Fungal peritonitis caused by Curvularia species in a child undergoing peritoneal dialysis

Abstract

We report the first case of peritonitis caused by Curvularia species in a child undergoing peritoneal dialysis. He presented with gray-black proteinaceous material obstructing the lumen of his Tenckhoff catheter. Although the peritoneal fluid was cloudy, the patient suffered neither significant abdominal tenderness nor systemic symptoms. Catheter removal and treatment with amphotericin B allowed complete recovery and return to peritoneal dialysis within 7 days. Outdoor play in a wooded environment may have allowed contact of this saprophytic fungus with the child's indwelling catheter transfer set.

Peritonitis Due toCurvularia inaequalisin an Elderly Patient Undergoing Peritoneal Dialysis and a Review of Six Cases of Peritonitis Associated with OtherCurvulariaspp

“…Two cases of Curvularia FP have been associated with documented gross environmental contamination. These include the case of a child who played in a wooded area (4) and that of a patient who would work in the garden prior to exchanges (20). These cases are consistent with the literature, which indicates that clinically relevant Curvularia disease is very often considered to be associated with soil contact.…”

“…In our review of the literature, we found no other cases of clinical infection due to C. inaequalis and only six other cases of a Curvularia species complicating PD (Table 1) (3,4,6,12,15,20). The mean age of the patient group was 49.4 Ϯ 18.1 years (range, 11 to 85 years).…”

Melanized Fungi in Human Disease

“…Peritonitis occurs essentially only in patients receiving peritoneal dialysis (6,8,69,97,106,115,117,144,197,261,302,305,367,405,416,461,466,563,598,605,618,619,656,690,762,765,783,784). The presentation is usually subacute, with many patients being without significant symptoms.…”

Case Report and Review: Is the Tendency for Curvularia Tubular Obstruction Significant in Pathogenesis?

“…Curvularia is a phytopathogen that causes turf blight in grass and rarely any human infection. It was reported to cause tubular obstruction with peritonitis in three previous case reports (1-3), tubular obstruction without peritonitis in three case reports (4)(5)(6), and peritonitis without tubular obstruction in two reports (7,8). Traditional risk factors have been considered to be (1) previous bacterial infection treated with antibiotics, (2) exposure to soil, (3) immunosuppression, and (4) bowel perforation (4,7,9).…”