Abstract
An unusual case of peritonitis in a 61-year-old patient is reported where culture for bacteria and fungi were negative. Acanthamoeba was isolated and the patient was treated with Ceftazidine, Cefazolin, Levofloxacin, Fluconazole and Rifampicin with regular haemodialytic support. The patient was completely cured of the infection and continuous ambulatory peritoneal dialysis (CAPD) fluid became clear after 2 weeks of treatment. Diagnosis and treatment of Acanthamoeba infections are difficult due to the rarity of the infections, lack of familiarity of most clinicians with disease syndromes, and limitations of therapeutics options. Even an experienced microbiologist can easily mistake the amoebae in ascitic fluid for peritoneal macrophages or lymphocytes.
Highlights
The process of continuous ambulatory peritoneal dialysis (CAPD) has provided a useful, relatively inexpensive, and safe alternative procedure for patients with end stage renal disease
The patient was continued on thrice weekly hemodialysis, Ceftazidine and Levofloxacin and in addition was treated with Rifampicin 600 mg daily and Fluconazole 150 mg daily
Peritonitis remains the major concern in patients on CAPD; with improved technology the incidence of peritonitis has decreased to less than one episode in 24 months
Summary
Introduction The process of continuous ambulatory peritoneal dialysis (CAPD) has provided a useful, relatively inexpensive, and safe alternative procedure for patients with end stage renal disease. Free-living amoebae of the genus Acanthamoeba are the causative agents of many infections in immunocompromised patients and may be life threatening. In February 2006, the patient was started on chronic ambulatory peritoneal dialysis and was doing well on 4 exchanges per day. The patient was hospitalized with a history of low-grade intermittent fever, mild abdominal pain, cloudy effluent dialysate, nausea and vomiting for one month, and altered sensorium for five days.
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