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Melioidosis and peritoneal dialysis related peritonitis

K W Wong1

  • 1Hospital Queen Elizabeth, Medical, Karung Berkunci 2029, Kota Kinabalu, Sabah 88586, Malaysia. drwongkohwei@gmail.com.

The Medical Journal of Malaysia
|May 1, 2013
PubMed

Insights

Melioidosis can cause peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Early identification and appropriate antibiotic treatment are crucial for successful management and catheter preservation.

Area of Science:

  • Infectious Diseases
  • Nephrology
  • Microbiology

Background:

  • Continuous ambulatory peritoneal dialysis (CAPD) is a common treatment for end-stage renal disease.
  • Peritonitis is a serious complication of CAPD, requiring prompt diagnosis and treatment.
  • Melioidosis, caused by Burkholderia pseudomallei, is an infectious disease endemic in certain tropical regions.

Observation:

  • A 47-year-old male CAPD patient presented with symptoms of peritonitis.
  • The patient, a lorry driver, performed dialysis exchanges in his vehicle.
  • Initial antibiotic treatment was ineffective, necessitating a change in regimen.

Findings:

  • Dialysate culture identified Burkholderia pseudomallei as the causative agent of peritonitis.
  • The patient was successfully treated with a combination of intraperitoneal meropenem and intravenous ceftazidime.
  • The Tenckhoff catheter was preserved, and the patient completed a six-month oral antibiotic course.

Implications:

  • This case highlights the importance of considering melioidosis in CAPD peritonitis, especially in patients with relevant exposure history.
  • Aggressive antibiotic therapy can lead to successful treatment outcomes without catheter removal.
  • Environmental factors, such as performing dialysis in a lorry, may play a role in pathogen exposure.

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