Peritoneal dialysis-associated peritonitis from pauci-septated mold: Life-threatening but curable

Theerachai Thammathiwat; Sajja Tatiyanupanwong; Uraiwan Parinyasiri; Dhammika Leshan Wannigama; Tanittha Chatsuwan; Talerngsak Kanjanabuch

doi:10.1016/j.mmcr.2023.100612

Peritoneal dialysis-associated peritonitis from pauci-septated mold: Life-threatening but curable

Med Mycol Case Rep. 2023 Sep 28:42:100612. doi: 10.1016/j.mmcr.2023.100612. eCollection 2023 Dec.

Authors

Theerachai Thammathiwat¹, Sajja Tatiyanupanwong², Uraiwan Parinyasiri³, Dhammika Leshan Wannigama^{4

5}, Tanittha Chatsuwan^{4

5}, Talerngsak Kanjanabuch^{6

7}

Affiliations

¹ Division of Nephrology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
² Division of Nephrology, Department of Internal Medicine, Chaiyaphum Hospital, Thailand.
³ Kidney Diseases Clinic, Department of Internal Medicine, Songkhla Hospital, Songkhla, Thailand.
⁴ Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁵ Center of Excellence in Antimicrobial Resistance and Stewardship, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁶ Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁷ Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Abstract

Two cases of PD-associated peritonitis due to Cunninghamella (C. bertholletiae and C. guizhouensis) were reported here with favorable outcomes, albeit presenting with septicemia. Both patients presented with classic features of bacterial peritonitis, cloudy effluent with a neutrophil predominance, followed by fever and septicemia/septic shock. The pathogen species were confirmed and verified by molecular phylogeny using universal and specific fungal primers. All isolations were susceptible/intermediately susceptible to amphotericin B but resistant to other antifungal agents, including triazoles, caspofungin, and terbinafine. Both cases were successfully treated with timely PD catheter removal and antifungal medications for 2-4 weeks.

Keywords: Cunninghamella-associated peritonitis; Fungal peritonitis; Mucormycosis; Peritoneal dialysis.