Fungal Peritonitis in Continuous Ambulatory Peritoneal Dialysis—The Auckland Experience

Nagappan, Ramesh; Collins, John; Lee, Wan Tin

doi:10.1016/s0272-6386(12)70262-7

Cited by 72 publications

(78 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another Indian centre reported that FP accounted for 14.3% of all peritonitis episodes [5]. Our patients contracted FP earlier in the course of peritoneal dialysis (12.47 ± 12.33 months after the start) than reported elsewhere [3, 4]. …”

Section: Discussionsupporting

confidence: 44%

See 1 more Smart Citation

Fungal Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis: A Single-Centre Experience in India

et al. 2008

View full text Add to dashboard Cite

Aims: The clinical features, treatment and outcome of fungal peritonitis (FP) in continuous ambulatory peritoneal dialysis (CAPD) patients were examined. Methods: Dialysis records of all 303 end-stage renal disease (ESRD) patients initiated on CAPD treatment between January 1998 and February 2008 were reviewed retrospectively. Results: In the 303 patients dialysed between January 1998 and February 2008, a total of 137 bacterial peritonitis and 43 FP episodes were recorded. The incidence rate of FP was 0.67/100 patient months or 1/148.67 months. It accounted for 23.88% of all peritonitis episodes. Three factors appeared to predict mortality: the presence of non-Candida species, the catheter being left in situ and a serum albumin level <3 g/dl. Multivariate analysis yielded only the latter 2 as predictors of mortality. The use of intraperitoneal antibiotics in the 3 months before infection and low serum albumin have been identified as risk factors for contracting FP. Conclusion: Risk factors for contracting FP and for mortality due to FP have been identified.

show abstract

Section: Discussionsupporting

confidence: 44%

“…It accounted for 23.88% of all peritonitis episodes. The incidence rate of FP has been previously reported to be 6% [1], 3% [3] and 3.2% [4]. Another Indian centre reported that FP accounted for 14.3% of all peritonitis episodes [5].…”

Section: Discussionmentioning

confidence: 99%

Fungal Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis: A Single-Centre Experience in India

et al. 2008

View full text Add to dashboard Cite

show abstract

“…Although the development of EPS usually requires repeated peritoneal infections, it can sometimes be induced by a single episode of peritonitis caused by a fungal or yeast infection (6,24). Zymosan, a yeast cell wall component, induced C-dependent proliferative peritonitis in the presence of a physical peritoneal injury induced by mechanical scraping (14), suggesting that C activation could be an initiating factor for acute and chronic peritoneal inflammation (14).…”

Section: Discussionmentioning

confidence: 99%

Membrane complement regulators protect against fibrin exudation increases in a severe peritoneal inflammation model in rats

Mizuno

Ito²,

Mizuno

et al. 2012

American Journal of Physiology-Renal Physiology

View full text Add to dashboard Cite

Peritonitis and the rare sequela of encapsulating peritoneal sclerosis (EPS) are serious problems in patients on peritoneal dialysis therapy. Chronic and persistent peritoneal injuries may be a risk factor of EPS. We previously reported that a chronic, proliferative peritonitis developed when zymosan was administered intraperitoneally following scraping injury of rat peritoneum (Mizuno M, Ito Y, Hepburn N, Mizuno T, Noda Y, Yuzawa Y, Harris CL, Morgan BP, Matsuo S. J Immunol 183: 1403–1412, 2009). Peritoneal membrane complement regulators (CRegs), especially Crry and CD59, protected from injury by inhibiting local complement activation, suggesting that CRegs play important roles in maintaining homeostasis in rat peritoneum. Here, we investigated roles of complement in the development of EPS by neutralizing CReg function with monoclonal antibodies (MAbs). Proliferative peritonitis was induced by scraping the peritoneum, followed by daily intraperitoneal administration of zymosan. When either Crry or CD59 alone was neutralized by MAb, the tissue injuries were not significantly changed compared with rats without neutralizing MAb. When both Crry and CD59 were neutralized in this model, severe fibrin exudation was observed on the peritoneal surface on day 5, accompanied by inflammatory cell infiltration, resembling the early stages of development of EPS. Dense peritoneal deposition of C3 fragments and membrane attack complex were observed, along with the fibrin exudates. Intravenous administration of cobra venom factor, which profoundly activates complement, further enhanced these pathological changes. Our results show that complement activation in injured peritoneum drives peritoneal inflammation, and that enhancement of complement activation by inhibiting CReg and/or enhancing systemic activation contributes to the initiation of EPS; therefore, anti-complement agents might be of therapeutic value in humans for the treatment of EPS.

show abstract

“…Peritoneal dysfunction and sclerosis related to recurrent and/or severe infective peritonitis are risk factors for the future development of encapsulating peritoneal sclerosis (EPS) (1). Fungal peritonitis, caused by yeast infection, most often Candida sp., is not common but carries a poor prognosis (2)(3)(4). In fungal peritonitis, removal of the PD catheter is recommended to rescue the PD patients according to the 2005 guidelines from the International Society for Peritoneal Dialysis (5).…”

mentioning

confidence: 99%

Zymosan, but Not Lipopolysaccharide, Triggers Severe and Progressive Peritoneal Injury Accompanied by Complement Activation in a Rat Peritonitis Model

Mizuno

Ito

Hepburn

et al. 2009

The Journal of Immunology

View full text Add to dashboard Cite

Fungal peritonitis is an important complication in peritoneal dialysis patients; either continuous or recurrent peritonitis may enhance peritoneal damage. Even when the peritoneal dialysis catheter is removed in patients with fungal peritonitis, peritoneal fibrosis can progress and evolve into encapsular peritoneal sclerosis. It is unclear why fungal infections are worse than bacterial in these respects. Zymosan is a cell wall component of yeast that strongly activates the complement system. In this study, we compared the effects of zymosan and bacterial LPS on peritoneal inflammation in a rat peritoneal injury model induced by mechanical scraping. Intraperitoneal administration of zymosan, but not LPS or vehicle, caused markedly enhanced peritonitis with massive infiltration of cells and deposition of complement activation products C3b and membrane attack complex on day 5. In rats administered zymosan and sacrificed on days 18 or 36, peritoneal inflammation persisted with accumulation of ED-1-positive cells, small deposits of C3b and membrane attack complex, exudation of fibrinogen, and capillary proliferation in subperitoneal tissues. When zymosan was administered daily for 5 days after peritoneal scrape, there was even greater peritoneal inflammation with peritoneal thickening, inflammatory cell accumulation, and complement deposition. Inhibition of systemic complement by pretreatment with cobra venom factor or local inhibition by i.p. administration of the recombinant complement regulator Crry-Ig reduced peritoneal inflammation in zymosan-treated rats. Our results show that yeast components augment inflammation in the injured peritoneum by causing complement activation within the peritoneal cavity. Local anticomplement therapy may therefore protect from peritoneal damage during fungal infection of the peritoneum.

show abstract

Fungal Peritonitis in Continuous Ambulatory Peritoneal Dialysis—The Auckland Experience

Cited by 72 publications

References 16 publications

Fungal Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis: A Single-Centre Experience in India

Fungal Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis: A Single-Centre Experience in India

Membrane complement regulators protect against fibrin exudation increases in a severe peritoneal inflammation model in rats

Zymosan, but Not Lipopolysaccharide, Triggers Severe and Progressive Peritoneal Injury Accompanied by Complement Activation in a Rat Peritonitis Model

Contact Info

Product

Resources

About