Abstract
Continuous ambulatory peritoneal dialysis (CAPD) has recently been introduced as an alternative hemodialysis for patients suffering from chronic renal failure. Unfortunately this therapy is accompanied by a high incidence of peritonitis. Fungal peritoneal infection after repeated antibiotic courses has been noted previously. We report a case of a patient who contracted fungal peritonitis not resulting from bacterial peritonitis. A 40-year-old man with a history of IgA nephropathy advanced to end-stage renal disease in August 1977 and he was introduced to hemodialysis therapy. CAPD treatment was initiated in March 1983. His condition was favorable. However, he contracted peritonitis for the first time in November 1984. A PAS stain of the peritoneal fluid and a culture proved the presence of Candida guilliermondii, and candida peritonitis was diagnosed. Immediately, the peritoneal catheter was removed and intravenous amphotericin B treatment was begun. These strategies cured his peritonitis. It was suspected that the patient caught the fungus from his pet cat, thus causing fungal peritonitis without a preceeding bacterial peritonitis. It appears to be important to protect CAPD patients from infection by animals. We also evaluated the cell-mediated immunity in this patient, but found no significant decrease compared with normal controls. In summary, PAS staining of peritoneal fluid in addition to a culture are useful for early diagnosis because the possible contamination by normal flora in the atmospere needs to be ruled out in peritoneal fluid culture.
