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Current Concepts in the Management of Fungal Peritonitis
Michelle R. Salvaggio1, Peter G. Pappas
1*Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, THT 229, 1530 3rd Avenue South, Birmingham, AL 35294-0006, USA. bugdoc@uab.edu
Abstract:
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.
Insights
Fungal peritonitis is rare but serious, especially in peritoneal dialysis patients. Treatment requires antifungals and often catheter removal, though fluconazole prophylaxis may help prevent recurrence.
Area of Science:
- Infectious Diseases
- Nephrology
- Gastroenterology
Background:
- Fungal peritonitis is an uncommon complication, particularly in peritoneal dialysis (PD) patients.
- It often arises from gastrointestinal tract breaches, leading to peritoneal contamination.
- Candida species are the most frequent fungal culprits, though other fungi can be involved.
Purpose of the Study:
- To review the characteristics, treatment, and prevention of fungal peritonitis.
- To highlight the unique challenges in PD-associated fungal peritonitis.
- To evaluate prophylactic strategies for fungal peritonitis.
Main Methods:
- Literature review of fungal peritonitis cases.
- Analysis of treatment outcomes for systemic antifungal therapy.
- Evaluation of prophylactic measures in high-risk patients.
Main Results:
- Most fungal peritonitis cases are caused by Candida species.
- Effective treatment involves systemic antifungals (e.g., amphotericin B, fluconazole) and often PD catheter removal.
- Fluconazole prophylaxis has shown benefit in preventing recurrent fungal peritonitis in specific patient groups.
Conclusions:
- Fungal peritonitis necessitates prompt diagnosis and management with systemic antifungals.
- Peritoneal dialysis catheter salvage is challenging; removal is frequently required for cure.
- Prophylaxis with fluconazole can reduce incidence in high-risk patients, while nystatin's role is uncertain.