Fungal peritonitis caused by Bipolaris spicifera

Area of Science:

• Mycology
• Nephrology
• Infectious Diseases

Background:

• Fungal peritonitis is a serious complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
• Bipolaris species are uncommon causes of fungal peritonitis in CAPD patients.
• This case highlights a rare instance of fungal peritonitis caused by Bipolaris spicifera in a pediatric patient with chronic renal failure.

Purpose of the Study:

• To report a case of fungal peritonitis caused by Bipolaris spicifera in a pediatric CAPD patient.
• To describe the diagnostic challenges and successful management of this rare fungal infection.
• To emphasize the importance of considering fungal etiologies in refractory peritonitis.

Main Methods:

• A 3-year-old girl with chronic renal failure on CAPD developed peritonitis.
• Initial dialysate analysis for bacteria and fungi was negative.
• Diagnosis was confirmed by fungal culture from dialysate and Tenckhoff catheter, identifying Bipolaris spicifera.
• Treatment involved catheter removal and oral fluconazole.

Main Results:

• Microscopic examination of dialysate was negative for fungal elements.
• Bipolaris spicifera was isolated from dialysate cultures and identified as a colony on the catheter.
• Successful treatment with catheter removal and fluconazole led to resolution of peritonitis.
• The patient tolerated a new catheter and continued CAPD without recurrence.

Conclusions:

• Bipolaris spicifera can cause fungal peritonitis in pediatric CAPD patients.
• Early diagnosis and management, including catheter removal and antifungal therapy, are crucial for successful outcomes.
• This case underscores the need for comprehensive microbiological evaluation in CAPD-related peritonitis, even with initial negative results.