Abstract
R. Khanna, D.G. Oreopoulos,
8.1. Vas, W. McCready and N. Dombros (will be presented at the European Dialysis and Transplantation Association, Prague, June 1980)
Ten patients with chronic renal failure on intermittent perito. neal dialysis (3) and CAPD (7) developed fungal peritonitis. Six were males and four females. Four had chronic glomerulonephritis, three had polycystic kidney disease and one each had chronic pyelonephritis, diabetes and analgesic nephropathy.
Dialysate effluent was cloudy in all. Eight patients had clinical symptoms (abdominal pain, nausea and vomiting) and signs (abdominal tenderness with rebound and guarding and lowgrade fever). Initially, gram stain identified fungus in six of them, namely Candida (6), Fusarium (2), Mucor (1), Trichosporon (1). Nine patients were treated with continuous lavage with a dialysate containing appropriate antifungal agents (Amphotericin B, 5 mg/l, 5-Fluorocytosine 50 mg/l and Miconazole 10 mg/l) for a period of 2 to 15 days. Only two patients improved on this therapy. In six the dialysis catheter had to be removed before there was any clinical improvement. Indications for catheter removal were persistent positive effluent culture and clinical deterioration. Four patients returned to peritoneal dialysis (IPD 1, CAPD 3); four were transferred to hemodialysis. Two who had bowel perforation died.
Fungal peritonitis is not infrequent in chronic peritoneal dia. lysis, especially in patients on CAPD. In most cases, clinical cure will require catheter removal and antifungal therapy. Following the infection, patients can he returned to peritoneal dialysis.
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