Department of Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand.
Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
BMC Nephrol. 2022 Aug 9;23(1):279. doi: 10.1186/s12882-022-02898-1.
The first case of Taralomyces flavus infection in human and peritoneal dialysis (PD) patient after exposure to biocontrol agent fumes is reported here.
A 77-year-old Thai female farmer with kidney failure presented with peritonitis and PD catheter obstruction from fungal biofilms. The potential root cause of infection was associated with exposure to biocontrol-agent fumes containing pathogen during agricultural work in her garden. This source of infection has not been mentioned previously. Showering and changing clothes right after outdoor activity with a high density of fungal matters or dust should be added to the routine aseptic technique before performing PD bag exchange to prevent the system contamination. Although the patient received early treatment with liposomal amphotericin B, itraconazole, and catheter removal, according to the ISPD Guideline 2016 and the Global Guideline 2021, the outcome was unfavorable. Antifungal susceptibility testing later revealed that the pathogen was only susceptible to voriconazole. Thus, antifungal susceptibility should be tested if the patient fails or slowly responds to the primary antifungal regimen.
T. flavus peritonitis is reported here after exposure to biocontrol-agent fumes containing the pathogen. This work also alerts and reiterates nephrology peers to be aware of this overlooked source of peritonitis, the exposure to dusty environments, specifically containing biocontrol-agent fumes.
本文报告了首例人类和腹膜透析（PD）患者在接触生物防治剂烟雾后感染 Taralomyces flavus 的病例。
一名 77 岁的泰国女性农民，因肾衰竭出现腹膜炎和 PD 导管阻塞，这是真菌生物膜引起的。感染的潜在根源与在花园中从事农业工作时接触含有病原体的生物防治剂烟雾有关。这种感染源以前没有被提及过。根据 ISPD 指南 2016 和全球指南 2021，在进行 PD 袋更换之前，应在常规无菌技术的基础上增加在户外进行高真菌密度或粉尘密集活动后的淋浴和换衣，以防止系统污染。尽管患者接受了早期治疗，包括脂质体两性霉素 B、伊曲康唑和导管拔除，但结果并不理想。随后的抗真菌药敏试验显示病原体仅对伏立康唑敏感。因此，如果患者对抗真菌治疗方案无反应或反应缓慢，应进行抗真菌药敏试验。
本文报告了一例接触含病原体生物防治剂烟雾后发生的 T. flavus 腹膜炎病例。这项工作还提醒并再次强调肾脏病学同行注意这种被忽视的腹膜炎来源，即接触多尘环境，特别是含有生物防治剂烟雾的环境。
