[Fungal peritonitis in ambulatory continuous peritoneal dialysis: description of 10 cases]

Fungal peritonitis is a rare but serious complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

During a ten-year period (1999-2008), from a total of 175 patients with chronic renal failure undergoing CAPD, we retrospectively studied 10 cases of fungal peritonitis analyzing the predisposing factors, clinical aspects, etiological agents and treatment. Diagnosis was based on elevated CAPD effluent count (>100/microl) and isolation of fungi on culture.

Fungal peritonitis represented 3.6% of all peritonitis episodes. Nine patients had a history of previous bacterial peritonitis and all of them were under antibiotic therapy. Other common findings were: age higher than 70 years old (50%) and diabetes mellitus (40%). Direct microscopic examination of the peritoneal fluid was useful for the suspicion of fungal infection in six patients (60%). The responsible agents for peritonitis were: Candida parapsilosis (4), Candida albicans (2), Candida tropicales (1), Candida glabrata (1), Candida famata (1) and Fusarium oxysporum (1). Intraperitoneal and oral fluconazole, intravenous and oral voriconazole and intravenous amphotericin B were the antifungal agents used in the treatment. As a result of fungal infection, eight patients were transferred to hemodialysis. One patient died before the diagnosis and three other during the episode of peritonitis.

Patients with previous bacterial peritonitis and antibiotic treatment were at greater risk of developing fungal peritonitis. Candida parapsilosis was the most common pathogen. For the successful management of fungal peritonitis besides the antifungal therapy, peritoneal catheter removal was necessary in 60% of patients.