<i>Mycobacterium fortuitum </i>Peritonitis in Two Patients Receiving Continuous Ambulatory Peritoneal Dialysis

Abstract

We present two cases of non-resolving peritonitis treated with a standard peritonitis protocol. The organism identified from the peritoneal effluent was Mycobacterium fortuitum, a group IV (Runyon’s classification) rapidly growing, nontuberculous mycobacterium. M. fortuitum is ubiquitous and can be isolated from a number of natural sources. Risk factors these two patients had for developing M. fortuitum peritonitis included underdialysis, the immunocompromised state associated with end stage renal disease, prior or prolonged broad spectrum antibiotic treatment, and possible exposure to environmental factors, since both were hospitalized at about the same time. The isolates were resistant to the conventional antibiotics recommended for the treatment of this mycobacterium. Both patients, however, responded to catheter removal and antibiotics administered according to the sensitivities of the mycobacterium isolated.

A hospital-acquired outbreak of catheter-related nontuberculous mycobacterial infection in children on peritoneal dialysis

“…It is extremely rare to find PD catheter-related NTB mycobacterial infections. Previous articles dealing with PD catheter-related infection were reviewed, and their main features are shown in Table 2 [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Summarizing the previous reports, adults (17 men, 12 women) had an average age of 47.7 ± 18.1 years at the time of diagnosis with PD catheter-related infection.…”

Mycobacterium fortuitum Peritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis (CAPD): A Case Report

“…Although mycobacterial infections are uncommon, they occur ten times more frequently in patients with ESRD than in patients with normal renal function, because of impaired cellular immunity [3]. Non-tuberculous (atypical) mycobacteria, including rapidly growing species, have sporadically been identified as aetiologic agents in continuous ambulatory peritoneal dialysis (CAPD) peritonitis [4][5][6][7][8][9].…”

“…This organism displays lowinherent pathogenicity, but when it is inoculated into a sterile body site, such as through accidental trauma or surgery or through the CAPD catheter into the peritoneum, it may cause a serious infection. It has been identified as a cause of sporadic post-surgical infections, as well as of outbreaks of nosocomial disease that involve dialysis [4][5][6][7][8][9] and specific types of surgery [11]. In this case, the patient had undergone surgical procedures twice, that could probably have resulted in infection with M. fortuitum.…”

Nontuberculous Mycobacterial Peritonitis in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis

“…Consequently, only a limited number of previous cases have been curable with medications 8,11,14) , and in most cases of NTM peritonitis, the PD therapies have eventually been discontinued 6,8,11,15) . Among the antimicrobial drugs, AMK 1,[6][7][8][9][10] , CAM 1,9,11,13,14) , fluoroquinolones 1,8,11,14) , and imipenem 1) have been reported to be effective in some cases with NTM peritonitis and exit-site infection.…”