We describe a case of peritonitis due to Vibrio fluvialis in a patient receiving continuous ambulatory peritoneal dialysis; we believe the case to be associated with the consumption of poorly prepared seafood. This was shown to be an important but rare cause of recurrent infection in our patient.
CASE REPORTA 55-year-old Cook Island woman living in New Zealand since 1972 presented with acute peritonitis related to continuous peritoneal dialysis (CAPD). She had received CAPD for end-stage renal failure secondary to diabetic nephropathy for 3 years prior to her admission. Her treatment had been previously complicated by episodes of CAPD-associated peritonitis caused by Streptococcus mitis, coagulase-negative staphylococci, and Klebsiella pneumoniae. Each episode was treated with standard intraperitoneal and oral antibiotics.The key clinical features on this occasion were a fever of 38.2°C, cloudy peritoneal dialysis fluid (PDF), generalized abdominal pain, and peritonism (no guarding of the abdominal wall or rebound tenderness on clinical examination). Mild diarrhea and vomiting were also present; however, a stool culture was not performed. There was no inflammation of the Tenckhoff catheter exit site.Analysis of PDF revealed a leukocyte count of 1,155 ϫ 10 6 /liter, with 56% polymorphonuclear cells; gram-negative bacilli were seen in the centrifuged deposit. Empirical treatment with intravenous ceftriaxone was commenced. The following day, an oxidase-positive, gram-negative bacillus was cultured. Aerobic growth occurred on supplemented chocolate agar, with beta-hemolytic colonies seen on Columbia agar containing 5% sheep blood. Anaerobic growth occurred on fastidious anaerobic agar (Fort Richard, Auckland, N.Z.). The organism grew in the presence of 6.5% salt, differentiating it from Aeromonas spp. Smooth yellow colonies were seen on thiosulfate citrate bile salt sucrose agar, excluding V. mimicus, V. hollisae, V. parahaemolyticus, V. damselae, and V. vulnificus from the diagnosis. When a Vitek I system (BioMerieux, Auckland, N.Z.) was used, the isolate was identified with 98% probability as Vibrio fluvialis, with a bionumber of 7420360274. Its identity was also confirmed by API 20E (BioMerieux). It was differentiated from V. furnissii by fermentation of D-glucose without the production of gas, clearing of tyrosine on an agar plate, and reduction of nitrate. It was ONPG (o-nitrophenyl--D-galactopyranoside) positive and lipase negative (4). Finally, identification was confirmed by the analysis of the 16S rDNA sequence by use of a BigDye Terminator cycle sequencing ready reaction kit on an ABI Prism 3100 apparatus (Applied Biosystems, Foster City, Calif.). Sequencing of 715 nucleotides demonstrated 95.8% homology with V. fluvialis (ATCC33809T). Susceptibility testing revealed it to be susceptible to ciprofloxacin, ceftriaxone, and imipenem but resistant to amoxicillin, amoxicillin-clavulanic acid, and gentamicin.Ciprofloxacin (250 mg) was prescribed twice daily orally for 5 days. However, 2 weeks later the patient...