Fungal peritonitis in patients on continuous ambulatory peritoneal dialysis

The purpose of this study was to analyze the microbiological and clinical f eatures of fungal peritonitis in patients with endstage renal failure treat ed with continuous ambulatory peritoneal dialysis (CAPD). The diagnosis of peritonitis was based on abdominal discomfort or pain, cloudy peritoneal ef fluent with an elevated leukocyte count and isolation of fungi from the per itoneal effluent. Amphotericin B, flucytosine, ketoconazole, miconazole and more recently fluconazole were used for antifungal therapy. From 1983 to 1 997 13 patients experienced 14 episodes of fungal peritonitis, comprising 3 .1% of all episodes of peritonitis in the dialysis centre. Isolates from th e peritoneal effluent comprised Candida tropicalis in two cases, Candida pa rapsilosis in two cases, Candida albicans in one case, Candida lusitaniae i n one case,Cephalosporium spp. in three cases, Aspergillus fumigatus in two cases, and an Aspergillus sp., a Trichoderma sp. and a yeast in one case e ach. In eight cases bacterial infection shortly before the episode of funga l peritonitis was documented. In 12 (86%) cases the peritoneal catheter had to be removed. Four patients died during the treatment, and one patient di ed 2 months after the end of treatment due to intra-abdominal bleeding from peritoneal adhesions. Only two patients continued CAPD later; the other pa tients were switched to hemodialysis. It is concluded that fungal peritonit is is a rare but serious complication in CAPD patients with high rates of m orbidity, mortality and drop-out from the CAPD programme (85%). The most fr equent isolates were Candida spp. A predisposing factor for fungal peritoni tis could be a recent bacterial infection treated with antibiotics. Early p eritoneal catheter removal is recommended.