Amici G, Grandesso S, Mottola A, Virga G, Teodori T, Maresca M C, Bocci C
Nephrology and Dialysis Division, Treviso Hospital, Italy.
Am J Nephrol. 1994;14(3):216-9. doi: 10.1159/000168718.
We describe a case of peritonitis due to Verticillium spp. in a 33-year-old farmer on continuous ambulatory peritoneal dialysis (CAPD) for 3 months for end-stage renal failure due to chronic pyelonephritis. The etiologic agent was a hyaline hyphomycete which we report as a new human opportunistic pathogen. The fungus was isolated from the peritoneal fluid culture and from the tip of the catheter; identification was made on the basis of macroscopic and microscopic features. The patient had previously been admitted to our hospital for peritonitis caused by mixed enteric flora and treated for 8 days with intraperitoneal broad-spectrum antibiotic therapy. Five days after discharge he was readmitted for severe abdominal pain and cloudy drainage fluid. Two days of intraperitoneal broad-spectrum antimicrobial therapy produced no clinical improvement. Intravenous fluconazole and oral flucytosine were administered upon identifying the fungus. After another 2 days without improvement, peritoneal dialysis was discontinued and the catheter removed. Antimycotic therapy was continued for 4 days with complete resolution of the peritonitis. The patient chose to start hemodialysis and was discharged in good clinical condition.
我们描述了一例由黄萎病菌引起的腹膜炎病例，患者为一名33岁的农民，因慢性肾盂肾炎导致终末期肾衰竭，已持续非卧床腹膜透析（CAPD）3个月。病原体是一种透明丝状真菌，我们将其报告为一种新的人类机会致病菌。该真菌从腹膜液培养物和导管尖端分离得到；根据宏观和微观特征进行鉴定。患者此前因混合肠道菌群引起的腹膜炎入住我院，并接受了8天的腹腔内广谱抗生素治疗。出院5天后，他因严重腹痛和引流液浑浊再次入院。两天的腹腔内广谱抗菌治疗未取得临床改善。在鉴定出真菌后，给予静脉注射氟康唑和口服氟胞嘧啶。又过了2天仍无改善，遂停止腹膜透析并拔除导管。抗真菌治疗持续4天，腹膜炎完全消退。患者选择开始血液透析，出院时临床状况良好。
