Coccidioidal Peritonitis Associated With Continuous Ambulatory Peritoneal Dialysis

Ampel, Neil M.; White, Janelle D.; Varanasi, Umamaheswara R.; Larwood, Thomas R.; Wyck, David B. Van; Galgiani, John N.

doi:10.1016/s0272-6386(88)80088-x

Cited by 22 publications

(10 citation statements)

References 10 publications

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“…In one study, uninfected patients showed PMN counts of 0 to 40% (mean, 12% ± 2%) whereas infected patients showed PMN counts of 50 to 100% (mean, 85.5% + 2.2%) (39). Occasionally, the number of eosinophils may increase, as in patients with etiologically unclear "eosinophilic peritonitis" (46) (which resolves spontaneously within days to weeks) or fungal peritonitis (3,55,60,128,133), or in those who have had intraperitoneal administration of antibiotics (116). In mycobacterial peritonitis, lymphocytosis is rarely observed (76,101); most dialysates show a predominance of PMNs (67,79).…”

Section: Cell Count and Turbiditymentioning

confidence: 99%

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Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

1992

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The process of continuous ambulatory peritoneal dialysis has provided a useful, relatively inexpensive, and safe alternative for patients with end-stage renal disease. Infectious peritonitis, however, has limited a more widespread acceptance of this technique. The definition of peritonitis in this patient population is not universally accepted and does not always include the laboratory support of a positive culture (or Gram stain). In part, the omission of clinical microbiological findings stems from the lack of sensitivity of earlier microbiological efforts. Peritonitis results from decreased host phagocytic efficiency with depressed phagocytosis and bactericidal capacity of peritoneal macrophages. During episodes of peritonitis, fluid movement is reversed, away from the lymphatics and peritoneal membrane and toward the cavity. As a result, bloodstream infections are rare. Most peritonitis episodes are caused by bacteria. Coagulase-negative staphylococci are the most frequently isolated organisms, usually originating from the skin flora, but a wide array of microbial species have been documented as agents of peritonitis. Clinical microbiology laboratories need to be cognizant of the diverse agents so that appropriate primary media can be used. The quantity of dialysate fluid that is prepared for culture is critical and should constitute at least 10 ml. The sensitivity of the cultural approach depends on the volume of dialysate, its pretreatment (lysis or centrifugation), the media used, and the mode of incubation. The low concentration of microorganisms in dialysate fluids accounts for negative Gram stain results. Prevention of infection in continuous ambulatory peritoneal dialysis patients is associated with the socioeconomic status of the patient, advances in equipment (catheter) technology, and, probably least important, the application of prophylactic antimicrobial agents.

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Section: Cell Count and Turbiditymentioning

confidence: 99%

“…Complications such as adhesions, abscess formation, and sclerosing peritonitis as well as fatalities (at least 15% even under treatment) are also more frequent (35,129). Occasionally, eosinophilia is observed in the dialysate (3,55,60,128,133). Prolonged incubation of media is crucial for detection.…”

Section: Enterobacteriaceaementioning

confidence: 99%

Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

1992

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“…Peritonitis from disseminated disease can be acute or indolent, and is characterized by abdominal pain with or without ascites, fever, chills, and anorexia. CAPD peritonitis from H. capsulatum or Coccidioides species is characterized by fever, abdominal pain, abdominal distension, and cloudy dialysate fluid (200–2133 cells/mm 3 ) with a neutrophilic or eosinophilic predominance, respectively . An unusual manifestation of coccidioidal peritonitis is an enlarging inguinal hernia, which occurs in 30% .…”

Section: Discussionmentioning

confidence: 99%

Peritonitis caused by Blastomyces dermatitidis in a kidney transplant recipient: case report and literature review

Barocas

Gauthier

2014

Transplant Infectious Dis

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Blastomyces dermatitidis is a dimorphic fungus endemic to the midwestern, south-central, and southeastern United States known to cause disseminated infection in immunocompromised individuals. We report a case of B. dermatitidis peritonitis in a renal allograft recipient with new-onset ascites and cytomegalovirus encephalitis. Peritoneal blastomycosis is a rare clinical entity and, to our knowledge, this patient represents the first known case of peritoneal blastomycosis in a solid organ transplant recipient. We review the clinical characteristics of B. dermatitidis peritonitis as well as the literature on fungal peritonitis with emphasis on dimorphic fungal pathogens. Clinical features suggestive of fungal peritonitis include new-onset ascites, abdominal pain, and fevers, especially with antecedent or concomitant pneumonia. A high index of clinical suspicion, along with the use of culture and non-culture diagnostics, is needed for early diagnosis and prompt initiation of therapy.

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“…Peritoneal fluid eosinophilia can also be related to infection (fungal, parasitic, tubercular), and appropriate tests must be performed to rule out these diagnoses in patients at risk. An allergic mechanism has been advanced to explain some cases of eosinophilic peritonitis following intraperitoneal injection of vancomycin and streptokinase …”

Section: Cloudy Dialysatementioning

confidence: 99%

When the color of peritoneal dialysis effluent can be used as a diagnostic tool

Dossin

Goffin

2018

Seminars in Dialysis

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Peritoneal dialysis (PD) effluent is normally transparent. A change in its appearance may be the first indication of an intra- or extraperitoneal abnormality which may or may not be related to the peritoneal dialysis technique itself. What diagnosis should be considered when PD effluent turns on red, orange, cloudy, milky white, green, yellow, purple or black in color? After review of the literature, we propose a differential diagnosis, as well as some management recommendations, for specific abnormal color presentations of the PD effluent.

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Coccidioidal Peritonitis Associated With Continuous Ambulatory Peritoneal Dialysis

Cited by 22 publications

References 10 publications

Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

Peritonitis caused by Blastomyces dermatitidis in a kidney transplant recipient: case report and literature review

When the color of peritoneal dialysis effluent can be used as a diagnostic tool

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