Streptococcus agalactiae: A rare peritoneal infection in a continuous ambulatory peritoneal dialysis patient

Abstract

Streptococcus agalactiae causes a rare and often fatal peritonitis in continuous ambulatory peritoneal dialysis (CAPD). A 52-year-old white female with Alport and chronic kidney disease was initiated on CAPD treatment. Nineteen months later she had a S. agalactiae peritonitis identified and received initially gentamicin-cephalothin, which was changed to ceftazidime, tobramycin, and vancomycin. Recovery started after peritoneal catheter removal. After 3 weeks, severe leucopenia occurred. Granulokine and steroids were given. Six weeks later, she felt well and an abdominal video laparoscopic procedure disclosed a diffuse peritoneal fibrosis, precluding CAPD resumption. She is now doing well on hemodialysis (HD).

ISPD Position Statement on Reducing the Risks of Peritoneal Dialysis–Related Infections

“…Peritonitis has been reported secondary to a vaginal leak occurring after recurrent peritonitis, leading to formation of a subcompartment in the peritoneal cavity (111), or to a vaginal fistula presenting as a vaginal leak (112,113), and even to a vaginal leak in a prepubescent child on PD (114). Vaginal colonization with Streptococcus agalactiae can be the source of contamination for a female patient or for a male patient who is the partner of a colonized woman (115)(116)(117). Organisms are variable, but vaginal sources can lead to fungal peritonitis.…”