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Rhodotorula rubra peritonitis in patients undergoing continuous ambulatory peritoneal dialysis
Abstract:
Although still uncommon, fungal peritonitis is being reported with increasing frequency in patients with renal failure who are undergoing long-term peritoneal dialysis. Although most cases have involved Candida albicans, other opportunistic pathogens have been reported as well. Recently, three patients were seen with serious peritoneal infections due to Rhodotorula rubra, a "nonpathogenic" fungus. In two patients, peritoneal fibrosis made further peritoneal dialysis impossible. The third patient died from complications of peritonitis. Environmental cultures revealed a possible common-source outbreak. Literature review reveals that infection due to this organism is most unusual and occurs only in the hospital setting in patients with serious compromise of host defenses.
Insights
Fungal peritonitis, often from Candida albicans, is rising in patients on peritoneal dialysis. Rhodotorula rubra, a rare fungus, caused severe infections in three patients, leading to dialysis cessation or death.
Area of Science:
- Nephrology
- Mycology
- Infectious Diseases
Background:
- Fungal peritonitis is an increasing concern in patients undergoing long-term peritoneal dialysis for renal failure.
- Candida albicans is the most common fungal pathogen, but other opportunistic fungi are also reported.
Observation:
- Three patients with compromised host defenses developed serious peritoneal infections due to Rhodotorula rubra, a fungus typically considered nonpathogenic.
- Environmental cultures suggested a potential common-source outbreak.
- Two patients experienced peritoneal fibrosis, necessitating cessation of peritoneal dialysis.
Findings:
- Rhodotorula rubra caused severe, life-threatening peritonitis in immunocompromised patients.
- Infection led to significant morbidity, including irreversible peritoneal damage and mortality.
- This organism's pathogenicity in the hospital setting, particularly in dialysis patients, is highlighted.
Implications:
- Highlights the potential for "nonpathogenic" fungi to cause severe opportunistic infections in vulnerable populations.
- Underscores the need for vigilance in diagnosing and managing fungal peritonitis, including rare pathogens.
- Suggests environmental monitoring and stringent infection control measures in healthcare settings to prevent outbreaks.