Along came a spider: an unusual organism identified in a peritoneal dialysis patient, a case report and literature revie
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CASE REPORT
Open Access
Along came a spider: an unusual organism identified in a peritoneal dialysis patient, a case report and literature review Victoria Jane Carnall1* , Stephanie Murdock2, Cressida Auckland2 and Christopher J. Mulgrew1
Abstract Background: Peritoneal dialysis-associated peritonitis can uncommonly be caused by fungal infections. When they do present, they are associated with significant mortality and morbidity. We describe a case where a sample of peritoneal dialysate fluid grew Rhodotorula muciliginosa, a yeast organism present in the normal environment which has previously been reported as rarely causing peritonitis. We believe this is the first case where the Rhodotorula spp. and its origin has been identified. Case presentation: A 20 year old male grew Rhodotorula muciliginosa from his peritoneal dialysis fluid on three separate occasions when a fluid sample was sent following a disconnection and subsequent set change. He was not systemically unwell and his peritoneal dialysate was clear. As Rhodotorula spp. is exceedingly difficult to treat our patient had his Tenchkoff catheter removed. Subsequent samples of soil and sand from his bearded dragon and Chilean tarantula cases, kept in his bedroom where dialysis occurred, were tested. The tarantula sand was identified as the source of the Rhodotorula spp. Of note, Candida was isolated from sand from the bearded dragon case. Once his Tenchkoff was removed he was treated with an intravenous course of antifungal therapy. He has since had a new Tenchkoff catheter inserted and recommenced PD following education around pets and hygiene. Conclusions: In this era where people are keeping increasingly rare and unusual wildlife in their homes, this case highlights the need for clinician and nursing staff awareness of a patient’s home environment and hobbies when they are undergoing peritoneal dialysis. Sand from our patient’s tarantula case grew the colonising organism but interestingly soil from his bearded dragon case also isolated candida. This can also cause difficult to treat peritonitis. Keywords: Peritonitis, Pets, Fungal infection, Rhodotorula, Zoonotic, Case report
Background Fungal infections are an uncommon but serious cause of PD (Peritoneal Dialysis)-associated peritonitis [1]. The incidence worldwide is heterogenous with rates varying from 2 to 23.8% [2]. In the United Kingdom an audit study reported a fungal peritonitis rate of 0.0099/patient year from centres not using prophylaxis and a lower rate of 0.0032/patient year in centres using daily oral * Correspondence: [email protected] 1 Exeter Kidney Unit, Royal Devon and Exeter Foundation Trust, Exeter, Devon, UK Full list of author information is available at the end of the article
fluconazole [3]. Despite its rarity fungal peritonitis is important due to its associated higher rates of catheter loss, morbidity and mortality [3]. Candida species are the commonest pathogen isolated in fungal peritonitis, accounting for 70–90% of the cases described [3]. Patients at particular risk for
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