Pichia ohmeri Peritonitis in a Patient on CAPD: Response to Treatment with Amphotericin

Abstract

Editor: Fungal peritonitis is associated with high morbidity and mortality. We present a case of continuous ambulatory peritoneal dialysis (CAPD) peritonitis due to Pichia ohmeri. Peritonitis due to this yeast has not been reported previously. The patient was a 64-year-old nondiabetic man on CAPD since 1995. He had an episode of Candida parapsilosis peritonitis in December 1997, which responded to amphotericin and Tenckhoff catheter removal; CAPD was successfully resumed in February 1998. He presented in August 1998 with low grade fever and turbid peritoneal fluid (PDF). The PDF white cell count was 869/mL (87% neutrophils, 2% lymphocytes, and 11% eosinophils). Empirical treatment with cefazolin and tobramycin was started then replaced by fluconazole and Tenckhoff catheter removal when yeast was grown from the PDF culture 3 days later. Fluconazole was later replaced with intravenous (IV) amphotericin because of persistence of clinical symptoms. Pichia ohmeri was isolated from the PDF after 7 days. This yeast was sensitive to amphotericin B, which was administered for 3 weeks. Posttreatment peritoneal fluid culture did not yield any fungi. Pichia ohmeri is a heterothallic ascosporogenous yeast first isolated from films of cucumber brine (1). Morphologically it is characterized by the formation of ascospores that are either hat shaped or spheroidal, as determined by the mating types (2). Pichia ohmeri is commonly used in the food industry for its fermentation properties in pickles and fruit (3). Kurtzman first reported isolation of the fungus as a contaminant in the pleural fluid of a patient in 1984 (2). The only other report incriminating Pichia ohmeri as a possible opportunistic human pathogen was by Bergman, who reported Pichia ohmeri fungemia in a debilitated, diabetic renal transplant patient who had received multiple antibiotics for bacterial infections (4). The clinical presentation of Pichia ohmeri peritonitis in our patient was largely indistinguishable from bacterial peritonitis, with turbidity of the dialysate, low grade fever, and neutrophilia in the dialysate. Our experience showed that this fungal infection responded to amphotericin but not to fluconazole treatment. Because uremic patients are immunocompromised, physicians should be aware of the possibility of infections by new opportunistic pathogens in our renal patients.