Korean J Med.  2015 May;88(5):593-597. 10.3904/kjm.2015.88.5.593.

Unusual CAPD Citrobacter freundii Peritonitis Complicated by a Fungal Infection, Identified by 16s Ribosomal RNA Gene Sequencing

• Oh TR
• Ma SK
• Kim SW

• KMID: 1834050
• DOI: http://doi.org/10.3904/kjm.2015.88.5.593

Abstract

We present a case of continuous ambulatory peritoneal dialysis peritonitis caused by Citrobacter freundii complicated by a fungal infection with abscess formation. A 34-year-old woman was admitted to our hospital with abdominal pain. Isolate cultures were confirmed as Citrobacter freundii by DNA sequencing of the 16s ribosomal ribonucleic acid (RNA). Antibiotic therapy was ineffective and Candida tropicalis was isolated in follow-up blood cultures. We administered an antifungal agent and removed the peritoneal catheter. A sudden fever developed, and abdominal computed tomography showed intra-abdominal abscesses. Percutaneous drainage was performed, but no bacteria were cultured. After draining the abscesses, the patient recovered. Citrobacter species are unusual pathogens in peritonitis, and fungal peritonitis is a serious complication of bacterial peritonitis. Indwelling catheters should be removed and appropriate antibiotic therapy provided. Suspicion of a fungal infection combined with bacterial peritonitis will improve the prognosis of patients on peritoneal dialysis.

Keyword

Continuous ambulatory peritoneal dialysis; Citrobacter; Peritonitis

MeSH Terms

Abdominal Abscess
Abdominal Pain
Abscess
Adult
Bacteria
Candida tropicalis
Catheters
Catheters, Indwelling
Citrobacter
Citrobacter freundii*
Drainage
Female
Fever
Follow-Up Studies
Humans
Peritoneal Dialysis
Peritoneal Dialysis, Continuous Ambulatory*
Peritonitis*
Prognosis
RNA
RNA, Ribosomal, 16S*
Sequence Analysis, DNA
RNA
RNA, Ribosomal, 16S