Cases Of Fungal Peritonitis Research Articles

Aspergillus terreus Peritonitis in a Child on Continuous Ambulatory Peritoneal Dialysis: A Case Report from Pakistan

Background: Aspergillus peritonitis is a rare, potentially fatal complication of continuous ambulatory peritoneal dialysis (CAPD). Several cases of fungal peritonitis (FP) caused by Aspergillus species have been reported worldwide; however, there is a paucity of data from Pakistan. Here, a case of congenital nephrotic syndrome is reported in a patient who progressed to Stage 5 chronic kidney disease when she was 8 years old, which was managed by CAPD and other supportive therapies. The patient developed FP and later succumbed to death despite appropriate management. Early diagnosis and careful interpretation of culture results are, therefore, important for the treatment of these patients. Case presentation: The patient outlined in this case report had congenital nephrotic syndrome, Stage 5 chronic kidney disease, and was on CAPD. She presented with peritonitis. Initially, broad spectrum antibiotics were started, and peritoneal samples did not yield any growth. Later, consecutive peritoneal samples taken from the patient grew Aspergillus terreus, with septate hyphae seen on a direct smear from the sample. Voriconazole was started immediately, and the patients’ catheter was removed. However, the patient’s condition deteriorated and, after prolonged intensive care and high ventilator support, the patient expired. Conclusion: A. terreus is an uncommon and deadly pathogen that does not respond to the commonly used antifungal treatments such as amphotericin B. The treatment of CAPD-related FP requires early diagnosis and the use of newer drugs such as voriconazole or caspofungin.

Characteristics Analysis, Clinical Outcome and Risk Factors for Fungal Peritonitis in Peritoneal Dialysis Patients: A 10-Year Case-Control Study.

Background: Fungal peritonitis (FP) is a rare but severe complication that can appear in patients receiving peritoneal dialysis (PD). This study aimed to investigate the incidence rate and clinical characteristics of FP, evaluate clinical outcomes between FP and bacterial peritonitis (BP) patients on PD, and especially estimate the risk factors for FP outbreak.Methods: All episodes of FP diagnosed in our hospital from January 1, 2011, to December 31, 2020, were reviewed in this single-center study. FP cases were analyzed and compared with patients diagnosed with BP in a 1:6 ratio matching for case-control study. Patient information, including clinical information, biochemical analysis, and outcomes, was recorded. Univariate and multivariate logistic regression model were used to analyze the risk factors for FP.Results: A total of 15 FP episodes were observed in 15 PD patients, with an FP rate of 0.0071 episodes per patient-year. Seventeen strains of fungi were isolated and identified. Candida was the most common pathogen (15 strains, 88.2%), followed by Aspergillus fumigatus (2 strains, 11.8%). Between the groups, FP group showed a higher rate of HD transfer and catheter removal, and a lower rate of PD resumption in the short-term outcome (all P < 0.01), while no significant difference in the mortality was noted during the whole study period. The multivariate logistic regression analysis showed that longer PD duration (odds ratio [OR] 1.042, 95% confidence interval [CI] 1.012–1.073, P < 0.01), higher serum potassium (OR 3.373, 95% CI 1.068–10.649, P < 0.05), elevated estimated glomerular filtration rate (eGFR) (OR 1.845, 95% CI 1.151–2.955, P < 0.05), reduced serum albumin level (OR 0.820, 95% CI 0.695–0.968, P < 0.05) and peritoneal effluent polymorphonuclear (PMN) count (OR 0.940, 95%CI 0.900–0.981, P < 0.01) were significantly increased the risk for FP.Conclusion: These results suggested that FP leads to higher rate of catheter removal and HD transfer, and a lower rate of PD resumption than BP, and that additional attention should be paid to hypoalbuminemia, increased serum potassium, long PD duration, and low peritoneal effluent PMN in PD patients.

Clinical Features and Risk Factors of Fungal Peritonitis in Children on Peritoneal Dialysis.

Objective: To analyse the clinical manifestations, aetiology, prognosis, and risk factors of fungal peritonitis (FP) in children on peritoneal dialysis (PD).Methods: Among 322 children undergoing PD at Children's Hospital of Fudan University, between January 2001 and December 2019, FP cases were retrospectively analysed and compared with those of bacterial peritonitis (BP) to analyse the risk factors of FP.Results: A total of 124 cases of peritonitis were treated, including 11 FP cases in 11 children (0.0019 episodes/patient*month) and 113 BP cases in 64 children (0.02 episodes/patient*month). Among the 11 FP cases, 7 cases (63.64%) were caused by Candida and Candida parapsilosis (5/7) was the most common pathogen of Candida. All FP patients were converted to haemodialysis (HD) and did not resume PD during follow-up. Two patients (18.2%) died after 6 months of HD due to heart failure, 2 patients underwent kidney transplant after 2 years of infection, and the other 7 patients were still on HD. The univariate analysis showed the usage rate of antibiotics in the month before the onset of peritonitis was higher (45.45 vs. 15.93%) and the mean serum albumin was lower (31.4 vs. 34.4 g/L) in the FP group when compared with BP group (P < 0.05), while multivariate analysis showed that serum albumin ≤ 30 g/L was an independent risk factor for FP (odds ratio 4.896, 95% confidence interval 1.335–17.961).Conclusion: FP is a rare complication of PD in children, but it is associated with high technique failure. Attention should be paid to hypoproteinaemia and antibiotic use in children on PD.

POS-640 FUNGAL PERITONITIS IN AUTOMATED PERITONEAL DIALYSIS : AN 18-YEAR SINGLE CENTRE EVALUATION

Infectious peritonitis is the most serious complication of peritoneal dialysis (PD). Its origin is often bacterial. Fungal peritonitis (FP) is rare but always devastating, accounting for high rates of technique failure, morbidity and mortality. It is therefore important to know its microbiological and clinical profile and its evolution in order to establish preventive and therapeutic strategies. The aim of our study is to determine the FP frequency and to describe its clinical, microbiological and therapeutic aspects in patients treated with automated peritoneal dialysis (APD), APD being the most frequent PD modality in our centre. This was a single-centre retrospective study carried out in the PD unit of Charles Nicolle Hospital in Tunis from January 01, 2000 to December 31, 2018, on patients treated with APD and having presented at least one fungal peritonitis. Clinical, biochemical characteristics and detailed data on peritonitis episodes were recorded. Six cases of FP were identified, ie 3% of all infectious peritonitis that occurred during the study period. The patients' sex ratio was 2. Their mean Charlson score at onset of APD was 3 [Extremes: 2-6]. Only one patient was diabetic. Their mean age at the time of peritonitis was 40 +/- 16 years. Candida albicans was the most frequently (50%) detected yeast followed by candida non albicans (2 patients). Aspergillus has been isolated in one patient. This group experienced an average of 2 bacterial peritonitis before FP. All FP were preceded by bacterial peritonitis: In five patients, they were diagnosed following refractory peritonitis mainly due to Enterobacteria (4 patients). In one case, the patient had a history of three episodes of bacterial peritonitis, FP presented as a new episode of infectious peritonitis occurring 5 months after the third peritonitis. All Candida peritonitis were treated with intravenous fluconazole for an average of 13 days. Aspergillary peritonitis was treated with amphotericin B for 15 days. The PD catheter was removed in all cases. Four patients were transferred to hemodialysis. APD was retried in the other two patients. They were switched to hemodialysis after 1 and 7 months, respectively, of placement of the second PD catheter for loss of ultrafiltration and catheter dysfunction. FP are certainly rare, but they are an ineluctable cause of PD failure.

Peritoneal Dialysis Access Associated Infections.

Infection is a significant driver of morbidity and mortality in patients with end-stage renal disease undergoing maintenance dialysis. In the United States, septicemia and other infections account for 8% deaths in patients undergoing dialysis. In patients undergoing peritoneal dialysis (PD), PD-related peritonitis remains the most frequent treatment-related infection and is the greatest contributor to infection-related morbidity, including risk for hospitalization, and temporary or permanent transfer to hemodialysis. In the 4 decades since the introduction of ambulatory PD in clinical practice, a large number of treatment innovations have been shown to be effective in reducing the risk for exit site infection and PD-related peritonitis. Notwithstanding the evidence for efficacy of these innovations and the numerous adverse health consequences with PD-related peritonitis, the uptake of these interventions in clinical practice around the world remains inconsistent. This article reviews current knowledge with regards to prevention of PD-associated infections, and the diagnosis and management of exit site infections and peritonitis.

The epidemiology of acute peritonitis in end-stage renal disease patients on peritoneal dialysis in Qatar: An 8-year follow-up study.

Acute peritonitis (AP) is a common and devastating complication in end-stage renal disease patients on peritoneal dialysis (PD). We are reporting an epidemiologic study of AP in Qatar over 8-year follow-up. We retrospectively reviewed medical records of all PD patients in Qatar from 2007 to 2014. The analysis was conducted to report epidemiology, outcome, and associated risk factors of AP. We had 318 AP episodes in 180 patients between 2007 and 2014. Six (3.3%) patients died as a result AP. Six cases of fungal peritonitis were reported. AP rate has decreased from 1 episode/29.7 PD-months in 2007 to 1/43.7 PD-months in 2014. Ninety-nine (55%) patients had single AP while 81 (45%) patients had 2 episodes or more (multiple AP). Patients on automated PD carried a higher risk of developing multiple AP [odds ratio (OR) = 1.46, 95% confidence interval (CI): 1.01-1.71]. The first episode of AP caused by Gram-positive cocci carried a significant risk of multiple AP (OR = 4.3, 95 % CI: 2.2-8.2). Negative-culture AP carried a significant protective role from multiple AP (OR = 0.35, 95% CI: 0.19-0.66). Most deaths occurred with the first episode of AP (4 out of 6). In this 8-year follow-up, epidemiologic study from Qatar, fungal peritonitis and mortality rate were very low, AP rate improved overall, multiple AP was prevalent (45%), and its risk increases with Gram-positive cocci infections. Our results signify the importance of implementing more efficient care bundles to prevent multiple AP.

Clinical Features of Fungal Peritonitis with Candida Albicans Infection after Gastric and Duodenal Perforation

Background: Acute fungal peritonitis due to gastric and duodenal perforation has been rarely reported. Methods: In this study, we retrospectively analyzed 15 cases with acute fungal peritonitis infected with Candida after gastric and duodenal perforation. Results: Gastric ulcer perforation was diagnosed in 5 cases and perforation of the duodenum was diagnosed in 10 cases. The medical background of patients included tuberculosis (TB) and long-term anti-TB therapy (5 cases), hypertension (4 cases), Type 2 diabetes (3 cases), rheumatoid arthritis (3 cases), hypoproteinemia (5 cases), and moderate anemia (7 cases). Two patients had a long-term history of drug abuse. All patients underwent surgery to repair the hole and suture the omentum over the perforation. All fungal peritonitis cases were caused by Candida, including C. albicans in 10 cases, C. tropicalis in 2 cases, C. Parapsilosis in 2 cases, and C. kefyr in 1 case. Fluconazole (400 mg for first day, then 200 mg/day for 7-14 days) was effective as anti-fungal treatment. The average length of hospital stay was 15.5 ± 4.1 days. Ten patients fully recovered. Incision infection was found in 3 patients. Two patients died due to multiple organ failure. Conclusion: Our study suggests that fungal culture is necessary for patients with gastrointestinal ulcer perforation, C. albicans is the most common fungal infection, and anti-fungal therapy is effective for acute fungal peritonitis due to Candida infection.

Infectious outcomes following gastrostomy in children receiving peritoneal dialysis.

Early institution of enteral feeding in paediatric end-stage kidney disease (ESKD) is recommended. For patients on peritoneal dialysis (PD) there is concern that gastrostomy tube (GT) insertion may be complicated by increased peritonitis, in particular fungal. Our unit favours early planned GT insertion, and for those with late presentation, there is prompt consideration of GT insertion following dialysis initiation. This study evaluates our rates of peritonitis with GT insertion following or concurrent with PD initiation. This was a retrospective, single-centre, cross-sectional study of of 17 New Zealand children with ESKD who received PD in the period 2000-2011. Inclusion criteria were GT placement while on PD or initiation of PD within 72 h of GT insertion. There were no cases of fungal peritonitis among the 17 children; however, two cases of early peritonitis with organisms derived from the gastrointestinal tract were identified. No statistically significant difference was found between incident rates of bacterial peritonitis before GT placement (0.6 episodes per patient-year; 95% confidence interval (CI) 0.26-1.18) and post-GT placement (1.21 episodes per patient-year; 95% CI 0.69-1.97). Fungal peritonitis has never been encountered by out unit during its many years of experience in GT placement in patients without advanced malnutrition. When children on PD have insufficient dietary intake to maintain appropriate growth velocity, enteral feeding should be initiated promptly. A GT is considered to be safe for long-term use in selected patients.

（1→3）-&amp;beta;-D-グルカン高値が遷延した十二指腸憩室穿孔後の真菌性腹膜炎の1例

症例は57歳，女性．急性腹症にて手術施行，十二指腸憩室による穿孔性腹膜炎であったが，Cushing症候群を併存し，全身状態も不良のため，分流手術を施行した．術後（1→3）-β-D-グルカン高値となり，腹腔内からCandidaも検出されたため，真菌性腹膜炎に対して抗真菌薬投与を開始した．臨床症状は改善したが（1→3）-β-D-グルカン高値は遷延し，抗真菌薬の投与中止の判断に難渋した．（1→3）-β-D-グルカンは迅速に結果が得られ，深在性真菌症の診断には非常に有用である．一方，（1→3）-β-D-グルカンは必ずしも深在性真菌症の病勢と一致しない場合もあるため，抗真菌薬の継続や中止の判断には，培養結果や臨床症状などを，総合的にBundleとして判断する必要がある．

Seeking Clarity within Cloudy Effluents: Differentiating Fungal from Bacterial Peritonitis in Peritoneal Dialysis Patients

BackgroundFungal peritonitis is a serious complication of peritoneal dialysis (PD) therapy with the majority of patients ceasing PD permanently. The aims of this study were to identify risk factors and clinical associations that may discriminate between fungal from bacterial peritonitis.MethodsWe retrospectively identified episodes of fungal peritonitis from 2001–2010 in PD patients at Liverpool and Westmead Hospitals (Australia). Fungal peritonitis cases were matched in a 1∶2 ratio with patients with bacterial peritonitis from each institution's dialysis registry, occurring closest in time to the fungal episode. Patient demographic, clinical and outcome data were obtained from the medical records.ResultsThirty-nine episodes of fungal peritonitis (rate of 0.02 episodes per patient-year of dialysis) were matched with 78 episodes of bacterial peritonitis. Candida species were the commonest pathogens (35/39; 90% episodes) with Candida albicans (37%), Candida parapsilosis (32%) and Candida glabrata (13%) the most frequently isolated species. Compared to bacterial peritonitis, fungal peritonitis patients had received PD for significantly longer (1133 vs. 775 catheter-days; p = 0.016), were more likely to have had previous episodes of bacterial peritonitis (51% vs. 10%; p = 0.01), and to have received prior antibacterial therapy (51% vs. 10%; p = 0.01). Patients with fungal peritonitis were less likely to have fever and abdominal pain on presentation, but had higher rates of PD catheter removal (79% vs. 22%; p<0.005), and permanent transfer to haemodialysis (87% vs. 24%; p<0.005). Hospital length of stay was significantly longer in patients with fungal peritonitis (26.1 days vs. 12.6 days; p = 0.017), but the all-cause 30-day mortality rate was similar in both groups. Fluconazole was a suitable empiric antifungal agent; with no Candida resistance detected.ConclusionPrompt recognition of clinical risk factors, initiation of antifungal therapy and removal of PD catheters are key considerations in optimising outcomes.

Does Antifungal Prophylaxis with Daily Oral Fluconazole Reduce the Risk of Fungal Peritonitis in Peritoneal Dialysis Patients? The Pan Thames Renal Audit

Background and Objectives: Fungal peritonitis increases the risk of transfer to haemodialysis and mortality. Methods: We audited the effect of co-prescription of daily oral fluconazole with antibiotics in the Pan Thames centres on fungal peritonitis. Results: We found 49 (1.5%) fungal peritonitis cases in 3,322 episodes of peritonitis. Two centres co-prescribed prophylactic fluconazole with antibiotics, with a fungal peritonitis rate of 0.0032/patient year, compared to 0.0099 from centres not using prophylaxis. However, centres using fungal prophylaxis had lower peritonitis rates of 0.036, compared to 0.05 for the other centres. Correcting for background peritonitis rates, there was no significant difference in the incidence of fungal peritonitis. Conclusions: In centres with a low incidence of fungal peritonitis, additional co-prescription of fluconazole with antibiotics appeared to reduce the risk of fungal peritonitis. However, variation in practice between centres is the main determinant of the observed incidence of fungal peritonitis rather than the use of antifungal prophylaxis.

Ten-year prevalence of fungal peritonitis in the city of Nis, South Serbia

Abstract Fungal peritonitis is a rare but serious complication in patients with chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD). The purpose of this study was to report the prevalence of fungal peritonitis in patients on CAPD in the Clinical Center-Nis (South Serbia) in the period from 1997 until the end of 2007. Fungal species were isolated in 66 cases (4.5%) of 1471 peritoneal fluid (PF) samples that we examined. During the study period, 22 (1.5%) cases of fungal peritonitis were registered. In 19 cases, Candida isolates were identified, Candida albicans (C. albicans) being the most common species (n=15). Two cases of fungal peritonitis caused by Aspergillus fumigatus and 1 possible case caused by Cladosporium cladosporioides (Cl. cladosporioides) were also detected.

Paecilomyces lilacinus peritonitis complicating peritoneal dialysis cured by oral voriconazole and terbinafine combination therapy

Fungal peritonitis (FP) is a serious complication in patients on continuous ambulatory peritoneal dialysis (CAPD). We report a case of CAPD-related FP caused by Paecilomyces lilacinus in a 15-year-old uraemic boy. The infection was successfully treated by combination therapy consisting of oral voriconazole and terbinafine, which has not been previously reported in the treatment of FP.

Candida parapsilosis peritonitis complicated with infected pancreatic pseudocysts in a peritoneal dialysis patient: a challenge for nephrologists

In continuous ambulatory peritoneal dialysis (CAPD)-related cases of fungal peritonitis, Candida parapsilosis (C. parapsilosis) has become as common as Candida albicans (C. albicans) in fungal isolates. This report describes a 74-year-old male CAPD patient who received bypass surgery for coronary artery disease, followed by an episode of bacterial peritonitis. The peritonitis was successfully treated with intraperitoneal antibiotics. However, C. parapsilosis peritonitis with concomitant pancreatitis and infected pseudocysts occurred one month later. Despite surgical drainage and intravenous administration of fluconazole, fungal peritonitis persisted. Finally, he died of nosocomial pneumonia. This case demonstrates the poor outcome of C. parapsilosis peritonitis, suggesting a more aggressive treatment in peritoneal dialysis patients.

Fungal peritonitis in children on peritoneal dialysis

Fungal peritonitis is a rare but serious complication in children on peritoneal dialysis (PD). In this study, risk factors were evaluated, and therapeutic measures were reviewed. A retrospective, multi-centre study was performed in 159 Dutch paediatric PD patients, between 1980 and 2005 (3,573 months). All peritonitis episodes were reviewed. Fungal peritonitis episodes were evaluated based on possible risk factors and treatment strategy. A total of 321 episodes of peritonitis occurred, with 9 cases of fungal peritonitis (2.9%). Candida peritonitis occurred most frequently (78%). Seven patients (78%) had used antibiotics in the prior month. Fungal peritonitis patients had a higher previous bacterial peritonitis rate compared to the total study population (0.13 versus 0.09 episodes/patient*month), with twice as many gram negative organisms. In all fungal peritonitis patients, the PD catheter was removed. In four patients restart on PD was possible. Fungal peritonitis is a rare complication of PD in children, but is associated with high technique failure. The most important risk factors are a high bacterial peritonitis rate, prior use of antibiotics, and previous bacterial peritonitis with gram negative organisms. The PD catheter should be removed early, but in children, peritoneal lavage with fluconazole before removal may be useful to prevent technique failure.

Fungal peritonitis in peritoneal dialysis patients: is previous antibiotic therapy an essential condition?

The aim of this study was to analyse the clinical and microbiological features of fungal peritonitis, in chronic peritoneal dialysis patients, focusing on non-traditional risk factors for this feared complication. From 2001 to 2004, five episodes of fungal peritonitis were diagnosed in five different patients, accounting for 4.5% of all peritonitis cases seen during this period. Candida spp. were the most frequent isolates. In all cases, peritoneal dialysis catheter removal and switching to haemodialysis were necessary. In these five cases of fungal peritonitis only one was preceded by antibiotic use, within the previous 3 months, the classical risk factor for fungal peritonitis. Identifying predisposing factors usually not taken into account, may lead to an early diagnosis and to a better understanding of fungal peritonitis pathogenesis.

Risk Factors for Poor Outcome of Fungal Peritonitis in Chinese Patients on Continuous Ambulatory Peritoneal Dialysis

Fungal peritonitis is rare among end-stage renal disease patients treated with continuous ambulatory peritoneal dialysis (CAPD), but when it occurs, it is associated with a high risk of mortality and peritoneal membrane failure. In the present study, we identified risk factors for poor outcome and examined the effect of treatment profile on outcome in fungal peritonitis. We identified cases of fungal peritonitis in CAPD patients in a regional dialysis center and analyzed the possible risk factors for poor outcome in fungal peritonitis. To estimate the amount of dextrose presented to the peritoneum, we scored the dextrose content of the peritoneal dialysis fluid used by the patient at the time of admission to hospital (1 point to each bag of 1.5% fluid, 2 points to each bag of 2.3% or 2.5% fluid, and 3 points to each bag of 4.25% fluid daily). Among 471 episodes of CAPD-related peritonitis in 7.8 years, we identified 22 episodes of fungal peritonitis (4.7%). The ratio of men to women in the fungal peritonitis group was 1.4:1. Seventeen patients (77.3%) practiced dialysis without a helper. Within the 3 months preceding the fungal peritonitis, 12 patients (55%) had had bacterial peritonitis. Among the cases of fungal peritonitis, we identified 9 cases of Candida parapsilosis and 13 cases of non C. parapsilosis. All of the patients received fluconazole, and 7 patients (31.8%) also received flucytosine. The Tenckhoff catheter was removed in 17 patients (77.3%). Eight patients (36.4%) either died or lost peritoneal function. The risk of mortality was increased if the fungal organism was C. parapsilosis [odds ratio (OR): 4.25; 95% confidence interval (CI): 1.8 to 10.0; p = 0.002], if a helper was involved (OR: 11.3; 95% CI: 1.1 to 114; p = 0.024), or if CAPD duration was more than 26 months (OR: 2.2; 95% CI: 1.3 to 3.5; p = 0.034). Addition of flucytosine to fluconazole did not significantly improve the mortality rate in either the C. parapsilosis or non C. parapsilosis group. Multivariate analysis showed that C. parapsilosis was an independent factor associated with mortality (p = 0.013). A dextrose score greater than 5 was associated with a trend toward increased risk of peritoneal failure (OR: 3.4; 95% CI: 1.6 to 7.1; p = 0.021). C. parapsilosis is an independent risk factor for mortality in fungal peritonitis.

Fungal peritonitis in patients on continuous ambulatory peritoneal dialysis: a single centre Indian experience.

Fungal peritonitis (FP) is a serious complication in patients on continuous ambulatory peritoneal dialysis (CAPD). We reviewed our FP cases to analyse the causative agents and possible risk factors in relation to FP and its outcome and mortality. Records of all FP cases were reviewed. FP was diagnosed based on effluent cell count and positive fungal culture in suitable media. Between October 1993 and November 2001, 261 patients underwent CAPD. FP was detected in 28 patients, one episode in each patient (14.3% of the total peritonitis episodes). Candida species and dematiaceous fungi+/-Candida species were responsible for 89.3 and 10.7% of episodes, respectively. Patients with preceding bacterial peritonitis (BP) developed FP more frequently (25.6%) than de novo cases (2.9%) (P<0.0001) and lower proportion of them continued CAPD (8.6% vs. 60%; P=0.007). Mortality in patients having abdominal pain with and without fever, and catheter in situ was significantly higher than in those patients who did not have these risk factors (9/11 vs. 6/17, P=0.01; 13/17 vs. 2/11, P=0.003; 6/6, vs. 9/22, P=0.01, respectively). Higher proportion of our patients had FP; preceding BP was a significant risk factor for development of FP and technique failure. Abdominal pain+/-fever in patients and catheter in situ were identified as risk factors associated with mortality.

Current Concepts in the Management of Fungal Peritonitis.

Fungal pathogens are uncommon isolates in the setting of peritonitis. Secondary peritonitis results from a breach in the gastrointestinal tract with gross contamination of the peritoneum. Peritonitis in patients undergoing peritoneal dialysis represents a unique form of secondary peritonitis often caused by nosocomial bacteria and fungi. Regardless of the clinical circumstances, most cases of fungal peritonitis are caused by Candida species, however, other yeasts and filamentous fungi have been uncommonly reported. Treatment of secondary peritonitis consists of appropriate surgical intervention and systemic antifungal therapy. Systemic antifungals such as amphotericin B or fluconazole are also essential for the treatment of fungal peritonitis in patients who are peritoneal dialysis dependent. Salvage of the peritoneal dialysis catheter may be attempted, however, removal is usually required to achieve cure. Prophylaxis with fluconazole in patients with recurrent gastrointestinal perforations or anastomotic leakages has reduced the incidence of Candida peritonitis. Benefit of nystatin for fungal peritonitis prophylaxis in peritoneal dialysis patients is questionable.

Fungal peritonitis in children receiving peritoneal dialysis: A report of the NAPRTCS

The rarity of fungal peritonitis (FP) in children receiving chronic peritoneal dialysis (PD) has limited the amount of information available regarding the risk factors and management associated with this infection. We reviewed all cases of FP occurring in patients entered into the dialysis registry of the NAPRTCS between January 1992 and May 1996 in an attempt to identify risk factors for infection, treatment strategies, and patient outcome data. A total of 1592 patients who were less than 21 years of age were enrolled in the dialysis registry and received maintenance PD during the period of observation. Of the total 1729 episodes of peritonitis in these patients occurring over 1732 patient-years of follow-up, FP accounted for 51 (2.9%) of the episodes. The patients on PD who developed FP were similar to those who did not develop FP with regard to race, gender, dialysis modality, and dialysis access characteristics. The overall peritonitis rate in patients who developed FP was 2.2 episodes per patient-year compared with 0.96 episodes per patient-year in the patients who did not develop this infection (P < 0.0001). In 25 (49%) cases, the FP was the patient's initial episode of peritonitis. Whereas recent antibiotic usage was present in 23 (56%) of 41 patients with FP, there was no statistically significant relationship (P = 0.26) noted between the presence of a gastrostomy and the development of FP. Candida species caused 33 of 42 (78.6%) FP episodes. Therapy consisted of PD catheter removal and Amphotericin B in the majority of patients. Six months after diagnosis, 27 patients remained on PD, twelve patients were receiving hemodialysis, and only three patients had died, in each case for reasons unrelated to their FP episode. FP is an infrequent cause of peritonitis in children receiving chronic PD. The presence of a gastrostomy does not appear to predispose patients to the development of this infection, and successful therapy most often consists of a combination of antifungal medication and dialysis catheter removal. The outcome of FP in children appears to be more favorable than in the adult dialysis population.