Campylobacter jejuni: A rare agent in a child with peritoneal dialysis-related peritonitis

Abstract

Peritonitis is a serious problem in children receiving peritoneal dialysis. Campylobacter jejuni is an unusual cause of peritonitis. A 10-year-old boy who had end stage renal failure due to atypical hemolytic uremic syndrome was admitted to our hospital with abdominal pain and fever. Peritoneal dialysis fluid was cloudy and microscopic examination showed abundant leukocytes. Intraperitoneal cefepime treatment was started. Campylobacter jejuni was isolated from peritoneal dialysis fluid culture and oral clarithromycin was added to the treatment. At the end of therapy, peritoneal fluid culture was negative. To our knowledge, C. jejuni peritonitis was not reported in children previously. Conclusion: Although C. jejuni peritonitis is rarely encountered in children, it should be considered as an etiologic factor for peritonitis. INTRODUCTIONPeritonitis is a major complication of peritoneal dialysis. Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus spp., Enterococcus faecalis and Escherichia coli are the most common causative pathogens for peritonitis.1 Guidelines recommend that selection of empiric therapy must cover both gram-positive and gram-negative microorganisms and a fourth-generation cephalosporin is a suitable agent. In addition a first-generation cefalosporin may be used with ceftazidime or aminoglycoside, if cefepime is not available. AfterCampylobacter jejuni: A rare agent in a child with peritoneal dialysis-related peritonitis causative organism is identified, treatment should be organized according to microorganism. 2Minimum length of therapy is two weeks, for severe infections the recommended treatment duration is three weeks. In literature Campylobacter peritonitis has been reported in adult patients. In this report we present the first pediatric case with C. jejuni peritonitis. CASE REPORTA 10-year-old boy with end stage renal failure secondary to atypical hemolytic uremic syndrome was treated with continuous ambulatory p e r i t o n e a l d i a l y s i s ( C A P D ) f o r 6 y e a r s . Methicillin resistant Staphylococcus epidermidis (MRSE) peritonitis occured in 3 rd month of dialysis treatment. Intravenous vancomycin and intraperitoneal cefazolin were used for therapy. Staphylococcus epidermidis peritonitis developed 12 months later. Four years after the second peritonitis, he admitted to hospital with abdominal pain and fever. The patient did not declare a complaint of diarrhea or constipation He reported ultrafiltration failure and peritoneal dialysis fluid was cloudy in the last 1 week. Physical examination revealed; temperature: 38.1 Cº, heart rate: 118 beats/minute, blood pressure: 130/85 mmHg, body weight: 34.5 kg (previous weight: 25 kg) and generalized edema. Ascites and tenderness were found in the abdomen. There were no signs of exitsite infection. Laboratory test results were as follows; haemoglobin: 9.4 g/dl, leukocyte count: 9500/mm 3 , platelet count: 183000/mm 3 , blood urea nitrogen: 91 mg/dl, creatinine: 7.09 mg/ dl, C-reactive protein: 78.2 mg/L, erythroc...