Environmental Mycobacterial Peritonitis Complicating Peritoneal Dialysis: Three Cases and Review

Abstract

Mycobacterial peritonitis is rare among patients undergoing peritoneal dialysis. It is usually caused by group IV environmental mycobacteria. We report three such cases and review the literature on this subject. Negative results in routine bacterial cultures and persistent peritonitis may be the only clues indicating the presence of mycobacterial infection. The lack of specific symptoms and signs as well as inadequate culture techniques may delay diagnosis. Multiple cultures of centrifuged dialysis fluid may be required for isolation of the organism. Peritoneal biopsy may yield additional diagnostic information. Management frequently entails removal of the dialysis catheter in addition to antimicrobial therapy. Significant morbidity may ensue if treatment is delayed. Amikacin--with or without another antibiotic--provides adequate coverage.

A hospital-acquired outbreak of catheter-related nontuberculous mycobacterial infection in children on peritoneal dialysis

“…It is extremely rare to find PD catheter-related NTB mycobacterial infections. Previous articles dealing with PD catheter-related infection were reviewed, and their main features are shown in Table 2 [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Summarizing the previous reports, adults (17 men, 12 women) had an average age of 47.7 ± 18.1 years at the time of diagnosis with PD catheter-related infection.…”

“…One week later, granulation tissue and purulent discharge again developed at the exit site. The peripheral white blood cell (WBC) count was 8,190/mm 3 , with 59.5 % neutrophils and a C-reactive protein (CRP) level of 1.3 mg/dL. The peritoneal fluid WBC count contained 3.9/ mm 3 .…”

Mycobacterium Porcinum Peritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis

“…11 Infection of the peritoneum is thought to be initiated via colonization of the dialysis fluid and catheter. 12 As with bacterial infections, fever, abdominal pain and cloudy dialysis fluid are the most common presenting symptoms. 12 But the presentation is generally subacute, with initial vague systemic complaints followed by abdominal symptoms.…”

“…12 As with bacterial infections, fever, abdominal pain and cloudy dialysis fluid are the most common presenting symptoms. 12 But the presentation is generally subacute, with initial vague systemic complaints followed by abdominal symptoms. 17 Vomiting, diarrhea and weight loss may also occur.…”

“…Although rare, NTM peritonitis is an important clinical entity as these infections are not well known to clinicians, are difficult to diagnose and can lead to significant morbidity. 12 Mycobacterium porcinum is a rapidly growing NTM that was recently identified as capable of causing human infections. We report a case of dialysis catheter-associated peritonitis caused by M. porcinum in a patient on CAPD.…”