Campylobacter fetus subspecies fetus peritonitis in continuous ambulatory peritoneal dialysis.
Campylobacter fetus subspecies fetus peritonitis in continuous ambulatory peritoneal dialysis.
复制标题
连续门诊腹膜透析中胎儿弯曲杆菌亚种胎儿腹膜炎。
作者：
M. Kubota;N. Ishiguro;Y. Tomino;H. Koide
H. Koide, MD, Division of Nephrology, Department of Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113 (Japan) Dear Sir, Peritonitis is the major complication of continuous ambulatory peritoneal dialysis (CAPD). As devices and technology have been improved to prevent peritonitis, its prevalence in patients on CAPD has gradually declined. However, some patients with peritonitis are subject to prolonged hospitaliza-tion and catheter loss, and eventually transfer to temporary or permanent hemodialysis. Many species of microorganisms have been reported as causative agents of CAPD peritonitis. We have experienced a case of peritonitis caused by Campylobacter fetus subsp. fetus in a patient with chronic renal failure on CAPD. A 47-year-old man with end-stage renal failure due to chronic glomerulonephritis was admitted for CAPD therapy in June 1989. In May 1990, he experienced an episode of exit site infection caused by Staphylococcus aureus, and was successfully treated with van-comycin. In July 1990, he complained of abdominal pain, sore throat, low-grade fever (37.7 °C), diarrhea, and cloudy peritoneal effluent. He had active bowel sounds throughout, without rebound pain or guarding. The blood leukocyte count was 7,900/ mm3, 59% of which were neutrophils and 12.5% juvenile forms. The peritoneal fluid contained 989 leukocytes/mm3,90% of which were neutrophils and 5% juvenile forms. He was given 1 g of vancomycin intraperito-neally. The peritoneal fluid was obtained for cultures. Three days later, he visited our hospital again, complaining of persistent cloudy effluent, although the subjective symptoms had been ameliorated. On the 7th day after onset of peritonitis, the initial peritoneal fluid culture was found to be growing C. fetus subsp. fetus. Cultures of the peritoneal fluid from the 4th day also yielded the same organism. Intravenous injection of 2 g cefmetazole sodium and oral administration of 600 mg norfloxacin were started on the 7th day. Three days later, the leukocyte count in peritoneal fluid was decreased to 42/mm3, and peritoneal fluid culture was negative. Multiple blood and urine cultures were negative throughout the period. Intravenous cefmetazole sodium was given for 7 days and oral norfloxacin for 14 days. Peritoneal fluid cultures were negative thereafter. Most episodes of peritonitis in CAPD patients are due to normal skin flora, i.e. S. epidermidis and S. aureus, and a smaller fraction of peritonitis episodes are caused by gram-negative organisms, presumed to originate from the bowel [1]. However, peritonitis is sometimes caused
