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Nocardia asteroides peritonitis during continuous ambulatory peritoneal dialysis
J O Lopes1, S H Alves, J P Benevenga
1Serviço de Micologia, Hospital Universitário, Universidade Federal de Santa Maria, Rio Grande do Sul, Brasil.
Summary
Nocardia asteroides peritonitis occurred in a patient undergoing continuous ambulatory peritoneal dialysis for systemic lupus erythematosus and chronic renal failure. Intraperitoneal Trimethoprim-Sulfamethoxazole effectively treated the infection.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment for end-stage renal disease.
- Patients with autoimmune conditions like systemic lupus erythematosus (SLE) are at increased risk for infections.
- Nocardia species are aerobic actinomycetes known to cause opportunistic infections.
Observation:
- A male patient with a history of SLE and chronic renal failure developed peritonitis.
- The peritonitis was caused by Nocardia asteroides, identified via Gram and Kinyoun staining of dialysis fluid.
- Microscopic examination and culture of centrifuged dialysis fluid confirmed the diagnosis.
Findings:
- Nocardia asteroides peritonitis is a rare but serious complication of CAPD.
- Diagnosis relies on direct examination and culture of peritoneal effluent.
- Intraperitoneal Trimethoprim-Sulfamethoxazole demonstrated efficacy in treating this specific case.
Implications:
- Early diagnosis and appropriate antibiotic therapy are crucial for managing Nocardia peritonitis in CAPD patients.
- This case highlights the importance of considering Nocardia in the differential diagnosis of peritonitis in immunocompromised patients on dialysis.
- Optimizing antibiotic routes and drug selection is key to successful treatment outcomes in CAPD-related infections.