Fungal Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis

Kerr, Clark M.; Perfect, John R.; Craven, Philip C.; Jorgensen, James H.; Drutz, David J.; Shelburne, John D.; Gallis, Harry A.; Gutman, Robert

doi:10.7326/0003-4819-99-3-334

Cited by 208 publications

(105 citation statements)

References 13 publications

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“…Both long-term PD therapy and infection play roles in the development of EPS in the PD patient. Fungal infections cause severe infectious peritonitis related to PD therapy, although they are not common (33). Peritoneal fungal infection provokes consideration of withdrawal of PD therapy in the patient according to recent guidelines (5), because of the poor prognosis and risk of development of EPS.…”

Section: Discussionmentioning

confidence: 99%

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

Mizuno

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Hepburn

et al. 2009

The Journal of Immunology

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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.

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Section: Discussionmentioning

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

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“…Less frequently, the infection may occur as a result of skin breakdown, such as burns and wounds (74), or the presence of foreign bodies, such as keratitis in contact lens wearers (23), which at times causes outbreaks of fusarial keratitis (16). Peritonitis in patients receiving continuous ambulatory peritoneal dialysis has also been described (34,52,92). Other infections in immunocompetent patients include sinusitis (56), pneumonia (62,97), thrombophlebitis (69), fungemia with or without organ involvement (74,104), endophtalmitis (35,86), septic arthritis (51), and osteomyelitis (10).…”

Section: Epidemiology and Clinical Spectrum Of Fusariosismentioning

confidence: 99%

Fusarium Infections in Immunocompromised Patients

2007

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SUMMARY Fusarium species cause a broad spectrum of infections in humans, including superficial, locally invasive, and disseminated infections. The clinical form of fusariosis depends largely on the immune status of the host and the portal of entry, with superficial and localized disease occurring mostly in immunocompetent patients and invasive and disseminated disease affecting immunocompromised patients. Risk factors for severe fusariosis include prolonged neutropenia and T-cell immunodeficiency, especially in hematopoietic stem cell transplant recipients with severe graft-versus-host disease. The most frequent presentation of disseminated fusariosis is a combination of characteristic cutaneous lesions and positive blood cultures, with or without lung or sinus involvement. The prognosis is poor and is determined largely by degree of immunosuppression and extent of infection, with virtually a 100% death rate among persistently neutropenic patients with disseminated disease. These infections may be clinically suspected on the basis of a constellation of clinical and laboratory findings, which should lead to prompt therapy. Treatment options include the lipid formulations of amphotericin B, voriconazole, and posaconazole. Prevention of fusarial infection among high-risk patients should be considered.

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“…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.…”

Section: Phaeohyphomycosismentioning

confidence: 99%

Melanized Fungi in Human Disease

2010

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SUMMARY Melanized or dematiaceous fungi are associated with a wide variety of infectious syndromes. Many are soil organisms and are generally distributed worldwide, though certain species appear to have restricted geographic ranges. Though they are uncommon causes of disease, melanized fungi have been increasingly recognized as important pathogens, with most reports occurring in the past 20 years. The spectrum of diseases with which they are associated has also broadened and includes allergic disease, superficial and deep local infections, pneumonia, brain abscess, and disseminated infection. For some infections in immunocompetent individuals, such as allergic fungal sinusitis and brain abscess, they are among the most common etiologic fungi. Melanin is a likely virulence factor for these fungi. Diagnosis relies on careful microscopic and pathological examination, as well as clinical assessment of the patient, as these fungi are often considered contaminants. Therapy varies depending upon the clinical syndrome. Local infection may be cured with excision alone, while systemic disease is often refractory to therapy. Triazoles such as voriconazole, posaconazole, and itraconazole have the most consistent in vitro activity. Further studies are needed to better understand the pathogenesis and optimal treatment of these uncommon infections.

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Fungal Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis

Cited by 208 publications

References 13 publications

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

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

Fusarium Infections in Immunocompromised Patients

Melanized Fungi in Human Disease

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