Abstract
BackgroundIn the present report case, we show a peritonitis infection in a continuous ambulatory peritoneal dialysis (CAPD) patient in Colombia. We isolated Rhodococcus equi in the peritoneal fluid culture. Rhodococcus equi is a rare pathogen in immunocompetent people. Rhodococcal peritonitis complicating CAPD has only been reported in few cases, and experience in its treatment is limited. Antimicrobial treatment is unsuccessful because of the virulence and resistance of the Rhodococcus equi. So, the removal of the catheter determines the clinical resolution in most of the cases. In our case, we present the resolution with a combined antibiotic therapy.Case presentationWe present the case of a 50-year-old female patient with chronic kidney disease secondary to diabetic nephropathy. The patient reported to our unit with abdominal pain 6 months after the start of the treatment with CAPD. An intraperitoneal empirical antibiotic scheme was initiated according to the guidelines of the International Society for Peritoneal Dialysis. Patient denies contact with farm animals in her daily life. After 7 days of treatment, Rhodococcus equi was found in the culture. It was decided to extrapolate antibiotic regimen based on the studies of immunocompromised patients suffering from pulmonary infections. The removal of the peritoneal dialysis catheter is decided, but the patient refuses to undertake the procedure. The patient progresses without abdominal pain, and the antibiotic treatment is changed by azithromycin 500 mg daily and performing peritoneal dialysis in CAPD mode.ConclusionsThis case, like the previously published ones, highlights the limitations in the treatment of Rhodococcus equi due to the limited number of reported cases of this pathogen and the absence of standard treatment protocols leading to variable response rates. The therapeutic resolution was due to the prolonged use of antibiotic treatment and being aware of the potential increase of the morbidity.
Highlights
In the present report case, we show a peritonitis infection in a continuous ambulatory peritoneal dialysis (CAPD) patient in Colombia
We report a case of Rhodococcal peritonitis in CAPD [3] patient in Colombia
We report a case of Rhodococcus equi peritonitis in CAPD patient in Colombia, and we discuss aspects of pathogenesis, clinical presentation, diagnosis, microbiology, and treatment of this disease entity
Summary
In the present report case, we show a peritonitis infection in a continuous ambulatory peritoneal dialysis (CAPD) patient in Colombia. Rhodococcus equi is a zoonotic organism that causes rare, potentially fatal several peritoneal infections, and most of the reported cases occurred as pulmonary infections in immunocompromised patients, especially among AIDS patients [1]. Rhodococcus equi is a rare pathogen in immunocompetent people, with only about 10–15% of all cases happening in the absence of any Rhodococcus equi is a common pathogen in veterinary medicine, but Rhodococcus infection recently emerged in the current era as an opportunistic infection in humans, with pulmonary disease being the most common clinical presentation. We report a case of Rhodococcus equi peritonitis in CAPD patient in Colombia, and we discuss aspects of pathogenesis, clinical presentation, diagnosis, microbiology, and treatment of this disease entity. Was the technique used with four refills per day, using two bags of 1.5% glucose and two bags of 2.3%, intercalated every 6 h? The peritoneal equilibration test (PET) performed at 2 months showed a high average; the patient reported to our unit with abdominal pain 6 months after the start of the treatment
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