Candida peritonitis in children on continuous ambulatory peritoneal dialysis

The management, complications and outcome of two small children who developed Candida albicans peritonitis are reported. Both children developed peritonitis while on continuous ambulatory peritoneal dialysis (CAPD) but their fungal infections were treated differently. In one patient, Amphotericin B (1-4 micrograms/ml) was added to the dialysate; infection resolved but an extensive fibrous reaction developed in the peritoneal cavity making subsequent CAPD ineffective. The second patient was treated with a recently introduced oral antifungal agent, Ketoconazole; her catheter was removed. This patient recovered without any identifiable side effects of the drug. This report discusses the clinical course of two different approaches to Candida peritonitis and suggests certain recommendations regarding the treatment of this uncommon, but potentially lethal complication of CAPD.