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Environmental mycobacterial peritonitis complicating peritoneal dialysis: three cases and review
1Division of Pediatric Infectious Diseases, Maimonides Medical Center, Brooklyn, New York 11219.
Abstract:
Mycobacterial peritonitis is rare among patients undergoing peritoneal dialysis. It is usually caused by group IV environmental mycobacteria. We report three such cases and review the literature on this subject. Negative results in routine bacterial cultures and persistent peritonitis may be the only clues indicating the presence of mycobacterial infection. The lack of specific symptoms and signs as well as inadequate culture techniques may delay diagnosis. Multiple cultures of centrifuged dialysis fluid may be required for isolation of the organism. Peritoneal biopsy may yield additional diagnostic information. Management frequently entails removal of the dialysis catheter in addition to antimicrobial therapy. Significant morbidity may ensue if treatment is delayed. Amikacin--with or without another antibiotic--provides adequate coverage.
Insights
Mycobacterial peritonitis is a rare complication in peritoneal dialysis patients, often caused by environmental mycobacteria. Early diagnosis and treatment with amikacin are crucial to prevent severe illness.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Mycobacterial peritonitis is an uncommon but serious complication in patients undergoing peritoneal dialysis (PD).
- It is typically associated with environmental mycobacteria, often Group IV species.
- Diagnosis can be challenging due to non-specific symptoms and difficulties in routine culture identification.
Observation:
- This report details three cases of mycobacterial peritonitis in PD patients.
- Persistent peritonitis with negative routine bacterial cultures should raise suspicion for mycobacterial infection.
- Inadequate culture techniques and lack of specific clinical signs can delay diagnosis.
Findings:
- Isolation of mycobacteria often requires multiple cultures of centrifuged dialysis fluid.
- Peritoneal biopsy can provide valuable diagnostic information.
- Amikacin, sometimes in combination with another antibiotic, is an effective treatment.
Implications:
- Prompt diagnosis and management, including catheter removal and antimicrobial therapy, are essential to minimize morbidity.
- Delayed treatment can lead to significant complications in PD patients.
- Awareness of this rare condition and appropriate diagnostic methods are critical for clinicians managing PD patients.