Abstract
Melioidosis is known to be endemic in Southeast Asian countries, including Malaysia where it commonly presents as severe pneumonia or abscesses. In end stage renal disease (ESRD) patients on peritoneal dialysis (PD), melioidosis is rarely reported as the cause of peritonitis. These are retrospective case series of PD for the past 6bmonths secondary to Melioidosis. Clinical features and managements of these two patients are being described. Case series: We reported 2 cases of ESRD patients on continuous ambulatory peritoneal dialysis (CAPD). Both patients were diabetics and presented with typical symptoms of peritoneal dialysis peritonitis where the dialysate effluents grew Burkholderia pseudomallei. Patient 1 was hypotensive on presentation and started on broad spectrum antibiotics, intravenous (IV) ceftazidime. He responded well and completed 4 weeks of intensive IV ceftazidime and was switched to oral Bactrim as eradication therapy upon discharged. Patient 2 was hemodynamically stable and promptly started on intraperitoneal (IP) ceftazidime. Unfortunately, he did not respond despite escalation to intraperitoneal imipenem. His Tenckhoff catheter was removed subsequently and he was converted to haemodialysis (HD). Both patients completed the intensive phase of treatment and were discharged on oral eradication therapy for the treatment of melioidosis. Both are currently well with no relapse. Discussion: There have been few treatment options for melioidosis peritonitis. Treatment comprises of intensive phase, usually IV ceftazidime or meropenem, followed by a prolonged course of eradications phase. If IV antibiotics fail to treat the peritonitis, prompt Tenckhoff catheter removal will be the next appropriate course of action. In our cases, one patient had catheter loss due to melioidosis peritonitis while the other was able to continue on PD. PD peritonitis due to melioidosis is uncommon but it may be associated with catheter loss and possibly fatal if not treated early as systemic melioidosis is associated with high mortality. Early diagnosis, high awareness and prompt management are important in treating melioidosis PD peritonitis.
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