Mycobacterium phlei peritonitis: a rare complication of chronic peritoneal dialysis
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Dialysis Brief report
Mycobacterium phlei peritonitis: a rare complication of chronic peritoneal dialysis Elahna Paul and Prasad Devarajan Division of Pediatric Nephrology, Yale University School of Medicine, New Haven, Connecticut, USA Received May 27, 1997; received in revised form August 1, 1997; accepted August 7, 1997
Abstract. We report the first case of chronic ambulatory peritoneal dialysis-associated peritonitis caused by Mycobacterium phlei. This organism was isolated from the peritoneal fluid of a patient who presented with recurrent episodes of ªculture-negativeº peritonitis. The therapeutic regimen was based on previous experience with other rapidly growing atypical mycobacteria, and included removal of the Tenckhoff catheter, institution of hemodialysis, and anti-mycobacterial therapy with amikacin, cefoxitin, and doxycycline. This successfully eradicated the organism, and permitted subsequent cadaveric renal transplantation with routine immunosuppression. Key words: Continuous ambulatory peritoneal dialysis ± Atypical mycobacteria ± Peritonitis ± Amikacin ± Mycobacterium phlei
Introduction Peritonitis remains the most important complication of chronic ambulatory peritoneal dialysis (CAPD), with an average incidence of 1.3 episodes per patient per year [1]. These infections are usually caused by Gram-positive (60%±70%), Gram-negative (20%±30%) or fungal (3%± 5%) species. In many cases [ranging from 3% to as many as 30% of CAPD peritonitis, as defined by peritoneal fluid white blood cell (WBC) count 4 100 cells/ml], the above organisms are not isolated [1]. Increased awareness and improved diagnostic procedures have revealed that such cases may be caused by a number of rare pathogens, including a variety of atypical mycobacteria. We report a case of CAPD peritonitis due to Mycobacterium phlei, which is generally considered to be a non-pathogenic environmental organism. Successful therapy, including removal of the Tenckhoff catheter, hemodialysis, and anti-mycobacterial therapy (amikacin, cefoxitin, and doxycycline) allowed for Correspondence to: P. Devarajan, Division of Pediatric Nephrology, 3105 LMP, 333 Cedar Street, New Haven, CT 06520, USA
subsequent cadaveric renal transplantation with routine immunosuppression. Case report A 17-year-old male on CAPD was admitted for evaluation of abdominal pain. Three years previously, CAPD had been instituted via a Tenckhoff catheter for end-stage renal disease secondary to biopsyproven focal and segmental glomerulosclerosis. He had been well until 3 weeks prior to admission, when he developed abdominal pain, fever, and cloudy dialysate. Peritoneal fluid WBC count was elevated at 760 cells/ml, but Gram stain and routine cultures revealed no organisms. Vancomycin was given as empiric therapy (intravenously, since he had a history of non-compliance with intraperitoneal antibiotics), with resolution of symptoms. Abdominal pain returned 4 days prior to admission, with elevated peritoneal fluid WBC count. Once again, Gram stain and cultures were negative for bacte
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