Fungal Peritonitis in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: A Report of Three Cases

Öz

Fungal peritonitis is a serious complication for patients undergoing continuous ambulatory peritoneal dialysis (CAPD). This retrospective study evaluates the clinical findings and treatment of three patients with chronic renal failure undergoing CAPD and had fungal peritonitis episodes at least once. In all cases the agents, responsible for the peritonitis, were non-albicans Candida species; all three had history of bacterial peritonitis and were under antibiotic therapy; all of them also had co-morbid diseases like diabetes mellitus and congestive hearth failure. Other common findings were hipoalbuminemia and anemia. They responded well to intraperitoneal fluconazole therapy. In two patients, remaining catheter in situ caused recurrence of fungal peritonitis.. Fungal peritonit (FP), sürekli ayaktan periton diyalizi (SAPD) programında olan kronik böbrek yetmezliği hastalarda nadir görülen, ancak fatal sonuçlanabilecek bir komplikasyondur. Biz bu çalışmamızda kliniğimizde izlediğimiz üç fungal peritonit vakasını ele aldık. Her üç olguda da etken non-albicans candida idi; bakteriyel peritonit nedeni ile antibiyotik tedavisi altında iken FP gelişmişti; bir önceki peritonit etkenleri gram negatif bakterilerdi; diabetes mellitus, konjestif kalp yetmezliği gibi eşlik eden dahili problemleri vardı. Hastalarda saptanan bir diğer ortak nokta hipoalbuminemi ve anemilerinin olması idi. Flukonazol ile yapılan intraperitoneal tedaviye yanıt alındı. Ancak periton diyaliz katateri çekilmediği takdirde fungal peritonitin tekrarladığı saptandı.

Anahtar Kelimeler

• Periton diyalizi
• fungal peritonit
• kandida

Fungal Peritonitis in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: A Report of Three Cases

Öz

Fungal peritonitis is a serious complication for patients undergoing continuous ambulatory peritoneal dialysis (CAPD). This retrospective study evaluates the clinical findings and treatment of three patients with chronic renal failure undergoing CAPD and had fungal peritonitis episodes at least once. In all cases the agents, responsible for the peritonitis, were non-albicans Candida species; all three had history of bacterial peritonitis and were under antibiotic therapy; all of them also had co-morbid diseases like diabetes mellitus and congestive hearth failure. Other common findings were hipoalbuminemia and anemia. They responded well to intraperitoneal fluconazole therapy. In two patients, remaining catheter in situ caused recurrence of fungal peritonitis..

Anahtar Kelimeler

• Peritoneal dialysis
• fungal peritonitis
• candida

Kaynakça

1. 1. Prasad N, Gupta A. Fungal peritonitis in peritoneal dialysis patients. Perit Dial Int 2005;25:207-22.
2. 2. Bren A. Fungal peritonitis in patients on continuous ambulatory peritoneal dialysis. Eur J Clin Microbiol Infect Dis 1998; 17: 839-43.
3. 3. Goldie SJ, Kiernan-Tridle L, Torres C, et al. Fungal peritonitis in a large chronic peritoneal dialysis population: a report of 55 episodes. Am J Kidney Dis 1996;20:396-411.
4. 4. Michel C, Courdavault L, al Khayat R, Viron B, Roux P, Mignon F. Fungal peritonitis in patients on peritoneal dialysis. Am J Nephrol 1994;14:113-20.
5. 5. The CARI guidelines, Treatment of peritoneal dialysis-associated fungal peritonitis. http://www.cari. org.au/Part_4_10_Treatment_of_PD_associated_fungal_p eritonitis.pdf. Access date: 10.01.2007.
6. 6. Prasad KN, Prasad N, Gupta A, Sharma RK, Verma AK, Ayyagari A. Fungal peritonitis in patients on continuous ambulatory peritoneal dialysis: a single centre Indian experience. J Infect 2004;48:96-101.
7. 7. Kaitwatcharachai C. Candida parapsilosis peritonitis in patients on CAPD. Mycopathologia 2002; 154: 181-4.
8. 8. Wang AY, Yu AW, Li PK, et al. Factors predicting outcome of fungal peritonitis in peritoneal dialysis:analysis of a 9-year experience of fungal peritonitis in a single center. Am J Kidney Dis 2000; 36:1183-92.

9. 9. Kleinpeter MA, Butt AA. Non Candida albicans fungal peritonitis in continuous ambulatory peritoneal dialysis patients. Adv Perit Dial 2001;17:176-9.
10. 10. Nannini EC, Paphitou NI, Ostrosky-Zeichner L. Peritonitis due to Aspergillus and zygomycetes in patients undergoing peritoneal dialysis: report of 2 cases and review of the literature. Diagn Microbiol Infect Dis 2003;46:49-54.