Peritonitis Caused by Monilia sitophila in a Patient Undergoing Peritoneal Dialysis

Abstract

Fungi have become an increasingly important cause of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. The most common cause of fungal peritonitis is Candida. However, in recent years unusual and "nonpathogenic" fungi have been reported as etiologic agents of CAPD-associated peritonitis. We are reporting the first case of CAPD-associated peritonitis caused by Monilia sitophila. This organism had previously been considered to be non-pathogenic, and a troublesome laboratory contaminant. Our patient was successfully managed with intravenous and intraperitoneal amphotericin B, followed by oral itraconazole, without removal of her Tenckhoff catheter.

Developments in Fungal Taxonomy

“…Neurospora sitophila is the teleomorph of Chrysonilia sitophila (syn. Monilia sitophila), a common laboratory contaminant that is usually known as "bread mold," which has caused several cases of human infection (253,444,541). This and other species of the genus have been the subject of a surprising number of genetic and molecular studies.…”

Case Report. Candida lusitaniae peritonitis in a patient on continuous ambulatory peritoneal dialysis

“…Fungal peritonitis has become increasingly important because of its high morbidity and CAPD drop‐out, causing 3.5–15% of all cases of peritonitis [1]. Most fungal peritonitis cases are caused by Candida albicans or other Candida species such as Candida guilliermondii , Candida krusei , Candida parapsilosis and Candida tropicalis [1–5]. However, in recent years, unusual fungi have been reported as etiologic agents of CAPD‐associated peritonitis [2].…”

“…Most fungal peritonitis cases are caused by Candida albicans or other Candida species such as Candida guilliermondii , Candida krusei , Candida parapsilosis and Candida tropicalis [1–5]. However, in recent years, unusual fungi have been reported as etiologic agents of CAPD‐associated peritonitis [2]. Candida lusitaniae has recently been encountered as an opportunistic pathogen in immunocompromised patients and may cause life‐threatening infections in the immunocompromised host [6].…”

Fatal Hormonema dematioides Peritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis: Criteria for Organism Identification and Review of Other Known Fungal Etiologic Agents

“…Investigators reviewing significant numbers of CAPD-associated fungal peritonitis episodes cite yeasts, particularly Candida species, as the predominant etiologic agents (10,12,13,20,29,37,38,50,52,53,54,58,61,63,65,66,68,73,78). Filamentous fungi complicating CAPD, although reported less frequently and fewer in number, encompass a wide array of agents, from the classic, systemic pathogens (4,42,45) to zygomycetous species (55,64) and members of numerous moniliaceous (3,11,16,25,27,30,33,39,40,48,51,57,67,71,75,76,77) and dematiaceous genera (1,2,6,7,14,21,…”

“…Had the filamentous and dematiaceous nature of the etiologic agent been known earlier, the institution of itraconazole therapy, with or without amphotericin B, may have facilitated defervescence. Several reports cite its use in CAPD-associated fungal peritonitis (12,22,28,39,67,77).…”