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Unusual causes of peritonitis in patients undergoing continuous peritoneal dialysis with emphasis on Listeria
N M Lunde1, J M Messana, R D Swartz
1Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0364.
Abstract:
Peritonitis remains a significant cause of morbidity in ESRD patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Staphylococcus species, Streptococcus species, and less commonly, gram-negative rods comprise the majority of isolated organisms. Other organisms, including unusual bacteria, fungi, and mycobacteria, comprise 5% or less of cases. Many of the uncommon causes of CAPD peritonitis have been reviewed, with special emphasis on antimicrobial therapy and whether catheter removal was required. The presumed third case of CAPD-associated peritonitis caused by Listeria monocytogenes is also described. In contrast to two other reported cases, our patient was not overtly immunosuppressed. L. monocytogenes infection should therefore be considered in CAPD patients with gram-positive rod peritonitis, even if immunocompetence is presumed.
Insights
Peritonitis is a common complication for patients with end-stage renal disease (ESRD) on continuous ambulatory peritoneal dialysis (CAPD). Listeria monocytogenes, a gram-positive rod, should be considered in CAPD peritonitis cases, even in immunocompetent patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Peritonitis is a major cause of morbidity in patients with end-stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Commonly isolated organisms include Staphylococcus, Streptococcus, and gram-negative rods.
- Unusual organisms like fungi, mycobacteria, and rare bacteria account for a small percentage of CAPD peritonitis cases.
Observation:
- This review focuses on uncommon causes of CAPD peritonitis, emphasizing antimicrobial therapy and the necessity of catheter removal.
- A presumed third case of CAPD-associated peritonitis caused by Listeria monocytogenes is presented.
- Unlike previously reported cases, the patient in this instance was not overtly immunosuppressed.
Findings:
- Listeria monocytogenes can cause peritonitis in CAPD patients.
- Gram-positive rod peritonitis in CAPD patients warrants consideration of L. monocytogenes.
- Infection by L. monocytogenes is possible even in presumed immunocompetent CAPD patients.
Implications:
- Clinicians should consider Listeria monocytogenes in the differential diagnosis of gram-positive rod peritonitis in CAPD patients.
- This finding expands the understanding of pathogens causing CAPD peritonitis, particularly in non-immunosuppressed individuals.
- Early and accurate identification of L. monocytogenes is crucial for appropriate antimicrobial therapy and patient management in CAPD-associated peritonitis.