Peritonitis Due to Drechslera spicifera Complicating Continuous Ambulatory Peritoneal Dialysis

O’Sullivan, Frank X.; Stuewe, Bradley R.; Lynch, Joseph M.; Brandsberg, John W.; Wiegmann, Thomas; Patak, Ram V.; Barnes, William G.; Hodges, Glenn R.

doi:10.7326/0003-4819-94-2-213

Cited by 35 publications

(10 citation statements)

References 7 publications

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“…However, there are isolated reports of cure with antifungal therapy alone using 5-flucytosine [3. 36, 37], miconazole [38], kétocon azole [39] and amphotericin [40], although one of our patients was cured without catheter removal, our experi ence over the 14-year period supports the importance of catheter removal/replacement. Antifungal therapy with out catheter removal/replacement appeared to suppress rather than eradicate the fungal infection, and multiple complications including relapsing infection, catheter out flow obstruction, intestinal adhesions and extracellular volume excess occurred in these patients.…”

Section: Discussionmentioning

confidence: 73%

Fungal Peritonitis in Patients on Peritoneal Dialysis: Incidence, Clinical Features and Prognosis

et al. 1985

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Fungal peritonitis occurred in 17 patients on chronic peritoneal dialysis. The incidence of infection per 100 patient-dialysis months was 0.36 for patients on intermittent peritoneal dialysis and 1.6 for patients on continuous ambulatory dialysis (p < 0.005). Initial clinical findings included abdominal pain (76%), fever (59%), cloudy dialysate (76%) and poor dialysate outflow (6%). 15 patients received antibiotics within 4 weeks of developing peritonitis. All infections were caused by yeasts, with Candida parapsilosis and Candida albicans as the most common species. 14 patients were unable to continue peritoneal dialysis due to persistent or relapsing infection or the development of complications. 2 of the 3 patients who were able to continue peritoneal dialysis were treated with catheter replacement, intraperitoneal miconazole and oral ketoconazole.

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Section: Discussionmentioning

confidence: 73%

Fungal Peritonitis in Patients on Peritoneal Dialysis: Incidence, Clinical Features and Prognosis

et al. 1985

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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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“…The disadvan tages consist in having to remove and replace the cathe ter, which weakens the abdominal wall, and increases the stress and discomfort to the patient. Fungal peritonitis often recovers in patients treated with intermittent perito neal dialysis without removing the catheter [2,3,7,14]. In the series of Bayeret al [2] of 10 cases of fungal peritoni tis, 4 recovered with only peritoneal lavage, 2 recovered with peritoneal lavage associated with local and systemic antifungal therapy, and 3 recovered after removal of the catheter.…”

Section: Discussionmentioning

confidence: 99%