Mycobacterium Abscessus: A Case Report Of Peritoneal Dialysis Peritonitis (original) (raw)
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BMC Nephrology
Background Peritoneal dialysis (PD) is a form of therapy for end-stage kidney disease (ESKD), and peritonitis is a known complication. Mycobacterium (M) species associated peritonitis in PD patients is uncommon. Our experience of managing PD associated peritonitis caused by M abscessus in a middle-aged man with ESKD due to focal segmental glomerulosclerosis is shared in this article with a review of the literature on this condition. Case presentation A 49-year old man presented to our unit with symptoms of peritonitis and cloudy PD effluent. Initial analysis of PD fluid showed Gram stain was negative, with no organism grown. Empirical PD peritonitis treatment with intra-peritoneal antibiotics did not improve his symptoms and he required intravenous antibiotics, PD catheter removal and a switch to haemodialysis. Cultures of the PD fluid later grew M abscessus, and the antibiotic regimen was changed appropriately, leading to clinical improvement. Conclusion M abscessus associated peri...
Renal Replacement Therapy, 2018
Background: Peritoneal dialysis (PD)-associated peritonitis caused by nontuberculous mycobacteria (NTM), including Mycobacterium abscessus (M. abscessus), is a rare but serious complication that forces PD to be withdrawn. Several cases of peritonitis by NTM have been reported, and optimal treatment has not yet been established. Case presentations: We report two cases of PD-associated peritonitis caused by M. abscessus. In both cases, peritonitis developed after an exit-site infection. The patients did not have any typical signs of peritonitis or an elevated nucleated cell count of the dialysis effluent in the early phase. In addition, effluent cultures were negative at admission in both cases, although M. abscessus was identified in effluent cultures in the late phase. One patient recovered after the PD catheter was removed, and multi-antibiotic treatment was administered for 6 months. The other patient subsequently developed encapsulating peritoneal sclerosis (EPS) 16 months after the onset of infection. In addition, the EPS was complicated by intestinal perforation into infected ascites. The infection resolved with antibiotic treatment and octreotide administration to diminish bowel leakage into the infected cavity. Conclusions: The combination of amikacin, clarithromycin, and imipenem/cilastatin with PD catheter removal may be effective for the treatment of M. abscessus PD-associated peritonitis. The prognosis of M. abscessus-induced peritonitis is generally poor, and it is of note that residual encapsulated ascites in the peritoneal cavity after treatment may increase the risk of infection recurrence or EPS development.
Successful Treatment of Peritoneal Dialysis-related Peritonitis due to Mycobacterium iranicum
Internal Medicine, 2016
A 68-year-old man on peritoneal dialysis (PD) was hospitalized with the clinical picture of peritonitis. The patient was diagnosed with peritonitis caused by nontuberculous mycobacteria (NTM) according to positive Ziehl-Neelsen staining and negative Mycobacterium tuberculosis polymerase chain reaction results. Oral levofloxacin and clarithromycin, and later intraperitoneal imipenem were started. According to the anti-NTM susceptibility test results, oral minocycline was administered. The patient was treated for 6 months. He recovered without PD catheter removal; thus, PD was successfully continued. A genetic analysis identified the isolate as Mycobacterium iranicum. This is the first report of PD-related peritonitis caused by M. iranicum.
Case Reports in Nephrology, 2014
Mycobacterium fortuitum is a ubiquitous, rapidly growing nontuberculous mycobacterium (NTM). It is the most commonly reported NTM in peritoneal dialysis (PD) associated peritonitis. We report a case of a 52-year-old man on PD, who developed refractory polymicrobial peritonitis necessitating PD catheter removal and shift to hemodialysis. Thereafter, M. fortuitum was identified in the PD catheter culture and in successive cultures of initial peritoneal effluent and patient was treated with amikacin and ciprofloxacin for six months with a good and sustained clinical response. Months after completion of the course of antibiotics, the patient successfully returned to PD. To our knowledge, this is the first reported case of M. fortuitum peritonitis in the field of polymicrobial PD peritonitis. It demonstrates the diagnostic yield of pursuing further investigations in cases of refractory PD peritonitis. In a systematic review of the literature, only 20 reports of M. fortuitum PD peritonitis were identified. Similar to our case, a delay in microbiological diagnosis was frequently noted and the Tenckhoff catheter was commonly removed. However, the type and duration of antibiotic therapy varied widely making the optimal treatment unclear.
Mycobacterium Porcinum Peritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis
Journal of General Internal Medicine, 2010
Mycobacterium porcinum has been reported to cause a variety of illnesses including wound infections, respiratory tract infections, osteomyelitis and catheter-related bacteremias. We report the first case of M. porcinum peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). A 67-year-old woman on CAPD presented with three weeks of constitutional symptoms and abdominal pain. Peritoneal fluid cultures on day three grew acid-fast rods. Nocardiosis was suspected and the patient was empirically treated with amikacin and trimethoprim-sulfamethoxazole. The dialysis catheter was removed. Two weeks later final culture results revealed M. porcinum. Ciprofloxacin and trimethoprim-sulfamethoxazole were initiated with good clinical response.
Mycobacterial peritonitis in pediatric peritoneal dialysis patients
Pediatric Nephrology, 2004
Peritonitis is the most common complication and the leading cause of death in pediatric peritoneal dialysis (PD) patients. According to the most recent data available from the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS), approximately 25% of pediatric PD patients who die succumb to infection. There are no reported cases of Mycobacterium tuberculosis (MTB) or Mycobacterium avium-intracellulare peritonitis in the NAPRTCS registry. With an increasing incidence of MTB worldwide and the impairment of cellular immunity in chronic renal failure patients, it is not surprising that mycobacterium peritonitis can occur in PD patients. We report two pediatric PD patients with mycobacterial peritoneal infection diagnosed over an 11-year period at our institution. One patient presented with a malfunctioning Tenckhoff catheter and again 3 years later with hyponatremia and ascites. The other presented with recurrent culture-negative peritonitis. These cases illustrate the importance of more extensive evaluation of PD complications, to include evaluation for mycobacterium with special media or peritoneal biopsy, in the above clinical settings if the routine work-up is unrevealing.