amphotericin-b and Peritonitis

Fungal peritonitis (FP) is a rare complication of peritoneal dialysis. We herein describe the second case in Asia of Histoplasma capsulatum peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD).. An 85-year-old woman with end-stage renal disease (ESRD) who had been on CAPD for 3 years and who had a history of 3 prior episodes of peritonitis presented with intermittent abdominal pain for 2 weeks and high-grade fever for 3 days. Elevated white blood cell (WBC) count and rare small oval budding yeasts were found in her peritoneal dialysis (PD) fluid. From this fluid, a white mold colony was observed macroscopically after 7 days of incubation, and numerous large, round with rough-walled tuberculate macroconidia along with small smooth-walled microconidia were observed microscopically upon tease slide preparation, which is consistent with H. capsulatum. The peritoneal dialysis (PD) catheter was then removed, and it also grew H. capsulatum after 20 days of incubation. The patient was switched from CAPD to hemodialysis. The patient was successfully treated with intravenous amphotericin B deoxycholate (AmBD) for 2 weeks, followed by oral itraconazole for 6 months with satisfactory result. The patient remains on hemodialysis and continues to be clinically stable.. H. capsulatum peritonitis is an extremely rare condition that is associated with high morbidity and mortality. Demonstration of small yeasts upon staining of PD fluid, and isolation of slow growing mold in the culture of clinical specimen should provide important clues for diagnosis of H. capsulatum peritonitis. Prompt removal of the PD catheter and empirical treatment with amphotericin B or itraconazole is recommended until the culture results are known.

Topics: Administration, Intravenous; Administration, Oral; Aged, 80 and over; Amphotericin B; Antifungal Agents; Asia; Deoxycholic Acid; Drug Combinations; Female; Histoplasma; Histoplasmosis; Humans; Itraconazole; Kidney Failure, Chronic; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Treatment Outcome

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.

Topics: Aged; Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Humans; Kidney Transplantation; Male; Peritonitis

To describe the clinical and microbiological features associated with fungal peritonitis in peritoneal dialysis (PD) patients at Hôpital Maisonneuve-Rosemont, from August 1996 to July 2006.. Cases were retrieved from the microbiology laboratory culture registry. Antifungal susceptibility was determined by the Clinical and Laboratory Standards Institute M27A3 method.. Among 288 PD patients (total follow-up of 7258 patient-months), nine were found with fungal peritonitis. Candida spp were identified in all of them, with a majority of non-albicans Candida species. Resistance to fluconazole, itraconazole, or voriconazole was as frequent as potential resistance to amphotericin B. No isolate was resistant to caspofungin and one was resistant to micafungin. Prior bacterial peritonitis was frequent (67%). All patients had their PD catheter removed and all of them survived.. In our institution, fungal peritonitis in PD patients is rare. All cases were caused by Candida species. Variable susceptibility patterns were observed, which may influence the initial empirical antifungal therapy and underscore the importance of individual speciation and susceptibility testing of invasive Candida isolates.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Candida; Caspofungin; Drug Resistance, Fungal; Echinocandins; Female; Fluconazole; Follow-Up Studies; Humans; Itraconazole; Lipopeptides; Male; Micafungin; Microbial Sensitivity Tests; Middle Aged; Mycoses; North America; Peritoneal Dialysis; Peritonitis; Pyrimidines; Triazoles; Voriconazole

A 57-year-old woman with end-stage kidney disease secondary to autosomal dominant polycystic kidney disease developed peritoneal dialysis-related Mucor peritonitis after her pet cockatoo bit through her transfer set. The infection persisted despite more than 8 weeks of treatment with liposomal amphotericin B. On a compassionate basis, she then received oral posaconazole, 800 mg/d, in divided doses for 6 months. She experienced complete remission and has remained disease free since then, for more than 2 years. We review the medical literature about mucormycosis peritonitis which, albeit rare, carries very high mortality. The treatment of choice is liposomal amphotericin B, which failed in our patient. Our case report suggests that posaconazole is an attractive treatment option in patients with peritoneal dialysis-related Mucor peritonitis.

Topics: Amphotericin B; Antifungal Agents; Female; Humans; Kidney Failure, Chronic; Liposomes; Middle Aged; Mucormycosis; Peritoneal Dialysis; Peritonitis; Polycystic Kidney, Autosomal Dominant; Treatment Failure; Treatment Outcome; Triazoles

Mucormycosis historically has caused substantial morbidity with high mortality in renal transplant patients with disseminated and/or rhinocerebral infection and in patients with gastrointestinal illness regardless of predisposing conditions. We report the first successful treatment of gastric mucormycosis in a renal transplant recipient and review presumed pathogenic mechanisms of mucormycosis in renal transplant recipients as well as historical data.

Topics: Amphotericin B; Antifungal Agents; Colonic Diseases; Combined Modality Therapy; Female; Gastrectomy; Humans; Kidney Transplantation; Middle Aged; Mucormycosis; Opportunistic Infections; Pancreatic Diseases; Peritonitis; Risk Factors; Stomach Diseases

Peritonitis caused by fungi of the species Aspergillus is rare in peritoneal dialysis patients and is associated with high mortality. Four of the six reported survivors have been unable to resume peritoneal dialysis. We report the successful treatment of Aspergillus niger peritonitis with a combination of intravenous amphotericin B and peritoneal catheter removal in a patient on continuous ambulatory peritoneal dialysis (CAPD), and review previously reported cases of Aspergillus peritonitis. Our patient returned to CAPD after 2 months and has maintained good peritoneal transport 1 year after resumption of CAPD. The early recognition and aggressive treatment of peritonitis due to Aspergillus sp may allow eventual return to and successful maintenance of CAPD.

Topics: Amphotericin B; Aspergillosis; Aspergillus niger; Humans; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Aspergillus peritonitis is a rare but treatable complication of continuous ambulatory peritoneal dialysis. We report a case of Aspergillus peritonitis in a continuous ambulatory peritoneal dialysis patient and review the nine other cases reported in the literature. The course was often insidious, and the clinical manifestation and laboratory findings were similar to those of bacterial peritonitis. The distinctive feature of these cases was the persistence of symptoms despite broad-spectrum antibiotics. Catheter removal is of crucial importance in the management of this disease.

Topics: Aged; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Fatal Outcome; Humans; Injections, Intraperitoneal; Itraconazole; Male; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

A patient developed cryptococcal peritonitis with systemic dissemination during continuous ambulatory peritoneal dialysis (CAPD). This case prompted a search of the literature for cases of cryptococcal peritonitis; 19 previously reported cases were identified. On the basis of their clinical characteristics, these cases were divided into two groups. Group 1 included 10 cases developing during CAPD. Treatment consisted of removal of the peritoneal dialysis catheter and administration of a short course of amphotericin B. Eight of the 10 cases had a benign course, and nine patients survived. Group 2 comprised 10 cases developing in patients with severe underlying illnesses, such as chronic liver disease, AIDS, systemic lupus erythematosus, and leukemia. Disseminated cryptococcosis was documented in eight of the nine patients in this group for whom relevant information was available. Seven patients died, some despite antifungal therapy. Cryptococcal disease may have protean manifestations and an insidious course. Accordingly, the diagnosis of cryptococcal peritonitis may well be delayed. An awareness of this entity may lead to earlier diagnosis and treatment and possibly to improved outcome.

Topics: Amphotericin B; Cryptococcosis; Cryptococcus neoformans; Humans; Infusions, Intravenous; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

This report describes the first successful treatment of an adult on continuous ambulatory peritoneal dialysis with Aspergillus peritonitis. The published literature is also reviewed. Early removal of the peritoneal catheter combined with antifungal chemotherapy appear to be necessary for cure in patients with this disease.

Topics: Aged; Amphotericin B; Aspergillosis; Female; Humans; Kidney Failure, Chronic; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Peritonitis is a frequent complication of CAPD. Sixty percent of all patients on CAPD will have at least one episode of peritonitis during the first year of this mode of dialysis. Most of the episodes of peritonitis are caused by touch contamination of the dialysis tubing or by extension of the catheter exit site or tunnel infection. Coagulase-negative and coagulase-positive Staphylococcus are the two most common organisms, accounting for 50% or more of all CAPD peritonitis. Other gram-positive and gram-negative bacteria and fungi account for the rest. Intraperitoneal antibiotic treatments are usually effective in eradicating the infection. The choice of antibiotics depends on organisms isolated from cultured dialysate. Fungal peritonitis and, occasionally, Pseudomonas peritonitis require removal of the catheter to eradicate the infection. Prompt identification and treatment of peritonitis are essential to ensure success of a CAPD program. Although with newer techniques, like Y-connector or ultraviolet light system, the rate of peritonitis has declined; however, it has still remained the major complication of the CAPD program.

Topics: Amphotericin B; Anti-Bacterial Agents; Fungi; Gram-Negative Bacteria; Humans; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum; Peritonitis

Intra-abdominal candidiasis (IAC) has a high mortality rate. However, the correct management of a critically ill patient with suspected IAC remains unclear. The aim of this study was to evaluate the safety of pulsed high-dose liposomal amphotericin B (L-AmB) in patients with suspected IAC managed with a beta-D-glucan (BDG)-guided strategy.. This phase 2 prospective study enrolled adult patients with intra-abdominal sepsis following surgery. Patients received a single dose of L-AmB 5 mg/kg on day 1. On day 3, L-AmB was discontinued in patients with a negative basal BDG result, and continued (3 mg/kg/daily) in patients with a positive basal BDG result or microbiologically confirmed IAC. The primary endpoint was the occurrence of adverse events, defined using the Common Toxicity Criteria classification.. In total, 40 patients were enrolled from January 2019 to August 2022. Fifteen (37.5%) patients were male, and the median age was 65 [interquartile range (IQR) 49-76] years. Thirty-one (77.5%) patients underwent urgent surgery, and the principal indication was secondary/tertiary peritonitis (n=22, 55%); half of the patients had undergone a previous surgical operation within the preceding 30 days. Five (12.5%) patients met the criteria for septic shock at enrolment. The median APACHE II score on admission to the intensive care unit was 12 (IQR 10-15). IAC was excluded in 33 (85%) patients, but IAC was probable and proven in five (12.5%) and two (5%) patients, respectively. The single dose of L-AmB 5 mg/kg was well tolerated in all patients, and no early or late severe adverse events related to the drug were reported. L-AmB was discontinued in 65% of patients following a negative basal BDG result. The all-cause 30-day mortality rate was 15%, and no deaths were related to L-AmB administration or uncontrolled IAC. The mortality rates for patients with and without proven IAC were 0% and 15.8%, respectively (P=0.99).. The rate of proven IAC among critically ill high-risk patients was low (5%). A single dose of L-AmB 5 mg/kg, with prompt withdrawal in the case of a basal negative BDG result, seems to be a safe and effective approach in this population.

Topics: Adult; Aged; Antifungal Agents; Candidiasis; Critical Illness; Female; Humans; Male; Middle Aged; Peritonitis; Prospective Studies

Twenty-one episodes of fungal peritonitis occurred over 35 months among 290 patients on CAPD, accounting for 6.3% of all peritonitis episodes. Patients with more frequent bacterial peritonitis were at higher risk of developing fungal peritonitis, and 28.6% of cases followed antimicrobial therapy. Candida species accounted for 85.7% of cases. Oral fluconazole was used as initial therapy in all patients, which was followed by catheter removal if peritonitis failed to improve. The cure rate with fluconazole therapy alone without catheter removal was 9.5%. Fluconazole plus catheter removal, the latter necessitated in 85.7% of cases, resulted in a cure rate of 66.7%. The remaining 3 (14.3%) patients responded to intravenous amphotericin given as salvage therapy. Disease-related mortality was 14.3%. Reinsertion of dialysis catheter was attempted in 15 patients and CAPD was successfully resumed in 13 (86.7%). We conclude that oral fluconazole can be safely used as initial therapy in patients with fungal peritonitis complicating CAPD. Although catheter removal was necessary in the majority of patients, this sequential approach resulted in a relatively low prevalence of peritoneal adhesions and subsequent CAPD failure.

Topics: Administration, Oral; Amphotericin B; Female; Fluconazole; Humans; Injections, Intravenous; Male; Middle Aged; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Amphotericin B; Candida; Catheters, Indwelling; Humans; Peritoneal Dialysis; Peritonitis; Retrospective Studies

Peritoneal dialysis-associated peritonitis can uncommonly be caused by fungal infections. When they do present, they are associated with significant mortality and morbidity. We describe a case where a sample of peritoneal dialysate fluid grew Rhodotorula muciliginosa, a yeast organism present in the normal environment which has previously been reported as rarely causing peritonitis. We believe this is the first case where the Rhodotorula spp. and its origin has been identified.. A 20 year old male grew Rhodotorula muciliginosa from his peritoneal dialysis fluid on three separate occasions when a fluid sample was sent following a disconnection and subsequent set change. He was not systemically unwell and his peritoneal dialysate was clear. As Rhodotorula spp. is exceedingly difficult to treat our patient had his Tenchkoff catheter removed. Subsequent samples of soil and sand from his bearded dragon and Chilean tarantula cases, kept in his bedroom where dialysis occurred, were tested. The tarantula sand was identified as the source of the Rhodotorula spp. Of note, Candida was isolated from sand from the bearded dragon case. Once his Tenchkoff was removed he was treated with an intravenous course of antifungal therapy. He has since had a new Tenchkoff catheter inserted and recommenced PD following education around pets and hygiene.. In this era where people are keeping increasingly rare and unusual wildlife in their homes, this case highlights the need for clinician and nursing staff awareness of a patient's home environment and hobbies when they are undergoing peritoneal dialysis. Sand from our patient's tarantula case grew the colonising organism but interestingly soil from his bearded dragon case also isolated candida. This can also cause difficult to treat peritonitis.

Topics: Amphotericin B; Animals; Antifungal Agents; Ascitic Fluid; Candida; Humans; Kidney Failure, Chronic; Lizards; Male; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rhodotorula; Spiders; Young Adult

In order to compare the effectiveness of liposomal amphotericin B (LAB) and caspofungin monotherapy in Candida tropicalis-induced peritonitis in an experimental mice model 56 healthy male BALB/c mice (10-12 weeks; 20-25 g) were divided into groups and C. tropicalis strains were intraperitoneally (IP) inoculated into mice groups except the control group. After the injection, three doses of LAB (0.5, 1.0, 2.0 mg/kg/day) and caspofungin (1.0, 2.0, 5.0 mg/kg/day) were administered to groups for five consecutive days, starting 48-h post-infection. The mice were then followed up for 14 days and killed by cervical dislocation. When their peritoneal fluid was examined, the difference in fungal growth between the treatment group and control group was significant (p <0.05). Evaluation of the treatment groups revealed that fungal growth decreased with increasing dose of the antifungal agent (p >0.05). There was no dose-related difference from mice which received LAB or those which received caspofungin in our experimental model. During our study, no death was detected despite the similar injection doses compared with other studies using Candida species. The results of this study suggest that C. tropicalis could have lower virulence, perhaps limited by natural immunity, and causes mortality at much higher doses.

Topics: Amphotericin B; Animals; Antifungal Agents; Candida tropicalis; Candidiasis, Invasive; Caspofungin; Male; Mice; Mice, Inbred BALB C; Peritonitis; Random Allocation

A 53-year-old man with Crohn's disease treated with adalimumab was hospitalised with abdominal pain, fatigue, fever and chills. CT scan of the abdomen showed chronic thickening of the terminal ileum and cecum and new-onset ascites. Further studies revealed weakly positive urine and serum histoplasma antigen. Laparoscopy revealed metastatic caking of the omentum and abdominal wall; peritoneal biopsy demonstrated organisms morphologically consistent with

Topics: Abdominal Pain; Adalimumab; Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Ascites; Crohn Disease; Histoplasma; Histoplasmosis; Humans; Itraconazole; Laparoscopy; Male; Middle Aged; Peritonitis; Tomography, X-Ray Computed; Treatment Outcome

Topics: Amphotericin B; Duodenal Ulcer; Female; Gentamicins; Humans; Infections; Middle Aged; Opportunistic Infections; Peritoneal Cavity; Peritonitis; Prototheca; Schizophrenia, Paranoid; Soil Microbiology

Fungal peritonitis is an uncommon complication in peritoneal dialysis patients. We report a case of blastomyces dermatitis peritonitis in a nonimmunocompromised peritoneal dialysis patient, who initially presented with symptoms of lower extremity weakness and altered mental status. Peritoneal blastomycosis is rare condition and not previously reported in end stage renal disease patients on peritoneal dialysis. Fungal peritonitis can present with subtle clinical findings so a high index of suspicion is needed as early detection and treatment may decrease mortality and morbidity.

Topics: Amphotericin B; Blastomyces; Blastomycosis; Female; Humans; Kidney Failure, Chronic; Middle Aged; Peritoneal Dialysis; Peritonitis

Trichosporon species are ubiquitously spread and known to be part of the normal human flora of the skin and gastrointestinal tract. Trichosporon spp. normally cause superficial infections. However, in the past decade Trichosporon spp. are emerging as opportunistic agents of invasive fungal infections, particularly in severely immunocompromised patients. Clinical isolates are usually sensitive to triazoles, but strains resistant to multiple triazoles have been reported.. We report a high-level pan-azole resistant Trichosporon dermatis isolate causing an invasive cholangitis in a patient after liver re-transplantation. This infection occurred despite of fluconazole and low dose amphotericin B prophylaxis, and treatment with combined liposomal amphotericin B and voriconazole failed.. This case and recent reports in literature show that not only bacteria are evolving towards pan-resistance, but also pathogenic yeasts. Prudent use of antifungals is important to withstand emerging antifungal resistance.

Topics: Amphotericin B; Antifungal Agents; Cholangitis; Drug Resistance, Fungal; Hepatic Encephalopathy; Humans; Liver Cirrhosis; Liver Transplantation; Male; Microbial Sensitivity Tests; Middle Aged; Peritonitis; Phylogeny; Trichosporon; Trichosporonosis; Voriconazole

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus; DNA, Ribosomal; Fluconazole; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Phylogeny; Saccharomyces cerevisiae; Sequence Homology, Nucleic Acid

Trichoderma longibrachiatum is an emerging pathogen in immunocompromised patients. We report a case of Trichoderma post-operative mediastinitis and peritonitis in a child with complex congenital cardiac disease and functional asplenia. The patient was treated unsuccessfully, initially with caspofungin alone followed by a combination of voriconazole (systemic and topical), caspofungin and intraperitoneal amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Caspofungin; Child, Preschool; Echinocandins; Fatal Outcome; Female; Heart Defects, Congenital; Humans; Immunocompromised Host; Lipopeptides; Mediastinitis; Mycoses; Peritoneal Dialysis; Peritonitis; Postoperative Complications; Pyrimidines; Spleen; Triazoles; Trichoderma; Voriconazole

Invasive fungal infections are serious complications of cancer therapy. We present a case report of a 12-year-old boy diagnosed with abdominal non-Hodgkin lymphoma and fecal and Candida peritonitis during induction chemotherapy. The invasive mycosis was managed using a combined approach of systemic antifungal agents including efungumab and surgical interventions. Efungumab, a recombinant antibody that inhibits extracellular heat shock protein 90, was used in combination with amphotericin B colloid dispersion after the failure of standard approaches.

Topics: Abdominal Neoplasms; Amphotericin B; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antifungal Agents; Candidiasis; Child; Drug Therapy, Combination; HSP90 Heat-Shock Proteins; Humans; Lymphoma, Non-Hodgkin; Male; Peritonitis

The incidence of fungal infections such as Aspergillosis is increasing among immunocompromised patients. Demand for diagnosis of mycotic diseases is steadily raising among clinicians and treatment of these patients represents a continually growing challenge. The authors present a case of a 53-year-old male patient with Aspergillus peritonitis. This case deserves attention because its extreme rarity in the medical literature and complex therapy of coinfections during the hospital stay which was difficult and relatively expensive. The importance of consultation and microbiological sampling is emphasized.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Aspergillosis; Clindamycin; Cross Infection; Humans; Immunocompromised Host; Male; Meropenem; Middle Aged; Peritonitis; Subphrenic Abscess; Thienamycins

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Arthritis, Rheumatoid; Colitis, Ulcerative; Combined Modality Therapy; Drainage; Fatal Outcome; Gastrointestinal Diseases; Humans; Ileal Diseases; Intestinal Perforation; Intraoperative Complications; Jejunal Diseases; Liposomes; Male; Mucormycosis; Peritonitis; Postoperative Complications; Shock, Septic; Triazoles

Long-term dialysis in children with multiple handicaps has become easier with the advent of continuous ambulatory peritoneal dialysis (PD). Due to the widespread use of PD and the long survival of patients with spina bifida, an increasing number of patients with spina bifida are on PD. The viability and safety of PD in spina bifida patients with a ventriculoperitoneal shunt (VPS) have been a matter of concern. Some authors consider the presence of a VPS a relative contraindication for PD, but more recent reports suggest that PD under close monitoring is not contraindicated. We report a 17-year-old girl born with meningomyelocele, hydrocephalus and neurogenic bladder who was maintained on VPS. She reached end-stage renal failure 17 years later and was put on PD based on family and patient preference. She had an uneventful course in the initial 9 months, but later developed fungal peritonitis which was successfully managed with catheter withdrawal and an intravenous antifungal agent (amphotercin 0.75 mg/kg). Simultaneous ventricle-aspirated cerebrospinal fluid was sterile. To our knowledge, this is the first report of fungal infection in such a patient. Although we share the view that PD is not an absolute contraindication in patients with a functioning VPS, its likely complications, especially infectious complications in developing countries, should be kept in mind before initiating PD in such patients.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Candida glabrata; Candidiasis; Female; Growth Disorders; Humans; Hydrocephalus; Kidney Failure, Chronic; Meningomyelocele; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Recurrence; Spina Bifida Cystica; Urinary Bladder, Neurogenic; Urinary Catheterization; Urinary Tract Infections; Ventriculoperitoneal Shunt

Fungal peritonitis is a rare but serious complication in children on peritoneal dialysis. Clinical presentation of fungal peritonitis is similar to bacterial peritonitis and Candida spp. are the most common agent. Fungal peritonitis has been usually associated with high morbidity, mortality and its treatment is difficult. In this report, we present an infant with Acremonium spp. peritonitis. A 7-month-old boy with Down syndrome, congenital heart disease, pulmonary hypertension and congestive heart failure required peritoneal dialysis for his persistent pulmonary oedema and symptomatic hyponatremia. Acremonium spp. peritonitis developed while he was on extended spectrum antibiotics and fluconazole. The patient was successfully treated with peritoneal dialysis catheter removal and liposomal amphotericin B. The case was presented to draw attention to a rare cause of peritonitis -Acremonium spp. - in a paediatric patient.

Topics: Acremonium; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Down Syndrome; Fluconazole; Heart Defects, Congenital; Humans; Infant; Male; Mycoses; Peritoneal Dialysis; Peritonitis

To study the relation between serum and peritoneal levels of amphotericin B and flucytosine during intravenous treatment in patients with abdominal sepsis due to a perforated gut.. Included were consecutive patients with abdominal sepsis due to a perforated gut, who were treated intravenously with amphotericin B and/or flucytosine after surgery if an abdominal drain was present. Amphotericin B and flucytosine were measured from simultaneously collected serum and abdominal fluid samples.. Twenty-one consecutive patients were included. Five repeated samples were taken from three patients. The time interval between the start of the medication and the first sampling was median 4.0 days (range 2-7 days). The correlation coefficient (r(2)) between serum and peritoneal levels of amphotericin B was 0.79. In nine patients (43%) with a maximum serum level of 0.28 mg/L, amphotericin B in the peritoneal fluid was undetectable. The lowest serum level that was present with a detectable peritoneal level was 0.16 mg/L. A short duration of treatment (2 days) was associated with low serum and undetectable peritoneal levels. In seven patients, flucytosine levels were measured. Peritoneal flucytosine levels did not differ significantly from serum levels. Serum and peritoneal flucytosine levels correlated well with r(2)=0.88. Peritoneal amphotericin B level was inversely correlated with C-reactive protein level on the same day (r(2)=0.30).. It is shown, during continuous infusion, that peritoneal levels of amphotericin B are lower than serum levels. The amphotericin B serum levels should exceed 0.5 mg/L to obtain peritoneal levels above MIC values. Flucytosine levels in the abdominal fluid are comparable to serum levels and within MIC ranges.

Topics: Aged; Amphotericin B; Ascitic Fluid; Candidiasis; Critical Care; Female; Flucytosine; Fungemia; Humans; Male; Middle Aged; Peritonitis; Prospective Studies

A woman on continuous ambulatory peritoneal dialysis (CAPD) due to renal failure in systemic lupus erythematosus (SLE) developed fungal peritonitis and survived following treatment with amphotericin B and removal of the dialysis catheter. The causative organism, Aspergillus fumigatus is very rare in fungal peritonitis and may be related in this case to the combination of SLE, end-stage renal disease (ESRD) and their treatment.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Drug Therapy, Combination; Female; Humans; Kidney Failure, Chronic; Lupus Erythematosus, Systemic; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Aged; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Caspofungin; Drug Therapy, Combination; Echinocandins; Follow-Up Studies; Humans; Kidney Failure, Chronic; Lipopeptides; Male; Peptides, Cyclic; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Risk Assessment; Severity of Illness Index; Treatment Outcome

We report a case of a 62-year-old female patient who developed peritonitis after receiving a renal transplant. Candida glabrata was detected and treated with voriconazole. As the patient did not improve under therapy, laparotomy was performed. Mould-like plaques were found on the peritoneum. Using culture as well as pan-fungal polymerase chain reaction (PCR) followed by DNA microarray hybridisation of the amplicon, the causative agent was identified as Rhizopus microsporus. Despite aggressive surgical treatment, intravenous therapy with amphotericin B and topical administration of Lavasept (polyhexamethylenbiguanide), the patient died.

Topics: Amphotericin B; Biguanides; Candida glabrata; DNA, Fungal; Fatal Outcome; Female; Humans; Kidney Transplantation; Laparoscopy; Middle Aged; Mucormycosis; Nucleic Acid Hybridization; Oligonucleotide Array Sequence Analysis; Peritonitis; Polymerase Chain Reaction; Renal Insufficiency, Chronic; Rhizopus

A 62-year-old man with a six months status post liver transplant due to hepatitis C infection, was admitted with ascites and pyrexia of unknown origin. Despite extensive investigations, his fever remained undiagnosed, so he was started empirically on anti tuberculous agents, ganciclovir and trimethoprim/sulfa. The liver function deteriorated and a liver biopsy showed evidence of allograft rejection for which the patient was started on systemic steroids. Later, yeast grew from the ascitic fluid, which was identified as Rhodotorula species. The draining peritoneal catheter was removed and the patient was started on Amphotericin B. The amphotericin was continued for 10 days during which the patient defervesced and repeat ascitic fluid culture became negative. In conclusion, Rhodotorula species infection is a rare form of infection in the immunocompromised host that is usually associated with indwelling catheter insertion. The infection responded to the removal of the indwelling catheter and amphotericin B treatment.

Topics: Amphotericin B; Catheters, Indwelling; Humans; Liver Transplantation; Peritonitis; Rhodotorula

Aspergillus peritonitis is a rare disease in continuous peritoneal dialysis. It is a severe form of peritonitis, which is frequently lethal. We report a case of Aspergillus fumigatus peritonitis in a female patient on automated peritoneal dialysis (APD), who was successfully treated with intravenous amphotericin B and the removal of the peritoneal catheter. As delayed treatment has an increased mortality rate, it is mandatory to remove the catheter and to start intravenous treatment with amphotericin B empirically.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Drug Therapy, Combination; Female; Humans; Itraconazole; Kidney Failure, Chronic; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Even though prominent technical improvements in continuous ambulatory peritoneal dialysis (CAPD) treatments during the last decade, peritonitis keeps its place as an important cause of morbidity and mortality in these patients. Among them fungal peritonitis is happened to be the most difficult one to deal with and comes out serious clinical presentation. It is presented here a case of CAPD related fungal peritonitis caused by Penicillium spp. This case experienced recently relapsing bacterial episodes of peritonitis and received long term antibiotics intraperitoneally and systemically. Eventually, Penicillium spp. was detected in several cultures of peritoneal effluent and also tip of Tenckhoff catheter, therefore it was considered as a causative agent. Then, the catheter was removed and amphotericin B therapy was performed. But the general condition of the patient did not improve till surgically drainage of peritoneal collection which was determined by MR (Magnetic Resonance) examination of abdomen after antifungal treatment was completed and Penicillium spp. in the drainage samples was not determined anymore.

Topics: Aged; Amphotericin B; Antifungal Agents; Catheterization; Drainage; Equipment Contamination; Humans; Male; Mycoses; Penicillium; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Fungal peritonitis is an uncommon but potentially life-threatening complication for patients undergoing continuous ambulatory peritoneal dialysis. This retrospective study evaluated the efficacy of fluconazole in fungal peritonitis treatment and the incidence of fungal peritonitis in different peritoneal dialysis disconnect systems. Fungal peritonitis was caused by Candida species in 67% of episodes. The most common pathogen in this series was Candida parapsilosis (29%), followed by Candida albicans (14%). One patient (5%) died within 1 month after admission for treatment of fungal peritonitis. Only 1 patient (5%) in this series could resume peritoneal dialysis. Treatment with fluconazole alone has an effect comparable to intraperitoneal (IP) amphotericin B alone or IP amphotericin B combined with oral or intravenous fluconazole. The incidence of fungal peritonitis in patients who used the spike, Y-set, and UV antiseptic systems was 5.69, 6.20, and 2.93 times, respectively, as frequent as that of fungal peritonitis in patients who used the twin-bag disconnect system.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Candida; Drug Therapy, Combination; Female; Fluconazole; Humans; Male; Middle Aged; Mycoses; Peritoneal Dialysis; Peritonitis; Retrospective Studies; Treatment Outcome

Topics: Amphotericin B; Antifungal Agents; Child, Preschool; Female; Humans; Mycoses; Peritoneal Dialysis; Peritonitis; Rhodotorula

Topics: Abdominal Wall; Amphotericin B; Antifungal Agents; Biopsy; Debridement; Enterobacteriaceae Infections; Fatal Outcome; Heart Transplantation; Humans; Male; Middle Aged; Mucormycosis; Necrosis; Peritonitis; Postoperative Complications; Radiography, Abdominal; Rare Diseases; Superinfection; Tomography, X-Ray Computed

Two consensus conferences taking place in the United States and Spain were organized to optimize diagnosis and treatment of Candida spp. infections. Among other results, clinical scenarios in which early prescription of antifungal agents is indicated were identified.. To determine the criteria followed by physicians for prescribing antifungal agents in critically ill patients in our country and to investigate adherence to the guidelines proposed by the consensus conferences.. A questionnaire was designed and directed to 4th- and 5th-year residents in intensive care medicine and to specialists in intensive care with training in infectious diseases or other medical areas. Four case reports for which expert consensus indicates early antifungal treatment were included in the questionnaire; 1) recurrent peritonitis secondary to perforation of the digestive tract, with mixed flora including fungi; 2) persistent febrile syndrome in a patient with multiple mucosal fungal colonizations treated with broad-spectrum antibiotics; 3) candiduria and pyuria in a febrile patient; and 4) candidemia.. A total of 135 questionnaires from 45 different ICUs were returned (60% response rate). In the candidemia and fungal peritonitis examples, early treatment with antifungal agents was indicated in 100% and 85.9% of responses, respectively, whereas for sepsis with multifocal candidiasis and candiduria associated with pyuria and fever, early treatment was prescribed in only 41.5% and 55.6% of responses, respectively. There were no significant differences in response with regard to degree of training of the physicians surveyed. Fluconazole prescription predominated, mainly at doses of 400 mg/day, in mixed peritonitis, disseminated candidiasis and candiduria, whereas amphotericin B lipid formulations were preferentially indicated in cases of candidemia. Antifungal treatment (early or late) was prescribed in all responses for candidemia, in 95.5% for mixed peritonitis (fungi and bacteria), in 79.5% for multifocal candidiasis in patients with persistent sepsis, and in 77.9% for candiduria with fever and pyuria.. Adherence to recommendations from the consensus conferences was high among intensive medicine specialists, with no differences according to level of training in infectious diseases.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Case Management; Consensus Development Conferences as Topic; Critical Care; Data Collection; Drug Utilization; Fever; Fluconazole; Fungemia; Guideline Adherence; Humans; Internship and Residency; Intestinal Perforation; Mycoses; Peritonitis; Practice Guidelines as Topic; Practice Patterns, Physicians'; Spain; Surveys and Questionnaires; Urinary Tract Infections

Phenotypic identification of fungi in clinical microbiology laboratories is often difficult and late, especially for slow growing and rarely encountered fungi. We describe the application of 18S ribosomal RNA (rRNA) gene sequencing in the early diagnosis of a case of Exophiala peritonitis. A yeast-like fungus was isolated from the dialysate fluid of a 66-year-old man undergoing continuous ambulatory peritoneal dialysis. It grew slowly after 12 days of incubation to yield mature cultures to permit recognition of microscopic features resembling those of Exophiala, a dematiacerous mold. 18S rRNA gene sequencing provided results 12 days earlier than phenotypic identification and revealed 15 base difference (0.9%) between the isolate and Exophiala sp. strain GHP 1205 (GenBank Accession no. AJ232954), indicating that the isolate most closely resembles a strain of Exophiala species. The patient responded to 4 weeks of intravenous amphotericin B therapy. Early identification of the fungus was important for the choice of anti-fungal regimen. As opportunistic fungal infections in immunocompromised patients are globally emerging problems, the development of molecular techniques for fungal identification is crucial for early diagnosis and appropriate treatment.

Topics: Aged; Amphotericin B; Base Sequence; Dialysis Solutions; Exophiala; Genes, rRNA; Humans; Kidney Failure, Chronic; Male; Molecular Sequence Data; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Polymerase Chain Reaction; Risk Assessment; RNA, Ribosomal, 18S; Sensitivity and Specificity; Treatment Outcome

A 42-year-old man, with a history of immunoglobulin A nephropathy, underwent a living-related kidney transplant. Allograft function progressively deteriorated secondary to chronic rejection and recurrence of IgA nephropathy, and he returned to peritoneal dialysis after 5 years of the transplant. Fifteen months after the discontinuation of immunosuppressive therapy, Eschericia coli peritonitis developed, which was treated with ceftazidime intraperitoneally; he received fluconazole as prophylactic antifungal therapy during this period. After completing his course of treatment, abdominal pain occurred with an increased peritoneal fluid white blood cell count. Peritoneal fluid cultures were negative. He received broad-spectrum antibiotics and fluconazole with no appreciable response. After removal of the Tenckoff catheter, peritoneal fluid cultures grew a zygomycete. The patient was treated with liposomal amphotericin B (AmBisome) intravenously for 6 weeks. He had episodes of recurrent intraabdominal abscesses requiring surgical drainage and antibiotics. A second course of liposomal amphotericin B was administered for histopathologic evidence of filamentous fungal recurrence. After 5 months, the patient remains well without any evidence of infection.

Topics: Abdominal Abscess; Amphotericin B; Antifungal Agents; Bacteroides fragilis; Combined Modality Therapy; Drug Therapy, Combination; Fluconazole; Glomerulonephritis, IGA; Graft Rejection; Gram-Negative Bacterial Infections; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Mucormycosis; Peritoneal Dialysis; Peritonitis; Recurrence

Twenty-four episodes of C. parapsilosis peritonitis in 23 patients on continuous ambulatory peritoneal dialysis (CAPD) over 6 years were reviewed. Clinical manifestations and laboratory findings were similar to those of other pathogens. All started treatment with intravenous amphotericin B. In six cases it was attempted to maintain a peritoneal catheter in situ, but removal became essential to relieve fungal peritonitis. Of the patients who developed peritonitis, 15 episodes (62.5%) continued the CAPD program. Nine cases could not resume CAPD because of death in 4, patient preference in 2, and abdominal adhesion in 3. Antifungal treatment alone was ineffective in most cases. It was found that peritonitis developing after gram negative bacterial peritonitis and the use of fluconazole after catheter removal were associated with CAPD discontinuation. It was suggested that C. parapsilosis peritonitis in CAPD patients should be treated with rapid catheter removal, particularly those with fungal peritonitis who had prior gram negative peritonitis.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; Humans; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Prognosis; Treatment Outcome

Sixty-two cases of peritonitis due to peptic ulcer perforation were diagnosed between January 2000 and December 2000. Of these 62 cases, 23 isolates of Candida in 23 cases (CP) were cultured from peritoneal fluid. Cultures of peritoneal fluid of 10 (BP) of the remaining 39 cases was positive for bacteria only. Cultures of peritoneal fluid of the remaining 29 cases was negative. Comparison of CP, BP and culture-negative cases did not reveal any significant risk factor. Of the 23 Candida isolates, the Candida species and 48-h MICs of fluconazole and amphotericin B (mean, range ug/ml) were C. albicans 18 (0.688, 0.125-1.0; 0.297, 0.031-0.5), C. glabrata 3 (0.542, 0.125-1.0; 0.25, 0.125-0.5), C. tropicalis 1 (0.25; 0.5), C. intermedia 1 (1.0; 0.125) respectively. Mortality rates of CP, BP and culture-negative peritonitis due to infection were 5/23(21.7%), 0/10 and 1/29(3.4%) respectively. Without effective antifungal therapy, the mortality rate of CP was not low.

Topics: Adult; Age Distribution; Aged; Amphotericin B; Ascitic Fluid; Candida; Cohort Studies; Female; Fluconazole; Humans; Incidence; Male; Microbial Sensitivity Tests; Middle Aged; Peptic Ulcer Perforation; Peritonitis; Probability; Prospective Studies; Risk Factors; Sex Distribution; Statistics, Nonparametric; Survival Rate; Taiwan

Topics: Abdominal Abscess; Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candida tropicalis; Candidiasis; Child, Preschool; Digestive System Surgical Procedures; Female; Fluconazole; Gastrins; Humans; Peritonitis; Reoperation; Rupture, Spontaneous; Stomach Rupture; Treatment Outcome

Aspergillus peritonitis is a rare, potentially fatal complication of continuous ambulatory peritoneal dialysis (CAPD). We report the successful treatment of refractory fungal peritonitis in an 8-year-old girl treated by peritoneal dialysis for 3.3 years. This is the second report of Aspergillus thermomutatus(telemorph: Neosartorya pseudofischeri) in humans. Comprehensive treatment included early removal of the CAPD catheter, the use of liposomal amphotericin B, and the use of itraconazole.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Catheterization; Child; Device Removal; Drug Therapy, Combination; Female; Humans; Itraconazole; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

We report the first case of peritonitis caused by Curvularia species in a child undergoing peritoneal dialysis. He presented with gray-black proteinaceous material obstructing the lumen of his Tenckhoff catheter. Although the peritoneal fluid was cloudy, the patient suffered neither significant abdominal tenderness nor systemic symptoms. Catheter removal and treatment with amphotericin B allowed complete recovery and return to peritoneal dialysis within 7 days. Outdoor play in a wooded environment may have allowed contact of this saprophytic fungus with the child's indwelling catheter transfer set.

Topics: Amphotericin B; Antifungal Agents; Catheters, Indwelling; Child; Device Removal; Equipment Contamination; Female; Humans; Mitosporic Fungi; Mycoses; Peritoneal Dialysis; Peritonitis

Administration and clearance of amphotericin B infused during high-efficiency or high-efficiency/high-flux dialysis were studied in two end-stage renal disease patients requiring systemic antimycotic treatment for fungal peritonitis. Amphotericin B concentrations were measured in the arterial and venous dialysis ports as well as in the ultrafiltrate. Amphotericin B is poorly dialyzable while administered during hemodialysis sessions with high-efficiency (CA 210) or high-efficiency/high-flux (CT 190 G) membranes. Amphotericin B infusion during hemodialysis was well tolerated and can be administered conveniently in an outpatient dialysis setting, avoiding prolonged hospitalization for parenteral antifungal therapy.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Humans; Kidney Failure, Chronic; Male; Peritonitis; Renal Dialysis

Fungal infections remain an important cause of morbidity and mortality in lung transplant recipients. Aerosolized amphotericin B lipid complex (ABLC) may be more efficacious than conventional amphotericin B in the prevention of fungal infections in animal models, but experience with aerosolized ABLC in humans is lacking.. We conducted a prospective, noncomparative study designed to evaluate safety of aerosolized ABLC in lung or heart-lung transplant recipients.. A total of 381 treatments were administered to 51 patients. Complete spirometry records were available for 335 treatments (69 in intubated patients, 266 in extubated patients). ABLC was subjectively well tolerated in 98% of patients. Pulmonary mechanics worsened by 20% or more posttreatment in less than 5% of all treatments. There were no significant adverse events related to study medication in any patient, and 1-year survival for all enrolled patients was 78%.. Administration of nebulized ABLC is safe in the short-term and well-tolerated in lung transplant recipients. Additional prospective, randomized studies are needed to determine the efficacy of aerosolized ABLC alone or in conjunction with systemic therapies in the prevention of fungal infections in lung transplant recipients.

Topics: Adult; Aerosols; Amphotericin B; Antifungal Agents; Candidiasis; Drug Combinations; Heart-Lung Transplantation; Humans; Incidence; Lung Diseases; Lung Transplantation; Middle Aged; Mycoses; Peritonitis; Phosphatidylcholines; Phosphatidylglycerols; Postoperative Period; Prospective Studies; Respiratory Mechanics; Safety; Survival Analysis

We report four episodes of non Candida albicans peritonitis (NCAP) in 3 patients on continuous ambulatory peritoneal dialysis (CAPD). Risk factors for NCAP included diabetes mellitus and prior antibiotic use in half of the cases. The antibiotic treatment was prescribed for exit-site infection (ESI) or peritonitis in the patient. Treatment for NCAP included antifungal therapy with oral fluconazole or intravenous amphotericin B. The NCAP resulted in catheter loss in 100% of the patients over time. Initial catheter salvage in one patient was followed 6 months later by catheter loss following treatment of a bacterial peritonitis that was complicated by the development of Candida (Torulopsis) glabrata peritonitis unresponsive to treatment with intravenous amphotericin B. Although the literature suggests that Candida peritonitis responds to oral fluconazole with and without catheter removal, this series suggests that the treatment of NCAP includes removal of the peritoneal dialysis catheter with appropriate antifungal agents.

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis; Catheters, Indwelling; Device Removal; Equipment Failure; Female; Fluconazole; Humans; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Risk Factors

A 19-year-old female on chronic peritoneal dialysis developed acute peritonitis; multiple peritoneal fluid and catheter tip cultures yielded Penicillium species. She promptly responded to catheter removal and intravenous amphotericin B, followed by oral fluconazole, without further recurrences 1 year later. This is the first reported case of Penicillium peritonitis in the pediatric population. We review the microbiology and clinical spectrum of this disease, as well as the few previous reported cases in adults.

Topics: Adult; Amphotericin B; Antifungal Agents; Female; Fluconazole; Humans; Kidney Failure, Chronic; Penicillium; Peritoneal Dialysis; Peritonitis

Topics: Adult; Amphotericin B; Antifungal Agents; Equipment Contamination; Female; Follow-Up Studies; Humans; Mitosporic Fungi; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Amphotericin B; Antifungal Agents; Female; Humans; Middle Aged; Mycoses; Paecilomyces; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Fungal peritonitis is a rare event in patients receiving peritoneal dialysis. This case report describes the blood and dialysate concentrations of fluconazole and amphotericin B following intravenous administration in a 5-month-old infant with Candida albicans peritonitis receiving continuous cyclic peritoneal dialysis. Fluconazole rapidly and efficiently penetrated the peritoneal fluid achieving concentrations that exceed the minimal inhibitory concentration (MIC) for most Candida species. In contrast, the amount of amphotericin B in the dialysate was below the limit of quantification despite measurable blood concentrations. This suggests that fluconazole represents a better choice for antifungal therapy because of its excellent peritoneal penetration.

Topics: Amphotericin B; Antifungal Agents; Ascitic Fluid; Candidiasis; Drug Combinations; Drug Therapy, Combination; Fluconazole; Humans; Infant; Infusions, Intravenous; Male; Peritoneal Dialysis; Peritonitis; Phosphatidylcholines; Phosphatidylglycerols

Fungal peritonitis (FP) is a rare complication of peritoneal dialysis (PD). Although treatment with fluconazole (FCZ) has improved catheter survival and preservation of the peritoneal membrane, FP still carries a high morbidity and mortality in pediatrics. High-risk factors for FP include previous usage of systemic antibiotics and recurrent bacterial peritonitis. A prospective experience in the treatment of FP was conducted at the University of Miami/Jackson Children's Hospital from 1992 to 1997. All patients received either oral or intravenous loading dose of FCZ (5-7 mg/kg) followed by intraperitoneal (i.p.) FCZ (75 mg/L). Amphotericin B (amp B) was added when clinical sepsis was present. A total of 6 patients had FP (all Candida sp.; mean age: 6 years). Two of these patients were neonates with Tenckhoff-catheter placement at less than 1 week of age. Five patients achieved sterilization of the peritoneal fluid. One patient required catheter removal (C. tropicalis). The 2 neonates were infection free for 29 and 41 days, respectively, but both died of superimposed bacterial sepsis. The remaining 4 patients survived and completed 6 weeks of FCZ treatment. Two have had preservation of the peritoneal membrane for more than 1 year. The other 2 were switched to hemodialysis. We conclude that FCZ is an effective treatment for fungal peritonitis in pediatric patients. Adjunct therapy with amp B is usually necessary if sepsis is present. Although eradication of the fungus is possible in a majority of cases, neonates and immunocompromised hosts remain at high risk for morbidity and mortality.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Candidiasis; Child; Child, Preschool; Fluconazole; Humans; Infant; Infant, Newborn; Peritoneal Dialysis; Peritonitis

Infectious peritonitis is a common complication of continuous ambulatory peritoneal dialysis (CAPD). Only one case of CAPD-related peritonitis due to Penicillium sp has previously been reported. We present a second case in which fungal colonies were observed on the inner surface of the CAPD catheter. The infection was successfully treated with catheter removal and intravenous amphotericin B.

Topics: Aged; Amphotericin B; Antifungal Agents; Humans; Male; Mycoses; Penicillium; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Fungal peritonitis (FP) is a rare but serious complication of chronic peritoneal dialysis (CPD) therapy and is associated with high morbidity and CPD drop-out. Risk factors and management of FP remain controversial. We reviewed our experience with FP in an attempt to identify risk factors and to examine outcome in relation to treatment strategies. Between March 1984 and August 1994, 704 patients were maintained on CPD therapy in our unit. A total of 1,712 episodes of peritonitis were identified among these patients. Fungal peritonitis accounted for 55 (3.2%) of these episodes. The patients on CPD therapy who developed FP were similar to those who did not develop FP with regard to age, gender, underlying etiology for end-stage renal disease, and comorbid disease. Prior antibiotic use was noted in 87.3% of episodes of FP. The peritonitis rate in the patients who developed FP was one episode every 5.1 months compared with one episode every 9.9 patient-months in the CPD patients who did not develop this infection. Candida sp caused 74.5% of the episodes of FP. All patients were treated with antifungal drugs. In 85.5% of infections the Tenckhoff catheter was removed within 1 week of the diagnosis of FP; 31.9% of the patients who had the Tenckhoff catheter removed did not have the catheter replaced because of death or transfer to hemodialysis. In the patients who developed FP, 68.1% had the Tenckhoff catheter replaced; of these patients, 90.6% and 59.4% were on CPD therapy 1 and 6 months after catheter replacement, respectively. We conclude that risk factors identified in our population include peritonitis rate and prior antibiotic use. Fungal peritonitis is rare in our CPD population, and although it leads to significant CPD drop-out, it can be managed in many patients with antifungal therapy, early catheter removal, and temporary hemodialysis. Of the catheters replaced between 2 and 8 weeks after the diagnosis of FP, 91% functioned successfully, allowing continuation of CPD.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Case-Control Studies; Catheters, Indwelling; Female; Fluconazole; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis; Peritonitis; Risk Factors; Treatment Outcome

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Drug Therapy, Combination; Flucytosine; Humans; Male; Peritonitis

Fungi have become an increasingly important cause of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. The most common cause of fungal peritonitis is Candida. However, in recent years unusual and "nonpathogenic" fungi have been reported as etiologic agents of CAPD-associated peritonitis. We are reporting the first case of CAPD-associated peritonitis caused by Monilia sitophila. This organism had previously been considered to be non-pathogenic, and a troublesome laboratory contaminant. Our patient was successfully managed with intravenous and intraperitoneal amphotericin B, followed by oral itraconazole, without removal of her Tenckhoff catheter.

Topics: Administration, Oral; Adult; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Cross Infection; Drug Therapy, Combination; Female; Humans; Injections, Intraperitoneal; Injections, Intravenous; Itraconazole; Kidney Failure, Chronic; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Adolescent; Amphotericin B; Antifungal Agents; Candidiasis; Drug Carriers; Humans; Liposomes; Male; Peritonitis; Postoperative Complications

Aspergillus peritonitis is a rare complication of continuous ambulatory peritoneal dialysis. The case is described of a 68-year-old man in whom Aspergillus fumigatus was isolated from the peritoneal dialysate after recurrent peritonitis with Gram-negative rods in association with diverticulosis. Treatment consisting of removal of the catheter and intravenous administration of amphotericin B followed by oral itraconazole was successful. A review of the sparse literature (12 cases) displays uncertainties regarding diagnostic awareness, culture diagnosis, and therapeutic management. Next to institution of appropriate antifungal therapy, early removal of the peritoneal dialysis catheter is recommended, as delayed removal of the catheter appears to be associated with increased mortality and morbidity.

Topics: Administration, Oral; Aged; Amphotericin B; Aspergillosis; Humans; Infusions, Intravenous; Itraconazole; Male; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Adult; Amphotericin B; Candidiasis; Hemiplegia; Humans; Immunocompromised Host; Infusions, Intravenous; Male; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Recurrence

We describe a case of peritonitis caused by Aureobasidium pullulans in a patient on continuous ambulatory peritoneal dialysis (CAPD). This dematiaceous fungus rarely causes infection in humans and to date has not been reported as an etiology of CAPD-associated peritonitis. The patient was managed successfully with peritoneal catheter removal and a prolonged course of intravenous amphotericin B, allowing resumption of CAPD. In vitro susceptibility testing confirmed sensitivity of this organism to amphotericin B.

Topics: Adult; Amphotericin B; Antifungal Agents; Catheterization; Humans; Infusions, Intravenous; Male; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Amphotericin B; Candidiasis; Catheters, Indwelling; Female; Humans; Injections, Intravenous; Middle Aged; Peritoneal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Two patients who developed fungal peritonitis after receiving continuous ambulatory peritoneal dialysis (CAPD) for various periods were successfully treated with intracatheter retention of amphotericin B and oral flucytosine for 5 weeks. The catheter was not removed and efficient peritoneal permeability was maintained. We suggest that intracatheter retention of antifungal agents to sterilize the catheter along with simultaneous oral antifungal agents be used to eradicate peritoneal infection. The catheter may not need to be removed, and CAPD can be accomplished. The period of hospitalization may, thereby, be shortened, and the efficiency of CAPD can be maintained.

Topics: Administration, Oral; Amphotericin B; Catheters, Indwelling; Drug Therapy, Combination; Female; Flucytosine; Humans; Male; Middle Aged; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

The recovery of Candida albicans along with bacteria from the abdomen in the setting of peritonitis is becoming increasingly common. It is not known whether the interactions between the fungal and bacterial elements of these infections are synergistic, competitive, or neutral. To study this question, we have examined the effects of both the addition of C. albicans to a solely bacterial infection caused by Escherichia coli and Bacteroides fragilis, and the deletion of various components of this system using directed antimicrobial therapy. In a mixed infection, both C. albicans and bacteria contributed to mortality, since only the combination of cefoxitin and amphotericin B improved survival (from 50% to 90%). The addition of C. albicans to the bacterial inoculum increased the recovery of abscesses, but only to the number seen with fungal infection alone, implying two fairly independent processes. Although the number of bacteria recovered from abscesses at 10 days postinfection was unchanged with the addition of fungi, the deletion of the bacterial component of mixed infections led to the overgrowth of C. albicans. We conclude that this model of mixed C. albicans/E. coli/B. fragilis peritonitis is best characterized as two nonsynergistic, parallel infections with incomplete competition, allowing the survival of all three organisms to eventual abscess formation.

Topics: Abscess; Amphotericin B; Animals; Bacteroides fragilis; Bacteroides Infections; Candida albicans; Candidiasis; Cefotetan; Cefoxitin; Clindamycin; Colony Count, Microbial; Drug Combinations; Escherichia coli; Escherichia coli Infections; Male; Mice; Mice, Inbred BALB C; Peritoneal Diseases; Peritonitis; Survival Rate

Topics: Amphotericin B; Candidiasis; Drug Therapy, Combination; Fluconazole; Humans; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Adult; Amphotericin B; Female; HIV Seropositivity; Humans; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rhodotorula

Topics: Amphotericin B; Fatal Outcome; Humans; Male; Middle Aged; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum; Peritonitis; Trichoderma

Two patients who developed fungal peritonitis after receiving continuous ambulatory peritoneal dialysis (CAPD) for various periods were successfully treated with intracatheter retention of amphotericin B 1-2 mg and oral flucytosine or fluconazole 50 mg b.i.d. for 5 weeks. The catheter was not removed and efficient peritoneal permeability was maintained. We suggest that intracatheter retention of antifungal agents to sterilize the catheter with simultaneous oral antifungal agents be used to eradicate peritoneal infection. The catheter may not have to be removed, and CAPD can be accomplished. Period of hospitalization may be shortened, and the efficiency of CAPD can be maintained.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Catheters, Indwelling; Female; Fluconazole; Flucytosine; Humans; Male; Middle Aged; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rhodotorula

Topics: Amphotericin B; Candidiasis; Drug Therapy, Combination; Female; Fluconazole; Humans; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

The authors have evaluated the pharmacokinetics of four antifungal agents used in the therapy of fungal peritonitis. Amphotericin B (Amph B) poorly diffuses from blood into peritoneal fluid, which intraperitoneal administration induces severe abdominal pain. 5-Fluorocytosine (5FC) easily crosses peritoneum, but resistance may appear when the drug is used alone. Ketoconazole (K) poorly penetrates into peritoneal fluid, while Fluconazole (F), used per os or intraperitoneally, shows a good antifungal activity both in serum and in the peritoneal fluid. In conclusion, from a pharmacokinetic point of view, all the antifungal agents examined, perhaps with the exception of F, do not offer, when used alone, sufficient guarantees in curing peritonitis. Therefore, for treating fungal infections in CAPD, drug combinations such as AmphB + 5FC, K + 5FC or 5FC+F have to be used.

Topics: Amphotericin B; Antifungal Agents; Fluconazole; Flucytosine; Humans; Ketoconazole; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Adult; Amphotericin B; Candidiasis; Catheters, Indwelling; Humans; Infusions, Parenteral; Male; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Peritoneal coccidioidomycosis is extremely rare. This report describes a patient infected with the human immunodeficiency virus who presented with unexplained ascites and was found to have peritoneal coccidioidomycosis. The ascites had a low serum-ascites albumin gradient, and laparoscopy showed peritoneal implants that grew Coccidioides immitis. This case is unique in several ways; this is the first case in which a patient's acquired immunodeficiency syndrome-defining illness was peritoneal coccidioidomycosis, and the serum-ascites albumin gradient determination as well as laparoscopy provided information critical to the diagnosis. This patient's dramatic response to systemic antifungal therapy, as evidenced by resolution of ascites and constitutional symptoms, underscores the importance of timely diagnosis and prompt therapy. In summary, this report reviews the previous cases of coccidioidal peritonitis and reports the first case in which localized peritoneal coccidioidomycosis was the acquired immunodeficiency syndrome-defining illness in a human immunodeficiency virus-infected patient.

Topics: Adult; Amphotericin B; Ascites; Blood Cell Count; Coccidioidomycosis; Humans; Laparoscopy; Male; Peritoneum; Peritonitis; Serum Albumin

Topics: Amphotericin B; Humans; Kidney Failure, Chronic; Male; Middle Aged; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Soil Microbiology

Topics: Aged; Amphotericin B; Candidiasis; Humans; Kidney Failure, Chronic; Male; Peritoneal Dialysis; Peritonitis; Remission, Spontaneous

Topics: Adult; Amphotericin B; Aspergillosis; Candidiasis; Dialysis Solutions; Female; Humans; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Feeding gastrostomies were placed in three children treated with chronic peritoneal dialysis at our center because of persistent, severe malnutrition and inadequate growth. Two had frequent fungal infections of the gastrostomy site and all three developed Candida peritonitis which occurred at 1 month, 2 months and 2 years after insertion of gastrostomy. Complications included multiple intra-abdominal adhesions, abscess formation and loss of peritoneal function necessitating transfer to hemodialysis. The presence of a gastrostomy may predispose to the development of fungal peritonitis with its high morbidity and should be avoided in children on chronic peritoneal dialysis.

Topics: Adolescent; Amphotericin B; Candidiasis; Child; Child, Preschool; Contraindications; Enteral Nutrition; Female; Gastrostomy; Humans; Male; Peritoneal Dialysis; Peritonitis

We describe the second reported case of peritonitis caused by the alga Prototheca wickerhamii in a patient on continuous ambulatory peritoneal dialysis (CAPD). This organism, which grows slowly on agar media, is recognised as a race cause of other infections. The condition is clinically similar to cases of fungal peritonitis, but there are important differences, particularly when choosing the best treatment.

Topics: Amphotericin B; Diabetes Mellitus, Type 1; Fluconazole; Flucytosine; Humans; Infections; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Prototheca

Amphotericin B is the drug of choice in continuous ambulatory peritoneal dialysis (CAPD) associated fungal peritonitis and is usually administered intraperitoneally. The drug is stated to be incompatible with anions. All CAPD fluids contain chloride and lactate anions. Therefore, the physical and chemical compatibility of amphotericin B with dextrose 5%, Dianeal 1.36% CAPD fluid, and Dianeal 1.36% peritoneal effluent was studied at amphotericin B concentrations of 1, 2, and 5 mg/L. Amphotericin B was most stable in Dianeal CAPD fluid. The rate of degradation was concentration dependent in dextrose 5% and peritoneal effluent. The higher the concentration, the lower the rate of degradation. After an incubation of 6 h at 37 degrees C, no significant decomposition was found at all concentrations studied in Dianeal CAPD fluid whereas 12-18% decomposition was found in effluent. No physical incompatibility with any solution was observed.

Topics: Amphotericin B; Chromatography, High Pressure Liquid; Dialysis Solutions; Drug Stability; Humans; Injections, Intraperitoneal; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Administration, Topical; Amphotericin B; Candidiasis; Humans; Male; Middle Aged; Peritonitis; Postoperative Complications; Therapeutic Irrigation

Topics: Amphotericin B; False Positive Reactions; Humans; Latex Fixation Tests; Male; Middle Aged; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Trichosporon

We report a case of Candida norvegensis invasive disease in an immunosuppressed renal transplant patient on continuous ambulatory peritoneal dialysis. Multiple cultures of peritoneal fluid, blood, and tracheal suction done over a 2-week period were positive for this unusual isolate. Despite treatment with amphotericin B and flucytosine the patient died. This is the first report of C. norvegensis fungemia documented by culture.

Topics: Adult; Amphotericin B; Blood; Candida; Candidiasis; Drug Therapy, Combination; Flucytosine; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Male; Microbial Sensitivity Tests; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Over a 2-year period, all surgical patients from whom Candida was isolated from intra-abdominal specimens were evaluated. All but 1 of the 49 evaluable patients had either a spontaneous perforation (57%) or a surgical opening of the gastrointestinal tract (41%). Candida caused infection in 19 patients (39%), of whom 7 had an intra-abdominal abscess and 12 peritonitis. In the other 30 patients (61%), there were no signs of infection and specific surgical or medical treatment was not required. Candida was more likely to cause infection when isolated in patients having surgery for acute pancreatitis than in those with either gastrointestinal perforations or other surgical conditions. The development of a clinical infection was significantly associated with a high initial or increasing amount of Candida in the semiquantitative culture. Surgery alone failed in 16 of 19 patients (84%), of whom 7 died and 9 recovered after combined antifungal and surgical treatment. The overall mortality and the mortality related to infections were significantly higher in the patients with intraabdominal candidal infections than in those without such infections.

Topics: Abscess; Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Candida; Candidiasis; Child; Child, Preschool; Combined Modality Therapy; Drainage; Female; Humans; Infant; Intestinal Perforation; Male; Middle Aged; Pancreatitis; Peritoneum; Peritonitis; Postoperative Complications; Prospective Studies; Retrospective Studies; Time Factors

Topics: Adolescent; Amphotericin B; Catheters, Indwelling; Cryptococcosis; Female; Humans; Kidney Failure, Chronic; Peritoneal Dialysis; Peritonitis

The clinical features, treatment and outcome of 27 cases of fungal peritonitis were studied. Twenty-one cases occurred in patients receiving CAPD and six in patients on intermittent peritoneal dialysis. Twenty-five cases were due to Candida spp., one was due to Trichosporon spp. and in one, both Candida and Trichosporon and an unidentified acid-fast bacillus were isolated. Clinical features of fungal peritonitis and bacterial peritonitis were the same. A direct comparison with patients without fungal peritonitis failed to reveal an increased incidence of diabetes mellitus. However, a history of recent bacterial peritonitis and antibiotic treatment was frequently obtained. We found that the combination of oral ketoconazole and intraperitoneal miconazole is successful in treating fungal peritonitis complicating peritoneal dialysis but catheter removal and replacement is often necessary. Analysis of the relationship between clinical outcome and various treatment strategies in cases reported in the literature and in our own showed that an initial trial of antifungal drugs consisting of oral ketoconazole and i.p. 5-fluorocytosine or miconazole is warranted in most cases before contemplating catheter removal.

Topics: Adolescent; Adult; Aged; Amphotericin B; Candidiasis; Female; Humans; Male; Miconazole; Middle Aged; Mycoses; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Trichosporon

A patient receiving continuous ambulatory peritoneal dialysis, and who was known to be seropositive for human immunodeficiency virus but without AIDS or ARC, had peritonitis secondary to Trichosporon beigelii. The patient had been receiving oral antibiotics and had had recurrent bouts of bacterial peritonitis. Infection was cured with removal of the peritoneal catheter and intraperitoneal and intravenous amphotericin B. The course of this episode of Trichosporon beigelii peritonitis was similar to that of peritonitis caused by other yeasts.

Topics: Amphotericin B; Female; HIV Seropositivity; Humans; Middle Aged; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Recurrence; Trichosporon

Between 1979 and 1985, six of 26 patients undergoing continuous ambulatory peritoneal dialysis developed fungal peritonitis. All had received antibacterial therapy with cefamandole and/or netilmicin prior to the diagnosis. The causal organisms were Candida albicans (three), Candida glabrata (one), Cryptococcus laurentii (one) and Saccharomyces cerevisiae (one). Treatment comprised catheter removal preceded by antifungal drugs (flucytosine and/or amphotericin B) in four patients and catheter removal alone in two. All patients were transferred to haemodialysis and five of the six developed extensive intra-abdominal adhesions. The most prudent management of fungal peritonitis in children would seem to be early cannula removal.

Topics: Adolescent; Amphotericin B; Candidiasis; Child; Child, Preschool; Cryptococcosis; Female; Flucytosine; Humans; Kidney Transplantation; Male; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Renal Dialysis

Although abdominal candidiasis in critically ill surgical patients is becoming increasingly common, optimal management has not been defined. We treated 16 patients with abdominal candidiasis over a 36 month period. Violation of the gastrointestinal tract mucosa was the most common precipitating event (13 patients). Predisposing factors included: CVP catheters, broad spectrum antibiotics, and parenteral hyperalimentation in all patients, H2-blockers/antacids in 14 patients, as well as malnutrition (7 patients), DM (3 patients), alcoholism (3 patients), and steroids/chemotherapy (3 patients). Candida was isolated from an abscess in seven patients, peritoneal fluid in six patients and both in three patients. In four patients abdominal candidiasis was preceded by positive cultures from blood or two peripheral sites which had not been treated. All patients were treated with amphotericin B (146-4000 mg) without any major adverse effects. Fungal infection was eradicated in ten patients; three patients succumbed to candidiasis. Patients treated within seven days required less Amphotericin B and appeared to have a better outcome than those having delayed treatment. The authors conclude that abdominal candidiasis is a potentially lethal infection in critically ill surgical patients that should be aggressively treated. Amphotericin B can be safely administered and concurrent antibiotics need not be stopped.

Topics: Abdomen; Abscess; Adult; Aged; Aged, 80 and over; Amphotericin B; Candidiasis; Digestive System Surgical Procedures; Female; Humans; Male; Middle Aged; Peritonitis; Postoperative Complications

A 48-year-old man receiving maintenance hemodialysis for 3 years and continuous ambulatory peritoneal dialysis for 1 year developed a clinical picture compatible with peritonitis. Three successive fluid cultures were negative, and only after filtration of a large volume of peritoneal fluid a fungus identified as a Rhizopus sp was isolated in cultures of the filtering devices. The same fungus was also isolated from the peritoneal catheter cuff. Intravenous amphotericin B was administered and both the abdominal and general conditions of the patient improved transiently. Twenty days after initiation of antifungal treatment, a clinical suspicion of intestinal perforation arose and an exploratory laparotomy was scheduled, but the patient died during the anesthetic induction. The patient never received deferoxamine; any conditions predisposing to mucormycosis, such as diabetes or immunosuppression, were also absent.

Topics: Amphotericin B; Ascitic Fluid; Humans; Male; Middle Aged; Mucormycosis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rhizopus

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Child; Child, Preschool; Cross-Sectional Studies; Dialysis Solutions; Eosinophilia; Female; Humans; Leukocyte Count; Male; Middle Aged; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Reference Values; Time Factors

Topics: Amphotericin B; Candidiasis; Flucytosine; Humans; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Female; Humans; Male; Middle Aged; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Seventeen cases of fungal peritonitis and one case of Nocardia asteroides peritonitis were observed in 141 patients during the first 5 years of our continuous ambulatory peritoneal dialysis program (CAPD). Fungal peritonitis accounted for 7% of the episodes of peritonitis observed in this interval. There were eight deaths associated with fungal peritonitis. In only three instances could factors predisposing to fungal peritonitis be identified. We were unable to predict who would develop fungal peritonitis by analysis of nutritional, demographic, or technical factors associated with the dialysis procedure. The diagnosis of fungal peritonitis was easily established using routine blood agar culture techniques. Successful management of these patients included prompt removal of the Tenckhoff catheter and intravenous (IV) administration of amphotericin.

Topics: Amphotericin B; Humans; Length of Stay; Mycoses; Nutritional Status; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Socioeconomic Factors

Nine peritonitis episodes caused by Candida sp were diagnosed in eight continuous ambulatory peritoneal dialysis (CAPD) patients. Treatment with intraperitoneal administration of amphotericin B and 5-fluorocytosine while the peritoneal catheter was left in situ was effective in six episodes in five patients. Of the three other patients, two started again with CAPD after peritonitis had been cured, but one patient preferred to stay on hemodialysis. In four episodes, peritoneal white cell counts remained high during treatment despite negative cultures. This was probably the result of irritation of the peritoneal membrane caused by the antifungal treatment, possibly by amphotericin B. Persistently-elevated leukocyte counts during antifungal therapy, with or without signs and symptoms of peritonitis, are not necessarily an indication of treatment failure.

Topics: Aged; Amphotericin B; Antifungal Agents; Candidiasis; Drug Evaluation; Drug Therapy, Combination; Female; Flucytosine; Humans; Infusions, Parenteral; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

This study compared the static and kinetic activities of six antifungal agents, in broth and used dialysate, against six yeast strains known to have caused peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). Minimum inhibitory concentrations (MIC) and IC50 results show a trend towards greater activity by amphotericin B, 5-fluorocytosine, tioconazole and itraconazole in comparison to miconazole and ketoconazole although there was some strain variability. Minimum fungicidal concentrations (MFCs) of amphotericin B were less than or equal to 1mg/l, while 5-fluorocytosine and the azoles showed large discrepancies between MIC and MFC values. In kinetic studies amphotericin B was the most potent fungicidal agent. 5-fluorocytosine showed modest activity and failed to achieve total killing. The azoles demonstrated variable degrees of inhibition of C. glabrata and showed minimal activity with C. albicans. Itraconazole showed good activity against C. parapsilosis in broth. All agents, with the exception of 5-fluorocytosine, showed reduced activity in used dialysate in comparison to broth.

Topics: Amphotericin B; Antifungal Agents; Azoles; Candida; Candidiasis; Drug Evaluation; Flucytosine; Humans; Kinetics; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Fungal infection is an uncommon cause of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). This report describes the clinical and microbiological features of 10 cases of fungal peritonitis. Although all patients survived, morbidity was high. Abscess and adhesion formation were particular problems. Only two patients were able to return to CAPD after microbiological cure. Currently available treatment strategies for fungal peritonitis are reviewed.

Topics: Adult; Aged; Amphotericin B; Catheters, Indwelling; Female; Flucytosine; Humans; Kidney Failure, Chronic; Male; Middle Aged; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritoneal Lavage; Peritonitis

A 41-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) presented with algal peritonitis. Prototheca wickerhamii was isolated from multiple dialysate effluent cultures. Despite treatment with amphotericin B, catheter removal was required. An attempt to reinsert a Tenckhoff catheter 3 months later was unsuccessful because of dense intraperitoneal adhesions. Prototheca sp are a rare cause of human disease, this being the first reported case of algal peritonitis complicating CAPD.

Topics: Adult; Amphotericin B; Catheters, Indwelling; Female; Humans; Infections; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Prototheca

A case of Candida peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD) is presented. Despite 2 weeks of intravenous and 4 weeks of intraperitoneal amphotericin B, good clinical response, and repeatedly negative fungal cultures from the peritoneal dialysate, her Tenckhoff catheter upon removal grew the same Candida species. This case emphasizes the point that Candida may persist on the catheter despite seemingly adequate antifungal treatment and good clinical and microbiologic response.

Topics: Aged; Amphotericin B; Candidiasis; Female; Humans; Infusions, Intravenous; Infusions, Parenteral; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

There are increasing numbers of reports of peritonitis caused by fungi in children undergoing continuous cycling peritoneal dialysis. Most of these cases are due to the Candida species, although other fungi have been reported. We report the first case (to our knowledge) of successfully treated Aspergillus peritonitis in a child on continuous cycling peritoneal dialysis.

Topics: Adolescent; Amphotericin B; Aspergillosis; Humans; Male; Peritoneal Dialysis; Peritonitis

During a four-year period there were 77 episodes and 15 recurrences of peritonitis in 30 children treated with continuous ambulatory peritoneal dialysis for periods of one to 39 months (mean, 15.3 months). The incidence was one episode per 6.0 patient-months. Organisms cultured included Staphylococcus epidermidis (17 episodes), Staphylococcus aureus (15 episodes), and fungi (four episodes). Special culture techniques were needed to ensure a high yield of positive cultures. Peritonitis was usually treated with intraperitoneal administration of cefazolin sodium, and 61% of the episodes were treated at home. There was one death, from Candida peritonitis, and catheters were removed in 11 children because of resistant or recurrent peritonitis (eight cases) or fungal peritonitis (three cases). Peritonitis rates were highest in children who had difficulty performing bag changes aseptically but who could not be transferred to hemodialysis and in hospitalized patients.

Topics: Adolescent; Adult; Amphotericin B; Anti-Bacterial Agents; Cefazolin; Child; Child, Preschool; Drug Therapy, Combination; Female; Flucytosine; Humans; Infant; Male; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Recurrence; Tobramycin

Fungal peritonitis occurred in 17 patients on chronic peritoneal dialysis. The incidence of infection per 100 patient-dialysis months was 0.36 for patients on intermittent peritoneal dialysis and 1.6 for patients on continuous ambulatory dialysis (p less than 0.005). Initial clinical findings included abdominal pain (76%), fever (59%), cloudy dialysate (76%) and poor dialysate outflow (6%). 15 patients received antibiotics within 4 weeks of developing peritonitis. All infections were caused by yeasts, with Candida parapsilosis and Candida albicans as the most common species. 14 patients were unable to continue peritoneal dialysis due to persistent or relapsing infection or the development of complications. 2 of the 3 patients who were able to continue peritoneal dialysis were treated with catheter replacement, intraperitoneal miconazole and oral ketoconazole.

Topics: Adult; Aged; Amphotericin B; Catheters, Indwelling; Drug Therapy, Combination; Female; Flucytosine; Humans; Ketoconazole; Male; Miconazole; Middle Aged; Mycoses; Peritoneal Dialysis; Peritonitis; Prognosis

We attempted to treat 5 patients on CAPD with fungal peritonitis without removing the catheter. In 1 case, amphotericin B caused a severe chemical peritonitis. The other 4 patients received amphotericin B intravenously and miconazole or flucytosine intraperitoneally. Recovery was obtained in 3 cases without removing the catheter and in 1 case the patient died.

Topics: Adult; Aged; Amphotericin B; Catheterization; Drug Therapy, Combination; Female; Flucytosine; Humans; Male; Miconazole; Middle Aged; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

A 3 1/2 year old child with chronic renal failure twice developed severe candida peritonitis in the course of treatment with continuous ambulatory peritoneal dialysis. Medical treatment was unsuccessful but removal of the catheter led to immediate cure. This case documents a long held clinical impression that the best, if not the only way of treatment of candida peritonitis is removal of the indwelling catheter. Thus, potentially hazardous, painful and costly medical treatment can and should be avoided.

Topics: Amphotericin B; Candidiasis; Catheters, Indwelling; Child, Preschool; Cytosine; Drug Therapy, Combination; Flucytosine; Humans; Male; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Torulopsis glabrata peritonitis occurred in a patient after surgery for a ruptured abdominal viscus. The infection was successfully treated with intraperitoneal amphotericin B alone. Pharmacokinetic information regarding the distribution and clearance of amphotericin B administered by this route is presented, and the clinical manifestations and treatment modalities for T glabrata and Candida peritonitis are reviewed.

Topics: Abdomen; Amphotericin B; Ascitic Fluid; Candida; Humans; Injections, Intraperitoneal; Kinetics; Male; Middle Aged; Mycoses; Peritoneum; Peritonitis; Surgical Wound Infection

The management, complications and outcome of two small children who developed Candida albicans peritonitis are reported. Both children developed peritonitis while on continuous ambulatory peritoneal dialysis (CAPD) but their fungal infections were treated differently. In one patient, Amphotericin B (1-4 micrograms/ml) was added to the dialysate; infection resolved but an extensive fibrous reaction developed in the peritoneal cavity making subsequent CAPD ineffective. The second patient was treated with a recently introduced oral antifungal agent, Ketoconazole; her catheter was removed. This patient recovered without any identifiable side effects of the drug. This report discusses the clinical course of two different approaches to Candida peritonitis and suggests certain recommendations regarding the treatment of this uncommon, but potentially lethal complication of CAPD.

Topics: Amphotericin B; Candidiasis; Catheterization; Child, Preschool; Female; Humans; Imidazoles; Infant; Ketoconazole; Male; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Piperazines

Thirty patients were treated with continuous ambulatory peritoneal dialysis during 313 patients months. 26 episodes of peritonitis defined by a cloudy dialysate with more than 100 cells/mm1 and more than 50 p. cent of polynuclear were observed. The organisms initially responsible were Gram-positive in 11 cases (6 Staphylococcus aureus, 1 Staphylococcus albus, 4 Streptococcus viridans), a gram negative in 3 cases (1 Klebsiella, 1 serratio, one unidentified), a Candida in 2 cases. In 10 cases, the culture was negative, Initial treatment was peritoneal lavage (40 l/day) with in situ antibiotics: in the absence of Candida, the association sulfamethoxazole (SMZ) (80 mg/l) and trimethoprim (TMP) (16 mg/l) was used; when Candida was present amphotericin B (5 mg/l) was used. The association SMZ + TMP led to cure of PT in 17 cases, in 7 +/- 4 days. In 5 cases, this initial treatment was changed at the 48th hour because of initial resistance in one case or secondary resistance of Candida surinfection (2 cases). Candida surinfection occurred later in 2 other cases. For these 6 primary or secondary Candida peritonitis, the catheter was changed within 48 hours. Nevertheless, death occurred in 3 cases and cure was obtained after 51 +/- 11 days in the 3 other cases.. 1) The initial treatment by SMZ + TMP appears quite effective in most cases (73%). 2) The severity and the high incidence of Candida surinfection suggest that its systematic prophylaxis may be appropriate.

Topics: Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Candidiasis; Drug Combinations; Humans; Kidney Failure, Chronic; Middle Aged; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The natural history of candidiasis in general surgical patients has been poorly documented, and the toxicity of amphotericin B is widely heralded. For these reasons therapy for candidiasis is frequently withheld in situations where antimicrobial treatment seems indicated on clinical grounds. The clinical courses of 47 general surgical patients who received amphotericin therapy for presumed Candida infection were reviewed. Nineteen patients had had solid tumors, but 12 were either localized or resected tumors. Only nine patients had received prior cancer themotherapy. Twenty-one patients were treated for fungemic disease, 10 for Candida in peritonitis fluid, and 16 for apparent colonization associated with fever and organ failure syndromes. Pre-existing renal or other organ failure was the primary determinant of survival with 4/22 survivors (18%) in patients with renal failure compared with 17/25 (78%) survivors in patients without such organ failure. In patients with serum creatinine values less than 2.5 mg/dl, amphotericin therapy was associated with a transient 30% fall in creatinine clearance and a proportionate rise in serum creatinine. Dose response curves were determined and revealed substantial sterilization of cultures in both fungemic and nonfungemic patients receiving greater than or equal to 6 mg/kg. This was confirmed by autopsy material. We suggest that in this acutely ill patient popoulation uncontrolled infection is the primary determinant of organ failure. Short-term limited dosing with amphotericin B (6-8 mg/kg total dose) in conjunction with appraisal of clinical response is adequate therapy for most presumed Candida infections. Long-term high dose therapy, such as that recommended in immuodepressed patients, is not a routine necessity.

Topics: Acute Kidney Injury; Amphotericin B; Candidiasis; Creatinine; Dose-Response Relationship, Drug; Drug Administration Schedule; Humans; Neoplasms; Peritonitis; Postoperative Complications; Sepsis; Surgical Procedures, Operative

The child presented in this report received intravenous amphotericin B 0.5 mg/kg every 36 hours, for dialysis-associated Candida peritonitis. Just prior to her third dose of amphotericin B, the peritoneal fluid concentration of this drug was 0.1 mcg/ml, and the simultaneous serum level was 0.2 mcg/ml. An hour following the third amphotericin B dose, the peritoneal fluid and serum concentrations were 0.2 and 0.4 mcg/ml respectively. The minimal inhibitory concentration (MIC) of amphotericin B for the C. albicans isolated from this patient was 0.05 mcg/ml, and the minimal lethal concentration (MLC) was 0.1 mcg/ml. Treatment included concurrent 5-fluorocytosine, and catheter removal. This is the first time that measurements of concentrations of amphotericin B in the peritoneal fluid have been reported in a child with peritonitis.

Topics: Amphotericin B; Ascitic Fluid; Candidiasis; Child; Female; Humans; Infusions, Parenteral; Peritonitis

Topics: Amphotericin B; Candida; Candidiasis; Female; Humans; Male; Peritonitis; Postoperative Complications; Risk

Topics: Amphotericin B; Ascitic Fluid; Cryptococcus; Cytosine; Flucytosine; Humans; Kidney Failure, Chronic; Male; Middle Aged; Mycoses; Peritoneal Dialysis; Peritonitis

Candida albicans peritonitis developed in a 48-year-old man with a perforated gastric ulcer who subsequently was treated with intravenous amphotericin B. The drug penetrated well into the inflamed peritoneal cavity and eradicated the organism from the peritoneal fluid. Nevertheless, at post-mortem, Candida organisms were demonstrated in a gall-bladder empyema and within the gall-bladder wall. Because intra-abdominal organs may be involved in Candida peritonitis, the use of high dose amphotericin B administered either intravenously, intraperitoneally, or both intravenously and intraperitoneally is recommended.

Topics: Amphotericin B; Candidiasis; Humans; Infusions, Parenteral; Male; Middle Aged; Peritonitis

In the absence of specific dietary lipids, large amounts of ethanol (ethyl alcohol) are produced from glucose in the stomachs of ruminant neonates by the resident yeast Torulopsis glabrata. Using new born lambs, oral dosing with the antifungal antibiotics Nystatin and Amphotericin "B" was shown in samples of stomach contents, to control the ethanol production entirely, and to suppress the yeast numbers partially but not permanently. Of 11 lambs receiving heavy and continous doses orally of the pure antibiotic powders, 7 died, of these 5 had developed adhesive peritonitis.

Topics: Amphotericin B; Animals; Candida; Ethanol; Glucose; Nystatin; Peritonitis; Sheep; Sheep Diseases; Stomach, Ruminant

Two patients undergoing peritoneal dialysis with permanent indwelling peritoneal catheters who developed Candida albicans peritonitis are presented. Both patients were successfully treated with low dose intravenous amphotericin B. Sequential candida precipitin assays were performed and the diagnostic application is discussed.

Topics: Acute Kidney Injury; Adult; Aged; Amphotericin B; Antibodies, Fungal; Candidiasis; Catheters, Indwelling; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Humans; Kidney Failure, Chronic; Male; Peritoneal Dialysis; Peritonitis; Surgical Wound Infection

Thirty-one patients with Candida isolated from peritoneal fluid were examined. Twenty-two were considered to have Candida peritonitis. The data on these 22 patients, plus 12 additional patients described in the literature, were reviewed. This infection was observed as a complication of peritoneal dialysis, gastrointestinal surgery or perforation of an abdominal viscus. Recent antibiotic administration seemed to be an important predisposing factor. The disease usually remained localized intra-abdominally, although disseminated candidiasis was also noted in three cases. Clinically significant infection could be differentiated from peritoneal contamination with Candida by the presence and persistence of fever, peritoneal signs, peripheral leukocytosis, positive peritoneal cultures for Candida, abnormal films of the abdomen and purulent ascitic fluid. Surgical interventions and removal of infected peritoneal fluid were the cornerstones of therapy. Short-term, low-dose systemic and/or intraperitoneally administered amphotericin B appeared promising in the treatment of unremitting infection. Mortality in treated patients was low and was comparable to that in patients with bacterial peritonitis.

Topics: Adult; Amphotericin B; Candidiasis; Female; Humans; Male; Peritoneal Dialysis; Peritonitis; Postoperative Complications; Prognosis; Therapeutic Irrigation

A 14-year-old girl, who was a renal transplant recipient, developed Candida tropicalis peritonitis during peritoneal dialysis and immunosuppressive and broad-spectrum antibiotic therapy. Therapeutic cure of the peritonitis followed a ten-day course of amphotericin B administered solely by peritoneal lavage.

Topics: Amphotericin B; Candidiasis; Child; Dialysis; Female; Humans; Kidney Transplantation; Peritonitis; Therapeutic Irrigation; Transplantation, Homologous

Topics: Adolescent; Amphotericin B; Antigens, Fungal; Ascitic Fluid; Cryptococcosis; Cryptococcus neoformans; Humans; Male; Peritonitis; Prednisone

Topics: Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Candida albicans; Candidiasis; Child, Preschool; Female; Humans; Intestinal Perforation; Male; Middle Aged; Peritonitis; Quadriplegia; Stomach Ulcer

Topics: Adult; Amphotericin B; Ascites; Candida; Candidiasis; Diagnosis, Differential; Diagnostic Errors; Humans; Liver Cirrhosis; Male; Peptic Ulcer Perforation; Peritonitis; Radiography; Stomach Ulcer

Topics: Abscess; Amphotericin B; Brain Abscess; Candidiasis; Carrier State; Child; Chloramphenicol; Colistin; Deoxyribonucleases; DNA; Empyema; Enteritis; Humans; Kanamycin; Meningitis; Methicillin; Penicillins; Peritonitis; Phlebitis; Pneumonia; Pneumothorax; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Sulfadiazine; Troleandomycin

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Humans; Peritonitis