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PD-related peritonitis from Psathyrella candolleana caused by poor PD catheter belt hygiene
Win Kulvichit1, Piyaporn Towangnang2, Phatcharida Klinphayom1
1Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Abstract:
Peritoneal dialysis (PD)-associated fungal peritonitis, although rare, presents significant challenges in diagnosis and management. Here, we present the first case of PD-related peritonitis attributed to Psathyrella candolleana and highlight a potential route of infection through contamination from the PD catheter belt. A 37-year-old female, with a history of heart and lung transplantation and undergoing continuous ambulatory PD, presented with acute abdominal pain and cloudy PD effluent (PDE). Genetic analysis of PDE and PD catheter tip confirmed diagnosis of P. candolleana. Treatment was successful without any relapses with timely PD catheter removal and an extended course of antifungal therapy. The root cause analysis suspected the dirt-stained PD catheter belt as the origin of contamination. In conclusion, this is the first case of P. candolleana infection in PD-related peritonitis. Preventive strategies should prioritize hygiene practices, including the PD belt to mitigate the risk of contamination and subsequent infections of such pathogens.
Insights
This study reports the first case of fungal peritonitis caused by Psathyrella candolleana in a peritoneal dialysis patient. Contamination from the dialysis catheter belt was identified as a likely infection source, emphasizing hygiene improvements.
Area of Science:
- Nephrology
- Mycology
- Infectious Diseases
Background:
- Peritoneal dialysis (PD)-associated fungal peritonitis is a rare but serious complication.
- Psathyrella candolleana is an uncommon pathogen in clinical settings, particularly in PD-related infections.
Purpose of the Study:
- To report the first case of PD-related peritonitis caused by Psathyrella candolleana.
- To identify a potential route of infection and emphasize preventive measures.
Main Methods:
- Case presentation of a 37-year-old female on continuous ambulatory PD.
- Diagnosis confirmed by genetic analysis of peritoneal dialysis effluent and PD catheter tip.
- Root cause analysis to identify the source of contamination.
Main Results:
- Successful treatment of Psathyrella candolleana peritonitis with PD catheter removal and antifungal therapy.
- Identified the PD catheter belt as a suspected source of fungal contamination.
- No relapse of infection observed post-treatment.
Conclusions:
- This is the first documented case of PD-related peritonitis due to Psathyrella candolleana.
- Contamination via the PD catheter belt is a plausible infection route.
- Enhanced hygiene practices, including PD belt cleanliness, are crucial for preventing fungal peritonitis in PD patients.
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