An Unusual Organism for PD-Related Peritonitis: Hafnia Alvei

Development of Pilonidal Sinus in an Old Exit Site Four Years after Removal of the Tenckhoff Catheter

“…Late complications after removal of the PD catheter are rare. There are no contemporary large series but older reports describe an incidence of 4.3%, with late infections and abscess due to retained cuff material (10). There have been case reports of pilonidal sinus occurring in the umbilicus but, to our knowledge, it has not been reported in association with PD.…”

“…The etiology of the disease remains controversial. Our patient is unusual in that he presented so late after removal of the catheter although, in a historical series, the mean time to develop an abscess after removal of the PD catheter was 541 ± 143 days (10). More recently, the disease has been believed to be due to repeated trauma with entry of hair and cellular debris into skin, leading to a foreign-body type inflammatory reaction (8).…”

“…There is a male:female preponderance of 3:1 (6) and the condition is most common in the third decade of life (7). There are no contemporary large series but older reports describe an incidence of 4.3%, with late infections and abscess due to retained cuff material (10). A congenital disorder was originally assumed and persistent remnants of the neural canal were postulated.…”

The pathogenHafnia alveiin veterinary medicine: a review

“…As pathogen, humans have generally been considered an opportunistic bacteria, and may cause infections associated to underlying illnesses or predisposing factors as immunocompromised patients (Sakazaki & Tamura 1992), causing septicaemia (Englund 1969;Ginsberg & Goldsmith 1988;Fazal et al 1997;Liu et al 2007), endocarditis (Gallego et al 1999;Loulergue et al 2007), meningitis (Mojtabaee & Siadati 1978), pneumonia (Klapholz et al 1994;Fazal et al 1997), abscesses (Agustin & Cunha 1995), urinary infections (Sakazaki & Tamura 1992;Krieg & Sneath 1994;Ramos & Dámaso 2000;Cardile et al 2011), peritonitis (Jung et al 2010;Yap et al 2010), endophthalmitis (Ruiz-Moreno et al 2001), cholecystitis (Palaniswamy et al 2009), intestinal disorders (Harada et al 1957;Emslie-Smith 1961;Ratnam 1991;Westblom & Milligan 1992;Reina et al 1993;Ridell et al 1994) and postenteritic arthritis (Newmark et al 1994).…”

First Report of Peritoneal Dialysis–Related Peritonitis Caused by Citrobacter amalonaticus

“…The bacterium probably gained entry to our patient's peritoneum by transmural invasion from the gastrointestinal tract. Common micro-organisms causing dialysis-related peritonitis are those that can enter the abdominal cavity because of contamination during dialysate exchanges, pericatheter access from the exit site, and transluminal spread from the gastrointestinal tract or, less commonly, from a hematogenous source (6). Because C. amalonaticus is present in human feces, the gastrointestinal tract is most likely the primary source in our patient, who did not have symptoms of tunnel tract infection or systemic sepsis.…”