Peritonitis as the First Presentation of Disseminated Listeriosis in a Patient on Peritoneal Dialysis-a Case Report

Perit Dial Int. Mar-Apr 2017;37(2):239-240. doi: 10.3747/pdi.2016.00205.

Abstract

Infections with Listeria monocytogenes are uncommon but serious, with mortality rate approaching 30% in cases of systemic involvement despite first-line therapy. They are usually caused by ingestion of contaminated foods, but spontaneous infections have also been described. Listeria monocytogenes is a rare cause of peritonitis, and most of the published cases are in patients with cirrhosis and ascites. There are a few reported cases of Listeria peritonitis associated with peritoneal dialysis (PD), primarily isolated peritonitis.If detected early, Listeria peritonitis can be successfully treated with ampicillin, alone or in combination with gentamicin. Vancomycin has been listed as a second-line agent. However, it has been associated with treatment failure.In this case report, we present a patient who developed disseminated listeriosis, with peritonitis as the first manifestation of disseminated infection. This case illustrates the importance of having a high index of suspicion for L. monocytogenes if patients deteriorate despite empiric therapy for PD-associated peritonitis and serves as a further example demonstrating the inadequate coverage of vancomycin for L. monocytogenes.

Keywords: Listeria monocytogenes; Peritoneal dialysis; peritonitis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / drug therapy*
  • Bacteremia / physiopathology
  • Disease Progression
  • Fatal Outcome
  • Female
  • Humans
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / therapy*
  • Listeria monocytogenes / isolation & purification
  • Listeriosis / diagnosis
  • Listeriosis / drug therapy*
  • Middle Aged
  • Peritoneal Dialysis / adverse effects*
  • Peritoneal Dialysis / methods
  • Peritonitis / drug therapy
  • Peritonitis / etiology
  • Peritonitis / microbiology*
  • Risk Assessment
  • Severity of Illness Index

Substances

  • Anti-Bacterial Agents