Successful in situ Treatment of a Fungal Peritonitis during CAPD

Abstract

A case of Candida peritonitis during continuous ambulatory peritoneal dialysis (CAPD) which recovered with intraperitoneal 5-fluorocytosine alone is reported. This seems to be the first case of fungal peritonitis during CAPD without removing the catheter to be described in the literature.

Fungal Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis

“…[17], 20 out of 22 cases of fungal peritoni tis, of which 13 were due to Candida sp., were successfully treated without catheter removal. These findings along with other studies reported in the literature demonstrate that local and systemic treatment with antifungal agents while continuing CAPD has met with success [12,16,17], but also some failures [1,4,[10][11][12]15).…”

“…This agent has been knonw to be poorly tolerated when mixed with the dialysate and given intraperitoneally [1,5,16], In addi tion, amphotericin B precipitates in electrolytic and/or acidic solutions, two characteristics of the dialysate used for CAPD. Therefore, if amphotericin B is administered by this route, it is possible that it will lose its antifungal activity.…”

Chemotherapy and/or Removal of the Peritoneal Catheter in the Management of Fungal Peritonitis Complicating CAPD?

“…They continued C A P D and 1 year after cessation of therapy had no evidence o f recurrence. Although appropriate therapy of fungal peritonitis in patients undergoing C A P D still re mains controversial, our experience, like that o f Poche ville et al [3], seems to suggest that a protracted course of 5 -F C therapy may be useful for the management of fungal peritonitis caused by susceptible strains o f Can dida Albicans and Torulopsis glabrata without having to remove the peritoneal catheter.…”

“…Medical therapy remains a critical problem and so far has not been uniformly successful. Peritoneal catheter removal is, at present, the recommended method for its treatment [1,2], We read with interest the recent paper by Pocheville et al [3] which reports a case of Candida peritonitis during chronic ambulatory perito neal dialysis (C A P D ) recovered with intraperitoneal ad ministration o f 5-fluorocytosine (5-FC) without remov ing the catheter. We report here our experience with this drug in the treatment o f fungal peritonitis in patients on C A P D .…”

Catheter Removal for Fungal Peritonitis: Sooner or Later?

“…In 1976, Mandell et al described 2 patients on continuous ambulatory peritoneal dialysis (CAPD) with Candida albicans peritonitis who were successfully treated with low-dose intravenous amphotericin and catheter removal (4). Lempert and Jones and Pocheville et al each successfully treated 1 CAPD patient with Candida species peritonitis with oral flucytosine and intravenous miconazole and intraperitoneal flucytosine, respectively, without catheter removal (5,6). Similarly, Benevent et al treated 5 cases of fungal peritonitis with amphotericin or miconazole and flucytosine.…”