Chan T H, Koehler A, Li P K
Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Am J Kidney Dis. 1996 Jan;27(1):138-42. doi: 10.1016/s0272-6386(96)90042-6.
Paecilomyces varioti infection is a rare cause of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). We report two patients who developed P varioti peritonitis complicating CAPD. The clinical features and microbiological data of seven other previously reported cases are reviewed. Approximately half of the patients had received multiple antibiotics before the onset of the peritonitis because of either bacterial peritonitis or exit site infection. There was no particular pattern of peritoneal dialysate cell count, which was characteristic in this fungal peritonitis. Although all patients survived, morbidity was high. All patients required antifungal chemotherapy and removal of peritoneal catheter for eradication of the organism. Amphotericin B was effective in most cases. Patients of all previously reported cases did not go back to peritoneal dialysis after removal of peritoneal catheters. A combination of oral flucytosine and itraconazole was successful in treating our two patients. Although we managed to resume CAPD in our two patients with good functional outcome, abscesses and adhesions were major problems rendering most patients from other series failing to return to CAPD after recovery.
拟青霉感染是持续性非卧床腹膜透析（CAPD）患者发生腹膜炎的罕见原因。我们报告了两名发生拟青霉腹膜炎并使CAPD复杂化的患者。对其他7例先前报告病例的临床特征和微生物学数据进行了回顾。约一半患者在腹膜炎发作前因细菌性腹膜炎或出口处感染而接受过多种抗生素治疗。在这种真菌性腹膜炎中，腹膜透析液细胞计数没有特定模式。尽管所有患者均存活，但发病率较高。所有患者都需要抗真菌化疗并拔除腹膜导管以根除病原体。两性霉素B在大多数情况下有效。先前报告的所有病例患者在拔除腹膜导管后均未恢复腹膜透析。口服氟胞嘧啶和伊曲康唑联合用药成功治疗了我们的两名患者。尽管我们成功地使两名患者恢复了CAPD且功能预后良好，但脓肿和粘连是主要问题，导致其他系列的大多数患者在康复后未能恢复CAPD。
