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Fungal peritonitis in children on continuous ambulatory peritoneal dialysis
H Mocan1, A V Murphy, T J Beattie
1Department of Nephrology, Royal Hospital for Sick Children, Glasgow.
Abstract:
Between 1979 and 1985, six of 26 patients undergoing continuous ambulatory peritoneal dialysis developed fungal peritonitis. All had received antibacterial therapy with cefamandole and/or netilmicin prior to the diagnosis. The causal organisms were Candida albicans (three), Candida glabrata (one), Cryptococcus laurentii (one) and Saccharomyces cerevisiae (one). Treatment comprised catheter removal preceded by antifungal drugs (flucytosine and/or amphotericin B) in four patients and catheter removal alone in two. All patients were transferred to haemodialysis and five of the six developed extensive intra-abdominal adhesions. The most prudent management of fungal peritonitis in children would seem to be early cannula removal.
Insights
Fungal peritonitis in continuous ambulatory peritoneal dialysis patients can occur, especially after antibacterial therapy. Early removal of the dialysis catheter is crucial for managing this serious complication.
Area of Science:
- Nephrology
- Infectious Diseases
- Mycology
Background:
- Fungal peritonitis is a rare but serious complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Antibacterial therapy, particularly with certain agents, may precede the development of fungal peritonitis.
Purpose of the Study:
- To investigate the incidence, causative organisms, and management outcomes of fungal peritonitis in CAPD patients.
- To identify risk factors and recommend optimal treatment strategies for fungal peritonitis in this population.
Main Methods:
- Retrospective analysis of six CAPD patients diagnosed with fungal peritonitis between 1979 and 1985.
- Review of patient histories, including prior antibacterial and antifungal therapies.
- Evaluation of treatment modalities (catheter removal with or without antifungal drugs) and patient outcomes.
Main Results:
- Six out of 26 CAPD patients developed fungal peritonitis, often after cefamandole and/or netilmicin therapy.
- Commonly identified fungi included Candida albicans, Candida glabrata, Cryptococcus laurentii, and Saccharomyces cerevisiae.
- Five patients developed extensive intra-abdominal adhesions post-treatment, necessitating transfer to haemodialysis.
Conclusions:
- Early removal of the peritoneal dialysis catheter is the most prudent management strategy for fungal peritonitis.
- Fungal peritonitis in CAPD patients requires prompt diagnosis and intervention to prevent severe complications like adhesions.