Neisseria Sicca/Subflava: Continuous Ambulatory Peritoneal Dialysis-Associated Peritonitis

Abstract

In this case report, we describe a rare continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis involving the gram-negative bacterium Neisseria sicca/subflava, which was reported as a grampositive coccus on Gram stain by 2 separate laboratories. Although this is not the first report of Neisseria sicca/subflava as the cause of peritonitis in a patient undergoing CAPD, it is an uncommon pathogen. Consideration must be given to uncommon pathogens and unexpected results, particularly when treatment based on laboratory results does not produce the expected outcome.

Mycobacterium Porcinum Peritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis

“…17 Reports of peritonitis caused by M.chelonae, M.abscessus and M.phlei have also been published. 5,7,17 Ours is the first reported case of PD catheter-associated peritonitis caused by M. porcinum as a separate species in the literature.…”

“…3 Therapy includes catheter removal and prolonged course of antibiotics cin, sulfamethoxazole and linezolid. 5 There is no generalized consensus on the duration of therapy. Though four to six weeks of therapy may be sufficient in uncomplicated cases, 12 a longer duration (6 months) is probably required.…”

“…3 During the 1960s, this complication occurred as frequently as 5.2-7.5 episodes per patient, per year of dialysis, but this rate has now declined to one case per patient, every 1 to 2 years. 4,5 Improvements in exchange systems design have helped decrease the occurence. 6 Though the incidence is on the decline, nearly 28% of patients switch to hemodialysis because of recurrent peritonitis.…”

“…6 Though the incidence is on the decline, nearly 28% of patients switch to hemodialysis because of recurrent peritonitis. 5,7,8 It is also implicated as a cause of death in 1-6% of patients on peritoneal dialysis (PD). 9 Fifty percent of cases of CAPD related peritonitis are caused by gram positive cocci (Staphylococcus epidermidis and Staphylococcus aureus), followed by 15% aerobic gram negative organisms, with fungi, anaerobes and mycobacteria accounting for less than 10% of cultured isolates.…”