Ghebremedhin B, Bluemel A, Neumann K-H, Koenig B, Koenig W
Clinical Microbiology, University Clinic, Magdeburg, Germany.
Division of Nephrology, University Clinic, Magdeburg, Germany.
J Med Microbiol. 2009 May;58(Pt 5):678-682. doi: 10.1099/jmm.0.005785-0.
Aspergillus peritonitis is a rare life-threatening complication of peritoneal dialysis (PD). We report a case of symptomatic Neosartorya pseudofischeri peritonitis in a 60-year-old woman treated by continuous ambulatory peritoneal dialysis (CAPD) for 13 months, who performed peritoneal exchanges independently. This is believed to be the first published case of N. pseudofischeri in an elderly patient. Comprehensive treatment included early removal of the PD catheter and the use of voriconazole (200 mg Vfend twice daily) for a period of 5 weeks. This case supports the need for more effective prophylaxis and treatment of non-Candida fungal infections in CAPD patients. Our conclusions from this case and a review of the literature are that infection with this fungus can cause substantial morbidity and is best treated with prompt catheter removal, aggressive antifungal therapy with voriconazole or amphotericin B, and vigilant observation for complications. Our report describes for what is believed to be the first time the administration of voriconazole to treat a Neosartorya peritonitis case.
曲霉性腹膜炎是腹膜透析（PD）一种罕见的危及生命的并发症。我们报告一例60岁女性患者发生有症状的拟费氏新萨托菌腹膜炎，该患者接受持续非卧床腹膜透析（CAPD）治疗13个月，且能独立进行腹膜透析换液。据信这是老年患者中首例发表的拟费氏新萨托菌病例。综合治疗包括早期拔除PD导管，并使用伏立康唑（威凡200毫克，每日两次），疗程为5周。该病例支持对CAPD患者的非念珠菌真菌感染需要更有效的预防和治疗。我们从该病例及文献回顾得出的结论是，这种真菌感染可导致严重发病，最好的治疗方法是迅速拔除导管、用伏立康唑或两性霉素B进行积极抗真菌治疗，并密切观察并发症。我们的报告首次描述了使用伏立康唑治疗拟费氏新萨托菌腹膜炎病例。
