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[Peritonitis in the course of peritoneal dialisis caused by Haemophilus influenzae with BLNAR phenotype]

Monika Miklaszewska1, Joanna Klepacka, Dorota Drozdz

  • 1Dialysis Unit, Children's University Hospital of Cracow, Poland.

Polski Merkuriusz Lekarski : Organ Polskiego Towarzystwa Lekarskiego
|July 8, 2009
PubMed

Insights

This case report details a rare instance of peritonitis in a patient undergoing peritoneal dialysis, caused by non-typeable Haemophilus influenzae (NTHi). The study highlights the importance of considering NTHi as a cause of peritonitis, especially in immunocompromised patients.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Microbiology

Background:

  • Peritonitis is a common complication of peritoneal dialysis (PD), typically caused by Staphylococcus species or streptococci.
  • Haemophilus influenzae is an uncommon cause of peritonitis in PD patients.

Observation:

  • A rare case of peritonitis in an 18-year-old male on automated peritoneal dialysis (APD) for Systemic Lupus Erythematosus (SLE) is presented.
  • The peritonitis was caused by non-typeable Haemophilus influenzae (NTHi) with a beta-lactamase negative, ampicillin-resistant (BLNAR) phenotype, isolated from both peritoneal fluid and a nasal swab.
  • The patient successfully responded to oral ciprofloxacin treatment.

Findings:

  • This is the first reported case of APD-associated peritonitis caused by NTHi with the BLNAR phenotype.
  • The findings suggest a probable respiratory origin of the infection due to the indistinguishable isolates from peritoneal fluid and nasal swabs.
  • The study underscores the need to consider Haemophilus species as potential causative agents of PD-associated peritonitis, particularly in immunosuppressed patients with upper respiratory tract carriage.

Implications:

  • This case highlights the importance of identifying specific antibiotic sensitivities for NTHi strains, especially the BLNAR phenotype, for effective treatment of peritonitis.
  • The findings suggest that H. influenzae should be considered in the differential diagnosis of peritonitis in PD patients, especially those who are immunosuppressed or carriers.
  • Specialized in vitro culture conditions may be required for the identification and susceptibility testing of H. influenzae.

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