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Peritonitis Caused by Various Species of Diaporthe in Peritoneal Dialysis Patients: A Plant Pathogen to Human
Guttiga Halue1, Rutchanee Chieochanthanakij2, Thanapat Kittipanyaworakun3
1Department of Medicine, Phayao Hospital, Phayao, THA.
Abstract:
Peritonitis caused by dematiaceous molds is uncommon but poses a significant threat to patients undergoing peritoneal dialysis (PD), leading to high mortality and morbidity. This report highlights three cases of peritonitis caused by three distinct species of Diaporthe (D. amygdali, D. eucalyptorum, and D. phaseolorum), initially unidentified through conventional culture methods. The nucleotide sequences of internal transcribed spacer regions (ITS), 18S nuclear ribosomal small subunit (SSU), and 28S nuclear ribosomal large subunit (LSU) of the ribosomal DNA gene correctly identified the isolates. Despite early catheter removal and administration of appropriate antifungal medications, all patients experienced fatal outcomes. DNA barcoding emerges as a valuable tool for accurately diagnosing species within the genus of pathogenic microbes, aiding in identifying the root causes of infections. It emphasizes the importance of strict adherence to aseptic techniques during PD exchanges to prevent peritonitis caused by plant-borne pathogens.
Insights
Dematiaceous mold peritonitis in peritoneal dialysis (PD) patients is rare but deadly. DNA barcoding identified three fatal cases caused by distinct *Diaporthe* species, highlighting the need for aseptic techniques.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Molecular Diagnostics
Background:
- Peritonitis from dematiaceous molds is a rare but severe complication in peritoneal dialysis (PD) patients.
- These infections are associated with high mortality and morbidity.
- Conventional culture methods often fail to identify causative agents accurately.
Observation:
- This report details three cases of peritonitis caused by distinct *Diaporthe* species (*D. amygdali*, *D. eucalyptorum*, *D. phaseolorum*).
- Initial identification attempts using conventional methods were unsuccessful.
- Molecular identification using DNA sequencing of ribosomal DNA gene regions (ITS, SSU, LSU) accurately identified the isolates.
Findings:
- All three patients experienced fatal outcomes despite prompt catheter removal and antifungal treatment.
- DNA barcoding proved essential for accurate species-level identification of the pathogenic *Diaporthe* isolates.
- The study underscores the limitations of traditional methods in diagnosing rare fungal peritonitis.
Implications:
- DNA barcoding is a critical tool for precise identification of pathogenic microbes and understanding infection origins.
- Strict adherence to aseptic techniques during PD exchanges is crucial to prevent peritonitis from plant-borne pathogens.
- This highlights a potential emerging threat of plant-associated fungi causing severe human infections.
