Peritoneal dialysis-associated peritonitis from pauci-septated mold: Life-threatening but curable

Area of Science:

• Mycology
• Infectious Diseases
• Nephrology

Background:

• Peritonitis is a serious complication of peritoneal dialysis (PD).
• Fungal peritonitis, though rare, poses significant treatment challenges.
• Cunninghamella species are emerging fungal pathogens.

Purpose of the Study:

• To report two cases of PD-associated peritonitis caused by Cunninghamella species.
• To describe the clinical presentation, diagnosis, and management of these infections.
• To highlight successful treatment strategies for Cunninghamella peritonitis.

Main Methods:

• Case report of two patients with PD-associated peritonitis.
• Identification of Cunninghamella species using molecular phylogeny.
• Antifungal susceptibility testing of isolated pathogens.
• Clinical data collection on presentation, treatment, and outcomes.

Main Results:

• Both patients presented with classic peritonitis symptoms, fever, and septicemia.
• Cunninghamella bertholletiae and Cunninghamella guizhouensis were identified.
• Isolates showed susceptibility to amphotericin B but resistance to azoles and echinocandins.
• Successful treatment involved PD catheter removal and amphotericin B therapy.

Conclusions:

• Cunninghamella species can cause severe PD-associated peritonitis with septicemia.
• Early diagnosis and prompt management, including catheter removal and appropriate antifungal therapy, are crucial for favorable outcomes.
• Amphotericin B appears to be an effective treatment option for Cunninghamella peritonitis.