Diagnosis, treatment, and outcome of aspergillus peritonitis in patients on peritoneal dialysis: A case report and review

Aspergillus peritonitis is a rare but serious complication of continuous ambulatory peritoneal dialysis (CAPD). Only 16 cases have been reported in the literature. Reviewing these cases, including one of our patient's records, revealed several distinctive points. Eight of the 17 patients had recent bacterial peritonitis or had received immunosuppressive therapy. Most patients exhibited clinical features similar to those of bacterial peritonitis. Four of the 17 patients suffered from peritoneal eosinophilia. Gram staining showed the characteristic hyphae in only 2 cases, but cultures of peritoneal effluent all grew Aspergillus species. The time lag to definite diagnosis in most cases was more than 3 days. Intravenous amphotericin B. was the most common therapeutic regimen. The total dosage of amphotericin B varied from 0.7 to 30 mg/kg. The peritoneal catheter was removed in 13 of the 17 patients, and 1 of the patients died. Of the 4 patients with the catheter in situ, 3 died and 1 survived and continued CAPD therapy. Four of the 12 survivors with catheter removal later resumed CAPD therapy; but the others were shifted to hemodialysis therapy. Contrary to previous observations, we could find no relationship between outcome and time interval to catheter removal or time lag for starting appropriate antifungal therapy. However, early recognition and aggressive treatment with appropriate antifungal drugs and catheter removal may allow successful resumption of CAPD.