CAPD peritonitis caused by Lactobacillus rhamnosus

Sanyal, Debasish; Bhandari, Shruti

doi:10.1016/0195-6701(92)90019-i

Cited by 20 publications

(9 citation statements)

References 9 publications

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“…Lactobacillus bacteremia might be under diagnosed, because lactobacilli are unwieldy to culture and to identify, and, in many cases, they have been regarded as contaminants, since they are viewed as being of low virulence or as potential commensal organisms . Clinically relevant isolates of L. rhamnosus have been reported in peritonitis , endocarditis , pneumonia , arteritis , deep abdominal abscesses , and pancreatitis , but the majority of isolates have been cultured from blood. Risk factors for Lactobacillus bacteremia include chronic illness, diabetes mellitus, and immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

Lactobacillus rhamnosus bacteremia in a kidney transplant recipient

Falci

Rigatto

Cantarelli

et al. 2015

Transplant Infectious Dis

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Lactobacillus rhamnosus is a rare clinical pathogen. A case of bacteremia caused by L. rhamnosus in a kidney transplant recipient is described. Once considered only as a contaminant or a low-virulence organism, L. rhamnosus might be an opportunistic pathogen in immunocompromised patients. To our knowledge, this is the first report of primary bloodstream infection caused by L. rhamnosus in a kidney transplant recipient.

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Section: Discussionmentioning

confidence: 99%

Lactobacillus rhamnosus bacteremia in a kidney transplant recipient

Falci

Rigatto

Cantarelli

et al. 2015

Transplant Infectious Dis

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“…The patient died within several days from cardiac arrest related to gastrointestinal bleeding but not related to peritonitis. Sanyal et al reported a patient who had seven prior episodes of CAPD-related peritonitis in 2 years and had received a prolonged course of vancomycin before developing Lactobacillus rhamnosus CAPD-related peritonitis (7,8). The isolate was initially misidentified as Enterococcus avium, emphasizing the difficulties in identification of Lactobacillus spp.…”

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confidence: 99%

“…Lactobacilli are part of the normal flora of the mouth, colon, and female genital tract but are not commonly found on the skin (1,3,4,6). There have been only four cases of CAPD-related Lactobacillus peritonitis (3,5,7,9). Schleifer et al were the first to report a case of Lactobacillus CAPD-related peritonitis (9).…”

mentioning

confidence: 99%

“…are gram-positive, nonmotile, nonsporulating, facultative anaerobes. They can form long slender rods or short coccoid rods, which may appear as cocci on a Gram stain (4,7,9). Moreover, they can often form chains and can be mistaken for Streptococcus spp.…”

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confidence: 99%

“…Previous successful treatment for Lactobacillus spp. CAPDrelated peritonitis included combinations of ampicillin with gentamicin and rifampin with erythromycin, as well as rifampin and imipenem alone (3,5,7,9). In general, active agents include penicillin, imipenem, aminoglycosides, clindamycin, erythromycin, and chloramphenicol (1).…”

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confidence: 99%

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Lactobacillus paracasei Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis and Review of the Literature

et al. 2003

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We describe the first case of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis due to Lactobacillus paracasei. It occurred in a 65-year-old patient with recurrent episodes of peritonitis while he was receiving a prolonged course of intraperitoneal vancomycin. L. paracasei should be considered in the differential diagnosis of pathogens in CAPD-related peritonitis, especially in patients receiving prolonged vancomycin or glycopeptide treatment. CASE REPORTA 65-year-old diabetic male with end-stage renal disease commenced continuous ambulatory peritoneal dialysis (CAPD) in March 1999. In July 2001, he first reported abdominal discomfort and cloudy dialysate but no fever. Physical examination demonstrated a benign abdomen with a normal-appearing catheter exit site. Peritoneal fluid dialysate was hazy in appearance (white blood cell [WBC] count of 2,040/l, with 96% segmented neutrophils). Therapy with intraperitoneal aztreonam and vancomycin was initiated. Peritoneal fluid culture grew methicillin-resistant Staphylococcus haemolyticus. The patient finished a 2-week course of vancomycin with good results. Shortly thereafter (at the end of August 2001), he developed another episode of CAPD-related peritonitis (peritoneal fluid WBC count of 500/l, with 90% segmented neutrophils). This time, the peritoneal fluid Gram stain showed gram-positive cocci in chains and the culture grew alpha-hemolytic streptococcus species, not enterococcus species. He was given an additional 4 weeks of intraperitoneal vancomycin, during which his abdominal complaints and peritoneal fluid pleocytosis worsened (WBC count increased to 3,200/l, with 80% segmented neutrophils, 5% lymphocytes, and 15% monocytes). Peritoneal fluid cultures during this period revealed diphtheroids and alpha-hemolytic streptococcus species, not enterococcus species. Due to nonclearing of the peritoneal dialysate and ongoing abdominal discomfort, vancomycin was stopped and he received oral levofloxacin and intraperitoneal ceftriaxone, with mild improvement. In early October 2001, the peritoneal fluid analysis showed a WBC count of 784/l (97% segmented neutrophils and 3% monocytes), and culture grew methicillin-resistant Staphylococcus simulans; he was restarted on intraperitoneal vancomycin and continued oral levofloxacin. Two weeks later, on 18 October 2001, the peritoneal fluid analysis revealed a WBC count of 126/l, with 21% segmented neutrophils, 16% lymphocytes, 61% monocytes, and 2% eosinophils, and culture grew a Lactobacillus species, later identified as Lactobacillus paracasei. Antibiotics were stopped at that point, with the assumption that the mild cloudy dialysate effluent represented chemical peritonitis. However, he continued to have abdominal discomfort and started becoming hypotensive. Intraperitoneal vancomycin and aztreonam were started. He was later admitted to the hospital. Repeat peritoneal fluid analysis (9 November 2001) revealed a WBC count of 325/l (21% segmented neutrophils, 16% lymphocytes, 61% monocytes, and 2% eosinophil...

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Pathogenic relevance of Lactobacillus: a retrospective review of over 200 cases

Cannon

Lee

Bolanos

et al. 2004

Eur J Clin Microbiol Infect Dis

389

304

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Given that Lactobacillus has been reported to be the causative pathogen in many types of infection despite debate regarding the organism's clinical significance, a literature review was conducted to investigate the treatments and outcomes of Lactobacillus infections reported to date. In this article, the characteristics of over 200 reported cases of Lactobacillus-associated infections are summarized. Lactobacillus was found to be frequently associated with endocarditis and bacteremia. Lactobacillus was also associated with a variety of other infections including, but not limited to, peritonitis, abscesses, and meningitis. The species casei and rhamnosus were the most common. The isolates tended to be most sensitive to erythromycin and clindamycin and most resistant to vancomycin. The species that was most sensitive to vancomycin was acidophilus. The overall mortality rate was nearly 30%. There was a significant association between mortality and polymicrobial infection (P=0.004). In the subset of patients with bacteremia, increased mortality was associated with inadequate treatment (P=0.001) and polymicrobial bacteremia (P=0.044).

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CAPD peritonitis caused by Lactobacillus rhamnosus

Cited by 20 publications

References 9 publications

Lactobacillus rhamnosus bacteremia in a kidney transplant recipient

Lactobacillus rhamnosus bacteremia in a kidney transplant recipient

Lactobacillus paracasei Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis and Review of the Literature

Pathogenic relevance of Lactobacillus: a retrospective review of over 200 cases

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