Fungal peritonitis in continuous peritoneal dialysis
- Gary M Cox, MD
Gary M Cox, MD
- Professor of Medicine
- Duke University Medical Center
- Carol A Kauffman, MD
Carol A Kauffman, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Fungal Infections
- Professor of Internal Medicine
- University of Michigan Medical School
- Veterans Affairs Ann Arbor Healthcare System
- Steve J Schwab, MD
Steve J Schwab, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- University of Tennessee Health Science Center
Patients undergoing maintenance dialysis have a markedly increased incidence of fungal infection. A retrospective review of more than 300,000 patients in the United States Renal Data System (USRDS) from 1992 to 1997 demonstrated that dialysis patients had an age-adjusted incidence ratio for fungal infections of 9.8 compared with the general population . The vast majority of these fungal infections were due to Candida species (79 percent).
The majority of fungal infections in patients with end-stage renal disease (ESRD) are related to the technique of peritoneal dialysis .
Among patients undergoing peritoneal dialysis, peritonitis resulting from fungi carries a higher morbidity and mortality than bacterial infections. Reported complications include sclerosing peritonitis, adhesions with resulting bowel obstructions or stricture, invasion of the bowel wall, and abscess formation . Extraperitoneal spread of infection is unusual, and mortality is usually related to underlying conditions.
An overview of fungal peritonitis in patients undergoing continuous peritoneal dialysis is presented in this topic review. A general overview of peritonitis in peritoneal dialysis is presented separately. (See "Microbiology and therapy of peritonitis in continuous peritoneal dialysis".)
Infections of the peritoneal space are the main complication of peritoneal dialysis; they are usually caused by staphylococcal species. By comparison, fungi are responsible for 2 to 13 percent of such cases. Most fungal peritoneal dialysis-associated infections are due to Candida species, especially C. albicans and C. parapsilosis. Assorted molds and yeasts, such as species of Aspergillus , Fusarium, Rhodotorula, Mucorales, and dematiaceous molds, are occasionally observed. Fungi, when found with bacteria as part of a polymicrobial peritonitis, are a predictor of a poor response to therapy .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Abbott KC, Hypolite I, Tveit DJ, et al. Hospitalizations for fungal infections after initiation of chronic dialysis in the United States. Nephron 2001; 89:426.
- Prasad N, Gupta A. Fungal peritonitis in peritoneal dialysis patients. Perit Dial Int 2005; 25:207.
- Uchida M, Sakemi T, Nagano Y, Mizuguchi M. Rectal stenosis associated with fungal peritonitis: a complication of continuous ambulatory peritoneal dialysis. Nephron 1989; 53:288.
- Schwetz I, Horina J, Buzina W, et al. Aspergillus oryzae peritonitis in CAPD: case report and review of the literature. Am J Kidney Dis 2007; 49:701.
- Szeto CC, Chow KM, Wong TY, et al. Conservative management of polymicrobial peritonitis complicating peritoneal dialysis--a series of 140 consecutive cases. Am J Med 2002; 113:728.
- Cheng IK, Fang GX, Chan TM, et al. Fungal peritonitis complicating peritoneal dialysis: report of 27 cases and review of treatment. Q J Med 1989; 71:407.
- Eisenberg ES, Leviton I, Soeiro R. Fungal peritonitis in patients receiving peritoneal dialysis: experience with 11 patients and review of the literature. Rev Infect Dis 1986; 8:309.
- Nagappan R, Collins JF, Lee WT. Fungal peritonitis in continuous ambulatory peritoneal dialysis--the Auckland experience. Am J Kidney Dis 1992; 20:492.
- Rubin J, Kirchner K, Walsh D, et al. Fungal peritonitis during continuous ambulatory peritoneal dialysis: a report of 17 cases. Am J Kidney Dis 1987; 10:361.
- Tapson JS, Mansy H, Freeman R, Wilkinson R. The high morbidity of CAPD fungal peritonitis--description of 10 cases and review of treatment strategies. Q J Med 1986; 61:1047.
- Bren A. Fungal peritonitis in patients on continuous ambulatory peritoneal dialysis. Eur J Clin Microbiol Infect Dis 1998; 17:839.
- Greaves I, Kane K, Richards NT, et al. Pigeons and peritonitis? Nephrol Dial Transplant 1992; 7:967.
- Yuen KY, Seto WH, Ching TY, et al. An outbreak of Candida tropicalis peritonitis in patients on intermittent peritoneal dialysis. J Hosp Infect 1992; 22:65.
- Nankivell BJ, Pacey D, Gordon DL. Peritoneal eosinophilia associated with Paecilomyces variotii infection in continuous ambulatory peritoneal dialysis. Am J Kidney Dis 1991; 18:603.
- Piraino B, Bailie GR, Bernardini J, et al. Peritoneal dialysis-related infections recommendations: 2005 update. Perit Dial Int 2005; 25:107.
- Wang AY, Yu AW, Li PK, et al. Factors predicting outcome of fungal peritonitis in peritoneal dialysis: analysis of a 9-year experience of fungal peritonitis in a single center. Am J Kidney Dis 2000; 36:1183.
- Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:503.
- Li PK, Szeto CC, Piraino B, et al. Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int 2010; 30:393.
- http://www.idsociety.org/Content.aspx?id=9088 (Accessed on December 12, 2011).
- Madariaga MG, Tenorio A, Proia L. Trichosporon inkin peritonitis treated with caspofungin. J Clin Microbiol 2003; 41:5827.
- Mora-Duarte J, Betts R, Rotstein C, et al. Comparison of caspofungin and amphotericin B for invasive candidiasis. N Engl J Med 2002; 347:2020.
- Reboli AC, Rotstein C, Pappas PG, et al. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med 2007; 356:2472.
- Pappas PG, Rotstein CM, Betts RF, et al. Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis. Clin Infect Dis 2007; 45:883.
- Kuse ER, Chetchotisakd P, da Cunha CA, et al. Micafungin versus liposomal amphotericin B for candidaemia and invasive candidosis: a phase III randomised double-blind trial. Lancet 2007; 369:1519.
- Chan TM, Chan CY, Cheng SW, et al. Treatment of fungal peritonitis complicating continuous ambulatory peritoneal dialysis with oral fluconazole: a series of 21 patients. Nephrol Dial Transplant 1994; 9:539.
- Vas S, Oreopoulos DG. Infections in patients undergoing peritoneal dialysis. Infect Dis Clin North Am 2001; 15:743.
- Herbrecht R, Denning DW, Patterson TF, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002; 347:408.
- Greig J, Harkness M, Taylor P, et al. Peritonitis due to the dermatiaceous mold Exophiala dermatitidis complicating continuous ambulatory peritoneal dialysis. Clin Microbiol Infect 2003; 9:713.
- Lau SK, Woo PC, Chiu SK, et al. Early diagnosis of Exophiala CAPD peritonitis by 18S ribosomal RNA gene sequencing and its clinical significance. Diagn Microbiol Infect Dis 2003; 46:95.
- Serna JH, Wanger A, Dosekun AK. Successful treatment of mucormycosis peritonitis with liposomal amphotericin B in a patient on long-term peritoneal dialysis. Am J Kidney Dis 2003; 42:E14.
- Nannini EC, Paphitou NI, Ostrosky-Zeichner L. Peritonitis due to Aspergillus and zygomycetes in patients undergoing peritoneal dialysis: report of 2 cases and review of the literature. Diagn Microbiol Infect Dis 2003; 46:49.
- Tzamaloukas AH, Fox L. Infections in patients on peritoneal dialysis. In: Principles and Practice of Dialysis, Henrich WL (Ed), Lippincott, Williams & Wilkins, New York 2004.
- Amici G, Grandesso S, Mottola A, et al. Fungal peritonitis in peritoneal dialysis: critical review of six cases. Adv Perit Dial 1994; 10:169.
- Záruba K, Peters J, Jungbluth H. Successful prophylaxis for fungal peritonitis in patients on continuous ambulatory peritoneal dialysis: six years' experience. Am J Kidney Dis 1991; 17:43.
- Moreiras-Plaza M, Vello-Román A, Sampróm-Rodríguez M, Feijóo-Piñeiro D. Ten years without fungal peritonitis: a single center's experience. Perit Dial Int 2007; 27:460.
- Wong PN, Lo KY, Tong GM, et al. Prevention of fungal peritonitis with nystatin prophylaxis in patients receiving CAPD. Perit Dial Int 2007; 27:531.