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A Case of Relapsing Peritoneal Dialysis-Associated Peritonitis by Dokdonella koreensis
Jamie Bee Xian Tan1, Alvin Ren Kwang Tng2, Htay Htay2
1Department of Microbiology, Singapore General Hospital, Outram Road, Singapore 169608.
Abstract:
Peritonitis is a common and serious complication of peritoneal dialysis (PD) with significant morbidity. We report the first case of relapsing Dokdonella koreensis peritonitis in a patient on peritoneal dialysis. A 63-year-old Chinese man, with history of renal failure on continuous ambulatory peritoneal dialysis, presented with cloudy peritoneal effluent and abdominal pain. There was no sign or symptom suggestive of exit-site/tunnel tract infection. Peritoneal effluent cultures yielded Dokdonella koreensis which was initially misidentified as Weeksella virosa and Brevundimonas species by the API® 20 NE and VITEK® 2 GN ID card, respectively. He was treated with intraperitoneal amikacin, but the infection relapsed within a few days upon completing each antibiotic course. He eventually required removal of catheter and was transferred to hemodialysis. Infections due to unusual organisms may pose a diagnostic issue as currently available commercial tests will not be able to identify them. There is a role for using 16S rRNA sequencing to help identify these organisms and guide patient management.
Insights
Relapsing peritonitis caused by Dokdonella koreensis occurred in a peritoneal dialysis patient. This rare infection highlights challenges in identifying unusual bacteria, necessitating advanced techniques like 16S rRNA sequencing for accurate diagnosis and management.
Area of Science:
- Infectious Diseases
- Nephrology
- Microbiology
Background:
- Peritonitis is a serious complication of peritoneal dialysis (PD), leading to significant patient morbidity.
- Accurate identification of causative pathogens is crucial for effective treatment of PD-related peritonitis.
Observation:
- A 63-year-old male on continuous ambulatory peritoneal dialysis presented with symptoms of peritonitis.
- Peritoneal effluent cultures isolated Dokdonella koreensis, initially misidentified by standard commercial assays.
- The patient experienced recurrent peritonitis despite intraperitoneal amikacin treatment, ultimately requiring catheter removal.
Findings:
- This case represents the first reported instance of relapsing Dokdonella koreensis peritonitis in a PD patient.
- Standard diagnostic methods (API® 20 NE, VITEK® 2 GN) failed to correctly identify Dokdonella koreensis.
- 16S rRNA sequencing proved valuable in identifying the unusual pathogen and guiding clinical management.
Implications:
- Unusual bacterial pathogens can pose diagnostic challenges in clinical microbiology laboratories.
- Advanced molecular techniques, such as 16S rRNA sequencing, are essential for identifying novel or difficult-to-identify organisms.
- Improved diagnostic strategies are needed to effectively manage rare infectious complications in peritoneal dialysis patients.
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