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Peritonitis caused by Monilia sitophila in a patient undergoing peritoneal dialysis
A E Radix1, V M Bieluch, C W Graeber
1Department of Internal Medicine, New Britain General Hospital, Connecticut, USA.
Abstract:
Fungi have become an increasingly important cause of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. The most common cause of fungal peritonitis is Candida. However, in recent years unusual and "nonpathogenic" fungi have been reported as etiologic agents of CAPD-associated peritonitis. We are reporting the first case of CAPD-associated peritonitis caused by Monilia sitophila. This organism had previously been considered to be non-pathogenic, and a troublesome laboratory contaminant. Our patient was successfully managed with intravenous and intraperitoneal amphotericin B, followed by oral itraconazole, without removal of her Tenckhoff catheter.
Insights
Fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients is rising, with unusual fungi emerging as causes. This study details the first CAPD peritonitis case from Monilia sitophila, successfully treated without catheter removal.
Area of Science:
- Mycology
- Nephrology
- Infectious Diseases
Background:
- Fungal peritonitis is a growing concern for patients on continuous ambulatory peritoneal dialysis (CAPD).
- While Candida species are the most frequent culprits, atypical fungi are increasingly implicated.
- This highlights the need to consider less common fungal agents in CAPD-associated peritonitis.
Observation:
- A case of CAPD-associated peritonitis caused by Monilia sitophila is reported.
- Monilia sitophila was previously considered a non-pathogenic laboratory contaminant.
- This represents the first documented instance of this fungus causing peritonitis in CAPD patients.
Findings:
- The patient with Monilia sitophila peritonitis was treated successfully.
- Treatment involved intravenous and intraperitoneal amphotericin B, followed by oral itraconazole.
- Crucially, the Tenckhoff catheter was not removed, demonstrating a potentially less invasive treatment approach.
Implications:
- This case expands the spectrum of fungi causing CAPD peritonitis.
- It suggests that organisms previously deemed non-pathogenic can cause serious infections in immunocompromised or debilitated patients.
- Successful management without catheter removal offers a potential therapeutic strategy, preserving dialysis access.