Fungal Peritonitis in Children on Continuous Ambulatory Peritoneal Dialysis

Abstract

Between 1979 and 1985, six of 26 patients undergoing continuous ambulatory peritoneal dialysis developed fungal peritonitis. All had received antibacterial therapy with cefamandole and/or netilmicin prior to the diagnosis. The causal organisms were Candida albicans (three), Candida glabrata (one), Cryptococcus laurentii (one) and Saccharomyces cerevisiae (one). Treatment comprised catheter removal preceded by antifungal drugs (flucytosine and/or amphotericin B) in four patients and catheter removal alone in two. All patients were transferred to haemodialysis and five of the six developed extensive intra-abdominal adhesions. The most prudent management of fungal peritonitis in children would seem to be early cannula removal.

Successful Treatment of <i>Cryptococcus laurentii</i> Peritonitis in a Patient on Peritoneal Dialysis

“…Cultures of samples yielded C. laurentii in 2 cases, and C. neoformans in 6 cases, but the Cryptococcus species of the remaining 2 cases were not stated. Therefore, to the best of our knowledge, only 2 cases of peritonitis in PD patients caused by C. laurentii have been reported (10,11). The PD catheters were removed in these 2 cases, resulting in successful treatment and survival (10,11).…”

“…Therefore, to the best of our knowledge, only 2 cases of peritonitis in PD patients caused by C. laurentii have been reported (10,11). The PD catheters were removed in these 2 cases, resulting in successful treatment and survival (10,11). Both were adolescent females, and neither was on immunosuppressive therapy.…”

“…However, the incidence of infection due to these organisms, such as Cryptococcus laurentii (C. laurentii) and Cryptococcus albidus (C. albidus), has increased over the past four decades (8,9). We know of two reported cases of peritonitis in PD patients caused by C. laurentii (10,11). We herein report a case of peritonitis caused by C. laurentii in an adult patient on PD.…”

Non-neoformans Cryptococcal Infections: a Systematic Review

“…In patients with fungemia, the mean duration of treatment was 25 days (ranged 14-33 days) [31][32][33][34][35], while it was longer for lung abscess (42 days) [46] and peritonitis (60 days) [54]. In one patient with peritonitis, successful treatment was restricted to removal of the peritoneal catheter followed by peritoneal irrigation with saline solution [55]. In one patient with fungemia, a 14-day course of amphotericin B plus flucytosine was successful [4].…”

“…In these cases, non-pharmocologic treatments, such as catheter or infected-tissue removal, were successful alone or in combination with antifungal agents [51,54,55]. Amphotericin B, at the similar dose and duration recommended for C. neoformans infection, [56] seemed effective for non-neoformans cryptococcal infection.…”