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Fungal peritonitis in patients on continuous ambulatory peritoneal dialysis
Abstract:
Fungal peritonitis is a rare complication in patients on continuous ambulatory peritoneal dialysis. We report five recent cases and their management. The fungi isolated were Candida albicans, C. parapsilosis, Exophiala jeanselmei, Drechslera spicifera, and a Fusarium species. Chemotherapy was attempted with various regimens including oral ketoconazole, intravenous or intraperitoneal amphotericin B, and oral flucytosine. Pharmacokinetic studies were done in two patients receiving treatment with one of these drugs. Three patients were cured of their fungal infection. Three patients whose Tenckhoff catheters were left in situ died, whereas two patients whose catheters were removed survived. Our experience suggests that removal of the peritoneal catheter should be considered once the diagnosis of fungal peritonitis is established.
Insights
Fungal peritonitis is a rare complication in patients on continuous ambulatory peritoneal dialysis. Removing the peritoneal catheter is recommended for better outcomes in these challenging cases.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Nephrology
Background:
- Fungal peritonitis is an uncommon but serious complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Early diagnosis and appropriate management are crucial for patient survival and treatment success.
Observation:
- This study reports on five recent cases of fungal peritonitis in CAPD patients.
- The identified fungal species included Candida albicans, Candida parapsilosis, Exophiala jeanselmei, Drechslera spicifera, and a Fusarium species.
- Various antifungal chemotherapy regimens were employed, including oral ketoconazole, intravenous/intraperitoneal amphotericin B, and oral flucytosine.
Findings:
- Three out of five patients were successfully cured of their fungal infection.
- Patients who had their Tenckhoff catheters removed showed better survival rates compared to those whose catheters remained in situ.
- Pharmacokinetic studies were conducted in two patients to evaluate drug efficacy.
Implications:
- The findings suggest that the removal of the peritoneal dialysis catheter should be strongly considered upon establishing a diagnosis of fungal peritonitis.
- This approach may improve patient outcomes and reduce mortality associated with this rare complication.
- Further research into optimal antifungal strategies and the role of catheter management in fungal peritonitis is warranted.