Successful catheter reinsertion in a case of Paecilomyces varioti peritonitis in a patient on continuous ambulatory peritoneal dialysis

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Abstract

Peritonitis is one of the most common and important complications in patients on continuous ambulatory peritoneal dialysis (CAPD). Fungal peritonitis isreported in 4–8% of peritonitis episodes. Fungal peritonitis due to Paecilomyces species is not common. We report a case of CAPD peritonitis due to P. varioti. We immediately removed the CAPD catheter and IV amphotericin was administered for 4 weeks along with temporary hemodialytic support followed by successful catheter reinsertion.

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Most cited references 19

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Clinical manifestations, treatment and outcome of Paecilomyces lilacinus infections.

F J Pastor, J. Guarro (2006)

The fungus Paecilomyces lilacinus is an emerging pathogen that causes severe human infections, including devastating oculomycosis. Usually, it shows low susceptibility to conventional antifungal drugs in vitro, and variable susceptibility to novel triazoles. A review of the published literature identified 119 reported cases of human infection by P. lilacinus between 1964 and 2004. Most were cases of oculomycosis (51.3%), followed by cutaneous and sub-cutaneous infections (35.3%), and a smaller group of miscellaneous infections (13.4%). Lens implantation is the most frequent predisposing factor for oculomycosis. Cutaneous and sub-cutaneous infections occur mainly in solid organ and bone marrow transplant recipients, although surgery and primary or acquired immunodeficiency are also relevant predisposing factors. Infections in apparently immunocompetent patients have also been reported. Surgical debridement combined with antifungal drug therapy, or the correction of predisposing factors, such as neutropenia, are usually required to obtain improvement. Treatment with traditional antifungal drugs often fails. Voriconazole has demonstrated good activity in both cutaneous and ocular infections in the few cases in which this drug has been used. The new triazoles ravuconazole and posaconazole show good in-vitro activity against P. lilacinus and could be promising therapeutic alternatives.

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Fungal peritonitis in a large chronic peritoneal dialysis population: a report of 55 episodes.

F Finkelstein, A Kliger, C Torres … (1996)

Fungal peritonitis (FP) is a rare but serious complication of chronic peritoneal dialysis (CPD) therapy and is associated with high morbidity and CPD drop-out. Risk factors and management of FP remain controversial. We reviewed our experience with FP in an attempt to identify risk factors and to examine outcome in relation to treatment strategies. Between March 1984 and August 1994, 704 patients were maintained on CPD therapy in our unit. A total of 1,712 episodes of peritonitis were identified among these patients. Fungal peritonitis accounted for 55 (3.2%) of these episodes. The patients on CPD therapy who developed FP were similar to those who did not develop FP with regard to age, gender, underlying etiology for end-stage renal disease, and comorbid disease. Prior antibiotic use was noted in 87.3% of episodes of FP. The peritonitis rate in the patients who developed FP was one episode every 5.1 months compared with one episode every 9.9 patient-months in the CPD patients who did not develop this infection. Candida sp caused 74.5% of the episodes of FP. All patients were treated with antifungal drugs. In 85.5% of infections the Tenckhoff catheter was removed within 1 week of the diagnosis of FP; 31.9% of the patients who had the Tenckhoff catheter removed did not have the catheter replaced because of death or transfer to hemodialysis. In the patients who developed FP, 68.1% had the Tenckhoff catheter replaced; of these patients, 90.6% and 59.4% were on CPD therapy 1 and 6 months after catheter replacement, respectively. We conclude that risk factors identified in our population include peritonitis rate and prior antibiotic use. Fungal peritonitis is rare in our CPD population, and although it leads to significant CPD drop-out, it can be managed in many patients with antifungal therapy, early catheter removal, and temporary hemodialysis. Of the catheters replaced between 2 and 8 weeks after the diagnosis of FP, 91% functioned successfully, allowing continuation of CPD.

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Paecilomyces pyelonephritis complicating nephrolithiasis and review of Paecilomyces infections.

J A Sherwood, A Dansky (1983)

We report a case of Paecilomyces variotii isolated from the renal pelvis at ureterolithotomy. The patient presented with nephrolithiasis, acute flank pain, fever and pyuria, which resolved postoperatively. Paecilomyces has infected the cornea, prosthetic lens implants, lacrimal sac, maxillary sinuses, prosthetic mitral and aortic valves, skin and a ventriculoperitoneal shunt.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Nephrol

Journal ID (iso-abbrev): Indian J Nephrol

Journal ID (publisher-id): IJN

Title: Indian Journal of Nephrology

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0971-4065

ISSN (Electronic): 1998-3662

Publication date (Print): May-Jun 2015

Volume: 25

Issue: 3

Pages: 177-179

Affiliations

[1]Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India

Author notes

Address for correspondence: Dr. Sree Bhushan Raju, Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad - 500 082, Telangana, India. E-mail: sreebhushan@ 123456hotmail.com

Article

Publisher ID: IJN-25-177

DOI: 10.4103/0971-4065.147377

PMC ID: 4446925

SO-VID: 56a5e5c0-e4dd-4f82-9f5d-10e21178ee6c

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Successful catheter reinsertion in a case of Paecilomyces varioti peritonitis in a patient on continuous ambulatory peritoneal dialysis

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Karger: Nephrology

Most cited references 19

Clinical manifestations, treatment and outcome of Paecilomyces lilacinus infections.

Fungal peritonitis in a large chronic peritoneal dialysis population: a report of 55 episodes.

Paecilomyces pyelonephritis complicating nephrolithiasis and review of Paecilomyces infections.

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