment required antifungal therapy and removal of the peritoneal catheter. We report the first case of P. variotii peritonitis in an infant on automated peritoneal dialysis successfully treated with combined intraperitoneal and oral fluconazole, without removal of the peritoneal catheter.
Insights
Fungal peritonitis in infants undergoing peritoneal dialysis is rare. This study details a successful fluconazole treatment for Paecilomyces variotii peritonitis in an infant, avoiding catheter removal.
Area of Science:
- Mycology
- Nephrology
- Pediatric Infectious Diseases
Background:
- Fungal peritonitis is a severe complication of chronic peritoneal dialysis (CPD), often leading to treatment cessation.
- Paecilomyces variotii, a fungus typically found in soil and decaying matter, rarely causes human infections, with limited cases reported in adult CPD patients.
Observation:
- This report presents the first documented case of Paecilomyces variotii peritonitis in an infant undergoing automated peritoneal dialysis (APD).
- Previous successful treatments in adults necessitated both antifungal therapy and peritoneal catheter removal.
Findings:
- The infant patient received a combination of intraperitoneal and oral fluconazole for treatment.
- Successful treatment was achieved without the need for peritoneal catheter removal, a significant departure from previous management strategies.
Implications:
- This case suggests that conservative management, including antifungal therapy without catheter removal, may be a viable option for treating Paecilomyces variotii peritonitis in infants on APD.
- Further research is warranted to establish optimal treatment protocols for this rare but serious complication in pediatric patients undergoing peritoneal dialysis.