Mycobacterium fortuitum as a cause of peritoneal dialysis-associated peritonitis: case report and review of the literature

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Peritoneal dialysis-associated peritonitis (PD-peritonitis) due to Mycobacterium spp is uncommon. Non-tuberculous Mycobacterium (NTB) PD-peritonitis can present in a similar fashion to more common causes of bacterial PD-peritonitis. We describe the first reported case of multiresistant Mycobacterium fortuitum PD-peritonitis in an Australian patient.

Case presentation

A 38 year-old woman developed mild PD-peritonitis during an overseas holiday. Treatment was complicated by delayed diagnosis, requirement for special investigations, treatment with multiple antibiotics, and conversion to haemodialysis following removal of her Tenckhoff catheter.

Conclusion

This case demonstrates the diagnostic yield of pursuing further investigations in cases of initially culture-negative, problematic PD-peritonitis. A systematic review of the literature identified only 17 reports of M. fortuitum PD-peritonitis. Similar to our case, a delay in microbiological diagnosis was frequently noted and the Tenckhoff catheter was commonly removed at the time of diagnosis. The type and duration of antibiotic therapy also varied widely so the optimum treatment appears to be poorly defined.

Related collections

Most cited references 18

Record: found
Abstract: found
Article: not found

Culture-negative peritonitis in peritoneal dialysis patients in Australia: predictors, treatment, and outcomes in 435 cases.

Johan B Rosman, Magid Fahim, Carmel Hawley … (2010)

Reports of culture-negative peritoneal dialysis (PD)-associated peritonitis have been sparse, conflicting, and limited to small single-center studies. The aim of this investigation is to examine the frequency, predictors, treatment, and outcomes of culture-negative PD-associated peritonitis. Observational cohort study using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. All Australian PD patients between October 1, 2003, and December 31, 2006. Demographic, clinical, and facility variables. Culture-negative PD-associated peritonitis occurrence, relapse, hospitalization, catheter removal, hemodialysis transfer, and death. Of 4,675 patients who received PD in Australia during the study period, 435 episodes of culture-negative peritonitis occurred in 361 individuals. Culture-negative peritonitis was not associated with demographic or clinical variables. A history of previous antibiotic treatment for peritonitis was more common with culture-negative than culture-positive peritonitis (42% vs 35%; P = 0.01). Compared with culture-positive peritonitis, culture-negative peritonitis was significantly more likely to be cured using antibiotics alone (77% vs 66%; P < 0.001) and less likely to be complicated by hospitalization (60% vs 71%; P < 0.001), catheter removal (12% vs 23%; P < 0.001), permanent hemodialysis therapy transfer (10% vs 19%; P < 0.001), or death (1% vs 2.5%; P = 0.04). Relapse rates were similar between the 2 groups. Patients with relapsed culture-negative peritonitis were more likely to have their catheters removed (29% vs 10% [P < 0.001]; OR, 3.83; 95% CI, 2.00-7.32). Administration of vancomycin or cephalosporin in the initial empiric antibiotic regimen and the timing of catheter removal were not significantly associated with clinical outcomes. Limited covariate adjustment. Residual confounding and coding bias could not be excluded. Culture-negative peritonitis is a common complication with a relatively benign outcome. A history of previous antibiotic treatment is a significant risk factor for this condition. Copyright 2010 National Kidney Foundation, Inc. All rights reserved.

0 comments Cited 26 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

The clinical course of rapidly growing nontuberculous mycobacterial peritoneal dialysis infections in Asians: A case series and literature review.

Paul Tambyah, Helen Renaud, B. Lee … (2011)

Peritoneal dialysis (PD)-related infections due to rapidly growing nontuberculous mycobacterium (RGNTM) are rare in Asians and have variable clinical outcomes. We analysed retrospectively a series of RGNTM infections in a single-centre multi-ethnic Asian population over a 5-year period. Clinical features, treatment, risk factors and outcomes are discussed. Ten infections are described. They constituted 3% of all culture-positive exit site infection (ESI) and PD peritonitis. Seventy percent were due to Mycobacterium abscessus (three ESI and four peritonitis). There were two Mycobacterim fortuitum and one Mycobacterium chelonei peritonitis. No specific findings differentiated RGNTM infections from those caused by traditional organisms. Six cases had received prior antibiotics, two being topical gentamicin. Initial routine culture and alcohol acid fast bacillus were negative except for one case of M. abscessus. A confirmatory diagnosis was made a median 9 days post culture. No infection responded to routine antibiotics. Antibiotic resistance was variable but M. abscessus was universally sensitive to clarithromycin. Combined antibiotics based on sensitivity profile were successfully used in 70% of the cases. PD catheter loss was 80%. Three-month mortality was 40% (vs. 8.5% and 12% in non-RGNTM ESI and peritonitis, respectively). This may be related to the cohort high mean Charlson score of 7.5. RGNTM PD infections are commoner in Asians than previously reported. Their early diagnosis requires a high index of suspicion and appropriate treatment started promptly. They are associated with prior antibiotic use and refractory culture-negative infections, delayed diagnosis and lead to significant catheter loss and death. © 2010 The Authors. Nephrology © 2010 Asian Pacific Society of Nephrology.

0 comments Cited 13 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Nontuberculous mycobacterial peritonitis associated with continuous ambulatory peritoneal dialysis.

Dayna Alexander, Suzanne Vernon, J. Pulliam … (1983)

We report two patients undergoing continuous ambulatory peritoneal dialysis (CAPD) in whom peritonitis developed and nontuberculous mycobacteria were isolated from peritoneal fluid. In one, Mycobacterium avium-intracellularis was the only organism isolated. Despite a three-month course of antibiotics to which the organism showed in vitro sensitivity, there was no apparent response. The patient died, and an autopsy showed disseminated mycobacterial disease. In the second case, Mycobacterium fortuitum and diphtheroids were isolated from the peritoneal fluid. Although it was not clear that the mycobacterium was solely responsible for the peritonitis in the second case, the infection failed to resolve with antibiotic therapy appropriate for diphtheroids. This patient also died. Both patients had indolent, chronic infections, although there was granulocyte predominance in the peritoneal fluid. Both had involvement of the catheter exit site. To our knowledge, these are the first reported cases of nontuberculous mycobacterial peritonitis in CAPD patients. We recommend evaluation for mycobacteria, including cultures and stains of dialysate specimens, in all cases of CAPD-associated peritonitis where no organism is identified, or where no improvement is noted after 48 hours of therapy. Repeated cultures for mycobacteria are appropriate for suggestive cases. Since these infections are difficult to treat, it may be prudent to remove the dialysis catheter if they are isolated.

0 comments Cited 5 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): BMC Nephrol

Journal ID (iso-abbrev): BMC Nephrol

Title: BMC Nephrology

Publisher: BioMed Central

ISSN (Electronic): 1471-2369

Publication date Collection: 2012

Publication date (Electronic): 8 June 2012

Volume: 13

Page: 35

Affiliations

[1 ]Department of Renal Medicine, Concord Repatriation and General Hospital, Concord, New South Wales, Australia

[2 ]School of Medicine, University of Queensland, Herston, Queensland, Australia

[3 ]School of Medicine, University of Western Sydney, Penrith, New South Wales, Australia

[4 ]Renal & Metabolic Division, The George Institute for Global Health, Camperdown, New South Wales, Australia

Article

Publisher ID: 1471-2369-13-35

DOI: 10.1186/1471-2369-13-35

PMC ID: 3443030

PubMed ID: 22682357

SO-VID: 0c3e569d-db4f-41b8-bd56-d1945b4058c9

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Mycobacterium fortuitum as a cause of peritoneal dialysis-associated peritonitis: case report and review of the literature

Read this article at

Abstract

Background

Case presentation

Conclusion

Related collections

Karger: Nephrology

Most cited references 18

Culture-negative peritonitis in peritoneal dialysis patients in Australia: predictors, treatment, and outcomes in 435 cases.

The clinical course of rapidly growing nontuberculous mycobacterial peritoneal dialysis infections in Asians: A case series and literature review.

Nontuberculous mycobacterial peritonitis associated with continuous ambulatory peritoneal dialysis.

Author and article information

Journal

Affiliations

Article

History

Categories

Comments

Comment on this article

Similar content 389

Cited by 2

Most referenced authors 145