Fungal peritonitis in peritoneal dialysis patients

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Introduction. Fungal peritonitis in peritoneal dialysis is a serious infection which compromises the functional prognosis of the peritoneum and the vital prognosis of the patient. It is the most common complication in peritoneal dialysis. The objective of our study is to determine the epidemiological profile of patients suffering from fungal peritonitis and to describe the clinical, biological and therapeutic aspects of this disease. Materials and method. We carried out a retrospective descriptive study over a period of 3 years (2022-2024) on fungal peritonitis diagnosed in the parasitology department at BATNA University Hospital. The diagnosis of the disease was supported by positive fungal cultures. We included in our study patients with clinical symptoms pointing towards the diagnosis of fungal peritonitis. Each patient received a peritoneal sample using a syringe, seeding was carried out in Sabouraud medium. - Chloramphenicol. The cultures are then incubated in an oven at 27°C and 37°C for 24 to 48 hours for yeasts and up to one week for filamentous fungi. Results. Our study was a series of 64 patients, 11 of whom had proven fungal peritonitis; the prevalence was 17%. We noticed a predominance of the male sex with 8 men or 73% and 3 women or 27%, with a sex ratio M/F = 2.66. The age group of [55-60 years] was the most predominant (50%) of cases, the average age was 53 years. Abdominal pain was the most common symptom in 82% of patients, followed by fever in 64%. Among the germs isolated from different cultures, yeasts of the Candida genus are the most frequently isolated; 10 cultures or 91%. Candida albicans was the most frequent species, isolated in 9 cultures or 82%. Only one culture was positive for Candida dubliniensis. Only one culture was positive for Aspergillus niger. We note that (50%) of the patients were diabetic. Treatment was started in 8 patients for 3 weeks. 3 patients (25%) did not receive any treatment. 2 patients (25%) received caspofungin, and 2 patients (25%) voriconazole. The combination was started in 4 patients (50%). Removal of the peritoneal dialysis catheter was not performed in the patients. In our study, we recorded 4 deaths or 36%. Conclusion: Fungal peritonitis remains a serious complication in patients undergoing peritoneal dialysis which can be life-threatening. In the majority of cases, it requires stopping the technique, hence the importance of preventive measures. Early diagnosis and administration of adequate antifungal treatment can reduce the mortality rate. Collaboration between the clinician and the biologist allows for more effective treatment and improves the prognosis.