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Takata K, Omae T, Hamano Y, Ishikawa T, Nogami K. Peritoneal dialysis-associated infection caused by Mycobacterium abscessus in a pediatric patient on continuous peritoneal dialysis without switching to hemodialysis. CEN Case Rep 2024:10.1007/s13730-024-00875-1. [PMID: 38581567 DOI: 10.1007/s13730-024-00875-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/31/2024] [Indexed: 04/08/2024] Open
Abstract
Most peritoneal dialysis (PD)-associated infections caused by Mycobacterium abscessus (M. abscessus) require a transfer from PD to hemodialysis (HD). Here, we report a pediatric case of exit-site and tunnel infections caused by M. abscessus, for whom PD was continued with catheter replacement, debridement of the infected site, and the administration of multiple antibacterial agents. A 10-year-old boy with end-stage kidney disease secondary to juvenile nephronophthisis with NPHP1 deletion, for whom PD was initiated at the age of 9 years, was admitted to the hospital with complaints of fever, pus at the exit-site of the PD catheter, and poor PD drainage. The dialysis effluent culture results were negative; however, M. abscessus was detected in the pus at the exit-site of the PD catheter. The management of HD was expected to be challenging owing to the presence of developmental disorders. Therefore, PD was continued with the simultaneous removal of the PD catheter, reinsertion of a new catheter at a new site, and debridement of the infected site. Multiple antibacterial therapies were administered for 2 months, and the patient was eventually discharged without switching to HD. To the best of our knowledge, this is the first pediatric case of a PD-associated infection caused by M. abscessus, for whom PD was continued without switching to HD. This treatment strategy is not generally recommended but may be an option for patients without peritonitis who have difficulty switching to HD.
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Affiliation(s)
- Koji Takata
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
- Department of Pediatrics, Minami-Nara General Medical Center, 8-1 Hukugami, Oyodo-cho, Yosino, Nara, 638-8551, Japan
| | - Takashi Omae
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yuri Hamano
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Tomoaki Ishikawa
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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2
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Chen X, Zhu J, Liu Z, Ye J, Yang L, Zhang Z. Mixed infection of three nontuberculous mycobacteria species identified by metagenomic next-generation sequencing in a patient with peritoneal dialysis-associated peritonitis: a rare case report and literature review. BMC Nephrol 2023; 24:95. [PMID: 37055720 PMCID: PMC10099677 DOI: 10.1186/s12882-023-03156-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/05/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Peritonitis caused by nontuberculous mycobacteria (NTM) is an infrequent but important complication in patients undergoing peritoneal dialysis (PD). There has been no report of mixed infections with multiple NTM. Peritoneal dialysis-associated peritonitis (PDAP) caused by Mycobacterium abscessus is more common than that caused by M. smegmatis and M. goodii. CASE PRESENTATION This case concerns a patient with PDAP caused by gram-positive bacilli, which could not be identified at the species level in successive detections of initial peritoneal effluent. Later, M. smegmatis was detected with no sensitivity results in bacterial culture. However, metagenomic next-generation sequencing (mNGS) and first whole-genome sequences indicated that there were three species coexisting in the culture, including M. smegmatis (24,708 reads), M. abscessus (9224 reads), and M. goodii (8305 reads). This is the first case of PDAP with specific evidence that conventional detection methods isolated a poorly pathogenic NTM, whereas mNGS and first whole-genome sequences identified multiple NTM. Pathogenic bacteria might not be detected using conventional methods due to their lower abundance. This case report is the first description of mixed infections with more than two species of NTM during PDAP. CONCLUSIONS PDAP caused by multiple NTM is rare, and the diagnosis is difficult. When NTM are isolated by conventional tests in patients who are suspected of infection, clinicians should be vigilant, and further tests should be performed to determine the presence of rare or even previously unknown bacteria, for which the quantity is relatively low, but the pathogenicity is high. The rare pathogen may be a primary agent in causing such complications.
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Affiliation(s)
- Xiangfeng Chen
- Department of Infectious Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jie Zhu
- Department of Infectious Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhou Liu
- Department of Infectious Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jun Ye
- Department of Infectious Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liqi Yang
- Department of Infectious Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhenhua Zhang
- Department of Infectious Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
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3
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Pan SF, Zhang YY, Wang XZ, Sun JJ, Song SL, Tang YR, Wang JL. Catheter-related infections caused by Mycobacterium abscessus in a patient with motor neurone disease: A case report. World J Clin Cases 2022; 10:5082-5087. [PMID: 35801055 PMCID: PMC9198855 DOI: 10.12998/wjcc.v10.i15.5082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/23/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mycobacterium abscessus (M. abscessus) is a rapidly growing mycobacterium and ubiquitous in the environment, which infrequently causes disease in humans. However, it can cause cutaneous or respiratory infections among immunocompromised hosts. Due to the resistance to most antibiotics, the pathogen is formidable and difficult-to-treat.
CASE SUMMARY Here, we present a case of catheter-related M. abscessus infections in a patient with motor neurone disease. Catheter and peripheral blood cultures of the patient showed positive results during Gram staining and acid-fast staining. The alarm time of catheter blood culture was 10.6 h earlier than that of peripheral blood. After removal of the peripherally inserted central catheter, secretion and catheter blood culture were positive. M. abscessus was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry and 16S rDNA sequencing.
CONCLUSION For catheter-related M. abscessus infection, rapid diagnosis and timely and adequate antimicrobial therapy are crucial.
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Affiliation(s)
- Su-Fei Pan
- Department of Laboratory Medicine, Shengli Oilfield Central Hospital, Dongying 257034, Shandong Province, China
| | - Yuan-Yuan Zhang
- Department of Laboratory Medicine, Shengli Oilfield Central Hospital, Dongying 257034, Shandong Province, China
| | - Xiao-Zhen Wang
- Department of Laboratory Medicine, Shengli Oilfield Central Hospital, Dongying 257034, Shandong Province, China
| | - Jing-Jing Sun
- Department of Laboratory Medicine, Shengli Oilfield Central Hospital, Dongying 257034, Shandong Province, China
| | - Shao-Ling Song
- Department of Laboratory Medicine, Shengli Oilfield Central Hospital, Dongying 257034, Shandong Province, China
| | - Yu-Rong Tang
- Department of Laboratory Medicine, Shengli Oilfield Central Hospital, Dongying 257034, Shandong Province, China
| | - Ji-Liang Wang
- Department of Laboratory Medicine, Shengli Oilfield Central Hospital, Dongying 257034, Shandong Province, China
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4
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Nakano S, Yamamura-Miyazaki N, Michigami T, Yazawa K, Yanagihara I, Yamamoto K. A case of a preschool child with a successful kidney transplant following the long-term administration of antibiotics to treat peritoneal dialysis-related ESI/peritonitis by Mycobacterium abscessus. CEN Case Rep 2022; 11:408-411. [PMID: 35179697 DOI: 10.1007/s13730-022-00689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 02/03/2022] [Indexed: 11/29/2022] Open
Abstract
A preschool child with refractory peritoneal dialysis-related exit-site infection (ESI)/peritonitis caused by Mycobacterium abscessus (M. abscessus) received multidrug antibacterial therapy for 6 months and then successfully underwent living-donor kidney transplantation. The patient was a 2.7-year-old boy and the primary disease was bilateral hypo/dysplastic kidneys. Peritoneal dialysis (PD) was initiated at the age of 4 months. Purulent drainage from the PD catheter exit site was observed, and pus and PD effluent cultures were negative. Since living kidney transplantation was scheduled for 2 months later, the PD catheter was replaced. Due to dialysate leakage from the exit site, the new PD catheter was removed and hemodialysis was initiated. M. abscessus subsequently grew from the PD effluent and abscesses that formed at the exit site continued to present bacteria even after catheter removal; therefore, additional debridement was performed. He received combination treatment with antibiotics, amikacin, clarithromycin, imipenem/cilastatin sodium, and tigecycline, for 6 months. After a 4-month observation period without antibiotics, the patient underwent living-donor kidney transplantation. The post-transplantation course was uneventful without the recurrence of infection for 2 years. Although PD-related ESI/peritonitis caused by M. abscessus was intractable, PD catheter removal, multiple debridement, and 6-month antibiotic combination therapy led to improvements. Follow-up observations for 4 months after the cessation of antibacterial treatment confirmed no recurrence of M. abscessus infection, which allowed kidney transplantation. The establishment of an appropriate treatment strategy and observation period for M. abscessus infection ahead of kidney transplantation requires further case accumulation.
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Affiliation(s)
- Shinya Nakano
- Department of Pediatric Nephrology and Metabolism, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Natsumi Yamamura-Miyazaki
- Department of Pediatric Nephrology and Metabolism, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan.
| | - Toshimi Michigami
- Department of Pediatric Nephrology and Metabolism, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan.,Department of Bone and Mineral Research, Research Institute, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Koji Yazawa
- Department of Urology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Itaru Yanagihara
- Department of Developmental Medicine, Research Institute, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Katsusuke Yamamoto
- Department of Pediatric Nephrology and Metabolism, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
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5
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Sachar M, Shah A. Epidemiology, management, and prevention of exit site infections in peritoneal dialysis patients. Ther Apher Dial 2021; 26:275-287. [PMID: 34435734 DOI: 10.1111/1744-9987.13726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/04/2021] [Accepted: 08/22/2021] [Indexed: 11/29/2022]
Abstract
Exit site infection (ESI) is a leading complication of peritoneal dialysis (PD), at an incidence of 0.6 episodes per year in the United States, and a major risk factor for catheter removal and peritonitis. An estimated 20% of all peritonitis cases are preceded by an ESI, with up to 50% of Staphylococcus aureus peritonitis associated with ESI. Gram-negative ESIs are less associated with succeeding peritonitis than their gram-positive counterparts, though when present, are associated with a lower peritonitis cure rate. The rate of catheter removal for refractory ESI is relatively highest in ESI due to mycobacteria (up to 40%), S. aureus (35%), Pseudomonas aeruginosa (28%), followed by Corynebacterium, Serratia, and fungi. In review of relevant literature, we found no prophylactic benefit of dressings over nondressings, specific antiseptics over normal saline, or topical honey over topical antibiotic prophylaxis, and thus recommend individualized exit site hygiene. We found topical gentamicin effective for prevention of most ESIs, including gram-negative ESIs, and thus recommend consideration of prophylactic topical gentamicin in areas of high gram-negative peritonitis incidence. With long-term use, observational studies detect up to 25% of gram-positive and 14% of gram-negative ESIs may be mupirocin and gentamicin resistant, respectively. We review empiric and targeted ESI management, including indications for ultrasound, anti-VMRSA, anti-Pseudomonal, and anti-mycobacterial antibiotic use, and catheter removal. We recommend further investigation into the earlier use of second-line treatment agents and the utility of treating post-infectious exit site colonization as avenues to decrease refractory and repeat ESI.
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Affiliation(s)
- Moniyka Sachar
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ankur Shah
- Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Nephrology, Rhode Island Hospital, Providence, Rhode Island, USA.,Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
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6
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Simultaneous catheter removal and reinsertion, is it acceptable in M. abscessus exit site infection? CEN Case Rep 2021. [PMID: 33728600 DOI: 10.1007/s13730-021-00593-y.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
In recent times, increasing reports of exit site infections (ESI) in peritoneal dialysis (PD) patients related to environmentally acquired atypical organisms, such as nontuberculous mycobacterium (NTM), have been reported in the literature. Among these NTM, Mycobacterium abscessus (M. abscessus) is unique and is associated with high morbidity and treatment failure rates. The international society of PD guidelines suggests individualizing therapeutic options for NTM-related ESI. Moreover, the guidelines encourage simultaneous catheter removal and reinsertion (SCRR) in isolated ESI, not responding to antimicrobial therapy to avoid PD interruptions. Physicians should be aware of the limitations of such approaches as delay in appropriate PD catheter intervention can be fraught with complications in patients with M. abscessus ESI. We report an M. abscessus ESI in a PD patient who underwent SCRR in conjunction with targeted antimicrobial therapy, and developed M. abscessus peritonitis requiring PD catheter removal and conversion to hemodialysis. The patient also developed ESI at the new exit site long after the PD catheter was removed, requiring prolonged antimicrobial therapy. Our case, taken together with available published case reports, highlights the futility of the SCRR approach towards the M. abscessus ESI and makes the cases for early PD catheter removal in these patients.
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7
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Simultaneous catheter removal and reinsertion, is it acceptable in M. abscessus exit site infection? CEN Case Rep 2021; 10:483-489. [PMID: 33728600 DOI: 10.1007/s13730-021-00593-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
In recent times, increasing reports of exit site infections (ESI) in peritoneal dialysis (PD) patients related to environmentally acquired atypical organisms, such as nontuberculous mycobacterium (NTM), have been reported in the literature. Among these NTM, Mycobacterium abscessus (M. abscessus) is unique and is associated with high morbidity and treatment failure rates. The international society of PD guidelines suggests individualizing therapeutic options for NTM-related ESI. Moreover, the guidelines encourage simultaneous catheter removal and reinsertion (SCRR) in isolated ESI, not responding to antimicrobial therapy to avoid PD interruptions. Physicians should be aware of the limitations of such approaches as delay in appropriate PD catheter intervention can be fraught with complications in patients with M. abscessus ESI. We report an M. abscessus ESI in a PD patient who underwent SCRR in conjunction with targeted antimicrobial therapy, and developed M. abscessus peritonitis requiring PD catheter removal and conversion to hemodialysis. The patient also developed ESI at the new exit site long after the PD catheter was removed, requiring prolonged antimicrobial therapy. Our case, taken together with available published case reports, highlights the futility of the SCRR approach towards the M. abscessus ESI and makes the cases for early PD catheter removal in these patients.
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8
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Terada K, Yan T, Mugishima K, Kawasaki S, Itagaki F, Yamada T, Sakai Y. Improvement of multiple intraperitoneal nodules resembling peritoneal cancer that developed after peritoneal dialysis-related peritonitis caused by Mycobacterium abscessus with literature review: granuloma or carcinoma. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00272-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Peritonitis is a crucial complication that leads to hospitalization or even death in patients who are undergoing peritoneal dialysis (PD). The incidence of PD-related peritonitis associated with nontuberculous mycobacteria has increased in recent years. However, a well-established treatment for peritonitis is lacking, particularly in peritonitis caused by Mycobacterium abscessus which is a difficult to treat disease due to its inherent resistance to majority of available antibiotics. To the best of our knowledge, this case is the first to report on intraperitoneal multiple nodules that developed due to PD-related peritonitis caused by M. abscessus.
Case presentation
This case reported a case of a 40-year-old female patient who was undergoing PD and who showed multiple intraperitoneal nodules that resembled peritoneal cancer on computed tomography (CT) and that developed after PD-related peritonitis and catheter removal. After multiantibiotic therapy, multiple nodules were found to have disappeared on CT. The nodules continued to disappear and the patient did not show signs of recurrent peritonitis, although there was a possibility of recurrence.
Conclusion
To the best of our knowledge, this case is the first to report on nodules that resembled peritoneal cancer and that developed in the abdominal cavity due to PD-related peritonitis caused by M. abscessus. Positron emission tomography–CT was not useful in distinguishing peritoneal cancer from nodules caused by M. abscessus.
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9
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Bnaya A, Wiener-Well Y, Soetendorp H, Einbinder Y, Paitan Y, Kunin M, Tanasiychuk T, Kushnir D, Kruzel-Davila E, Gershkovitz R, Rosenberg R, Bloch A, Doviner V, Assous MV, Peretz O, Shavit L, Ben-Chetrit E. Nontuberculous mycobacteria infections of peritoneal dialysis patients: A multicenter study. Perit Dial Int 2020; 41:284-291. [PMID: 32400280 DOI: 10.1177/0896860820923461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Nontuberculous mycobacteria (NTM) infections pose a diagnostic challenge in peritoneal dialysis (PD) patients. In this study, we sought to identify findings that are suggestive of NTM infection in PD adult patients. METHODS All patients with NTM exit-site infection (ESI) with/without tunnel infection and peritonitis identified during the last decade in eight medical centers in Israel were included. Clinical, microbiological, and outcome data were collected and analyzed. RESULTS Thirty patients were identified; 16 had ESI (53%) and 14 had peritonitis (47%). Median age was 65 years (interquartile range 52-76). Abdominal pain and cloudy PD fluid were reported in all patients with peritonitis, whereas exit-site discharge and granulation tissue were common in patients with ESI. Fourteen patients (47%) had negative cultures prior NTM diagnosis, and isolation of diphtheroids or Corynebacterium spp. was reported in 9 of 30 patients (30%). Antimicrobial treatment prior to diagnosis was documented in 13 of 30 patients (43%). Delayed diagnosis was frequent. Treatment regimens and duration of therapy varied widely. In 26 of 30 (87%) patients, catheter was removed and 19 of 30 patients (63%) required permanent transition to hemodialysis. Two patients with peritonitis (2 of 14, 14%) and seven with ESI (7 of 16, 44%) were eligible for continuation of PD. CONCLUSIONS Culture negative peritonitis, isolation of diphtheroids or Corynebacterium spp., previous exposure to antibiotics, and/or a refractory infection should all prompt consideration of PD-related NTM infection and timely workup. Catheter removal is recommended aside prolonged antimicrobial therapy. In select patients with ESI, continuation of PD may be feasible.
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Affiliation(s)
- Alon Bnaya
- Institute of Nephrology, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Yonit Wiener-Well
- Infectious Diseases Unit, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Hila Soetendorp
- Department of Nephrology, Sourasky Medical Center, Affiliated with the Tel Aviv University, Israel
| | - Yael Einbinder
- Department of Nephrology, Meir Medical Center, Kfar Saba, Affiliated with the Tel Aviv University, Israel
| | - Yossi Paitan
- Department of Clinical Microbiology and Immunology, 37253Meir Medical Center, Kfar Saba, Affiliated with the Tel Aviv University, Israel
| | - Margarita Kunin
- Institue of Nephrology and Hypertension, 26744Sheba Medical Center, Ramat Gan, Affiliated with the Tel Aviv University, Israel
| | - Tatiana Tanasiychuk
- Department of Nephrology, 37255Carmel Medical Center, Affiliated with the Technion - Israel Institute of Technology, Haifa, Israel
| | - Daniel Kushnir
- Department of Nephrology, 37255Carmel Medical Center, Affiliated with the Technion - Israel Institute of Technology, Haifa, Israel
| | - Etty Kruzel-Davila
- Department of Nephrology and Hypertension, 58878Rambam Health Care Campus, Affiliated with the Technion - Israel Institute of Technology, Haifa, Israel
| | - Regina Gershkovitz
- Israel Institute of Nephrology and Hypertension, 26736Hillel Yaffe Medical Center, Hadera, Affiliated with the Tel Aviv University, Israel
| | - Roza Rosenberg
- Division of Nephrology, 37256Assaf Harofeh Medical Center, Be'er Ya'akov, Affiliated with the Tel Aviv University, Israel
| | - Aharon Bloch
- Department of Nephrology and Hypertension, 58884Hadassah Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Victoria Doviner
- Department of Pathology, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Marc V Assous
- Clinical Microbiology Laboratory, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Orly Peretz
- Institute of Nephrology, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Linda Shavit
- Institute of Nephrology, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Eli Ben-Chetrit
- Infectious Diseases Unit, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
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10
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Sardiña LA, Kaw U, Jour G, Knabel D, Dyck RM, Procop GW, Bergfeld WF, Harrington S, Demkowicz R, Piliang MP. Diagnosis of Mycobacterium abscessus/chelonae complex cutaneous infection: Correlation of tissue culture and skin biopsy. J Cutan Pathol 2019; 47:321-327. [PMID: 31804711 DOI: 10.1111/cup.13623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/06/2019] [Accepted: 11/15/2019] [Indexed: 01/05/2023]
Abstract
Mycobacterium abscessus and M. chelonae belong to the rapid-growing nontuberculous mycobacteria (NTM) group, which are defined by their ability to form visible colonies on agar within 7 days of subculture. Cutaneous infections by this complex show a heterogeneous clinical presentation with varied histopathologic findings. However, the presence of vacuoles in many specimens has been reported as a specific histologic finding. Herein, we correlate the histopathology of patients with tissue-culture positive M. abscessus/M. chelonae complex in order to identify features that may prompt a rapid categorization of the infectious etiology. The cohort includes 33 skin punch biopsy specimens from 28 patients who had associated positive tissue cultures. The most frequent clinical presentation was a single or multiple nodule. Twenty-seven specimens (81.81%) were found to have vacuoles. The observation of certain histologic features (ie, polymorphonuclear microabscesses and epithelioid granuloma formation) should raise the possibility of infection by NTM. In addition to these findings, we believe the presence of vacuoles in the dermal and subcutaneous inflammation should raise suspicion for NTM.
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Affiliation(s)
- Luis A Sardiña
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Urvashi Kaw
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - George Jour
- Department of Pathology and Dermatology, New York Langone Medical Center, New York, New York
| | - Daniel Knabel
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Rayna M Dyck
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.,Skin Wellness Center Of Alabama, Birmingham, Alabama
| | - Gary W Procop
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wilma F Bergfeld
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Susan Harrington
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ryan Demkowicz
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Melissa P Piliang
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
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11
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Marzuk SM, Rohit A, Nagarajan P, Nzana V, Katuraga VM, Parthasarathy R, Mathew M, Abraham G. An unusual case of unresolving tunnel infection in a patient on continuous ambulatory peritoneal dialysis. Indian J Med Microbiol 2019; 36:600-602. [PMID: 30880716 DOI: 10.4103/ijmm.ijmm_18_425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Atypical mycobacteria remain a rare cause of peritoneal dialysis catheter-related tunnel infection (TI) and poses serious risk because of the resistant nature to most antibiotic therapy. Non-tubercular mycobacterial infections lead to chronicity requiring peritoneal dialysis catheter removal. We report an 82-year-old male, with diabetic nephropathy who had a coinfection with Staphylococcus hominis and Mycobacterium abscessus who presented with pus discharge at exit site and TI. He was treated with relocation of the extraperitoneal part of the catheter with a new exit site without catheter removal and multidrug mycobacterial therapy.
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Affiliation(s)
- S Mohamed Marzuk
- Department of Nephrology, Institue of Kidney Disease Urology and Organ Transplantation, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Anusha Rohit
- Department of Microbiology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - P Nagarajan
- Department of Nephrology, Institue of Kidney Disease Urology and Organ Transplantation, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Victorine Nzana
- Department of Nephrology, Institue of Kidney Disease Urology and Organ Transplantation, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Verus Mboneko Katuraga
- Department of Nephrology, Institue of Kidney Disease Urology and Organ Transplantation, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Rajeevalochana Parthasarathy
- Department of Nephrology, Institue of Kidney Disease Urology and Organ Transplantation, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Milly Mathew
- Department of Nephrology, Institue of Kidney Disease Urology and Organ Transplantation, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Georgi Abraham
- Department of Nephrology, Institue of Kidney Disease Urology and Organ Transplantation, Madras Medical Mission, Chennai, Tamil Nadu, India
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12
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Peritoneal dialysis-associated infection caused by Mycobacterium abscessus: a case report. BMC Nephrol 2018; 19:341. [PMID: 30497395 PMCID: PMC6267060 DOI: 10.1186/s12882-018-1148-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/22/2018] [Indexed: 12/21/2022] Open
Abstract
Background Peritoneal dialysis (PD)-associated infection caused by Mycobacterium spp. is rare. Mycobacterium abscessus is one of the most resistant acid-fast bacteria, and treatment is also the most difficult and refractory. Thus, we report a case of PD-associated peritonitis caused by Mycobacterium abscessus that was difficult to treat and led to PD failure. Case presentation We recently encountered a 56-year-old man who developed PD-associated infection. We initially suspected exit-site infection (ESI) and tunnel infection (TI) caused by methicillin-resistant coagulase-negative Staphylococcus. However, antibiotic therapy did not provide any significant improvement. Thus, we performed simultaneous removal and reinsertion of a PD catheter at a new exit site. The patient subsequently developed peritonitis and Mycobacterium abscessus was detected in the peritoneal effluent. Thus, the reinserted catheter was removed, hemodialysis was started, and the patient was eventually discharged. Conclusions In cases of refractory ESI or TI, it is important to consider non-tuberculous mycobacteria as the potentially causative organism. Even if acid-fast bacterial staining is negative or not performed, detection of Gram-negative bacillus may lead to suspicion and early identification of Mycobacterium spp. In PD-associated infection by Mycobacterium abscessus, catheter removal is necessary in many cases. Simultaneous removal and reinsertion of the catheter is not recommended, even in cases of ESI or TI. Reinsertion should only be attempted after complete resolution of peritoneal symptoms. After removal of the catheter, careful follow-up is necessary, paying attention to complications such as wound infection, peritonitis, and ileus. In addition, the selection and treatment period of antibiotics in PD-associated infection by Mycobacterium abscessus remains unclear, and it is an important topic for future discussion.
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Peritoneal dialysis-associated catheter infection caused by Mycobacterium abscessus in an elderly patient who was successfully treated with catheter removal. CEN Case Rep 2017; 6:175-179. [PMID: 28795380 DOI: 10.1007/s13730-017-0270-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/06/2017] [Indexed: 12/11/2022] Open
Abstract
An 89-year-old Japanese man on peritoneal dialysis (PD) was suspected of having a PD-associated catheter infection. He visited the hospital because of the discharge of pus from the exit site of his catheter. Gram staining of the pus showed Gram-positive bacilli, but these were acid-fast bacilli. The rapidly growing nontuberculous mycobacteria, Mycobacterium abscessus, was isolated. PD catheter removal and debridement were immediately performed. The patient received combination antibiotic therapy. His clinical course was good, but he required hemodialysis due to the discontinuation of PD. However, the patient and his family chose not to continue hemodialysis even when the symptoms of uremia appeared. Best supportive care was arranged by his primary care physician. M. abscessus is a rare causative organism for PD-associated catheter infections and is difficult to treat. In our case, a rapid and precise diagnosis was made using acid-fast staining and Mycobacterium culture. The risk of nontuberculous mycobacterial infections should be considered in patients on PD.
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Mooren VHJF, Bleeker MWP, van Ingen J, Hermans MHA, Wever PC. Disseminated Mycobacterium abscessus infection in a peritoneal dialysis patient. IDCases 2017; 9:6-7. [PMID: 28529886 PMCID: PMC5430147 DOI: 10.1016/j.idcr.2017.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 05/02/2017] [Accepted: 05/02/2017] [Indexed: 12/23/2022] Open
Abstract
A disseminated peritoneal dialysis-related Mycobacterium abscessus infection is very rare. M. abscessus belongs to the rapidly growing mycobacteria and can be misidentified as a diphtheroid bacterium, which in our case delayed diagnosis and optimal treatment. Due to intrinsic resistance to most antimicrobials, therapeutic options in M. abscessus infections are limited. Infection often leads to catheter loss. A fatal outcome, like in our case, is not exceptional.
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Affiliation(s)
- Vincent H J F Mooren
- Department of Internal Medicine and Nephrology, Bernhoven Hospital, Uden, The Netherlands.,Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Michiel W P Bleeker
- Department of Internal Medicine and Nephrology, Bernhoven Hospital, Uden, The Netherlands
| | - Jakko van Ingen
- Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Mirjam H A Hermans
- Molecular Diagnostics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Peter C Wever
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
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Martínez López AB, Álvarez Blanco O, Ruíz Serrano MJ, Morales San-José MD, Luque de Pablos A. Mycobacterium fortuitum como causa de infección del orificio del catéter de diálisis peritoneal. Caso clínico y revisión de la literatura. Nefrologia 2015; 35:584-6. [DOI: 10.1016/j.nefro.2015.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 03/15/2015] [Indexed: 11/28/2022] Open
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A hospital-acquired outbreak of catheter-related nontuberculous mycobacterial infection in children on peritoneal dialysis. CEN Case Rep 2015; 4:43-47. [PMID: 28509267 DOI: 10.1007/s13730-014-0137-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 07/14/2014] [Indexed: 10/25/2022] Open
Abstract
Catheter-related nontuberculous mycobacterial infection in children with chronic renal failure on peritoneal dialysis (PD) is rare. However, there have been five such infections in infants among PD patients at our center. Although the patients were treated with antibiotics to which the organisms showed in vitro sensitivity, they were clinically drug resistant. Hence, all PD catheters needed to be removed. Thereafter, following hemodialysis treatment for approximately 1 month, the PD catheters were replaced, with no recurrence of infection. On investigation of the infection route, it was found that these bacteria had colonized around a shower head in one of the bathrooms. These findings suggest that, in cases where hot water systems at hospitals are considered at a high risk, frequent sterilization is needed, especially around the shower heads. It is also necessary to reconsider current standard practices in the management of catheter exit sites, especially if the national incidence of infection increases.
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Mok MM, Ma MK, Yap DY, Chan TM, Lam FM. Secondary atypical mycobacterial infection after peritoneal catheter removal. Int Wound J 2014; 13:1021-2. [PMID: 24827937 DOI: 10.1111/iwj.12284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 03/27/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Maggie My Mok
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
| | - Maggie Km Ma
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Desmond Yh Yap
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Tak M Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Fei Mf Lam
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
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19
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Lo MW, Mak SK, Wong YY, Lo KC, Chan SF, Tong GMW, Lo KY, Wong PN, Tse CWS, Kam KM, Wong AKM. Atypical mycobacterial exit-site infection and peritonitis in peritoneal dialysis patients on prophylactic exit-site gentamicin cream. Perit Dial Int 2012; 33:267-72. [PMID: 23032088 DOI: 10.3747/pdi.2011.00184] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We report 9 cases of exit-site infection and continuous ambulatory peritoneal dialysis peritonitis associated with atypical mycobacteria. All patients had been using topical gentamicin cream as prophylaxis for exit-site infection before the onset of these infections. Gentamicin cream is postulated to be a potential risk factor for atypical mycobacterial infection because of selective pressure on other micro-organisms. The microbiology of atypical mycobacteria and the treatment for atypical mycobacterial infections are discussed.
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Affiliation(s)
- Man-wai Lo
- Renal Unit, Department of Medicine and Geriatrics, and Microbiology Unit,1 Department of Pathology, Kwong Wah Hospital, Hong Kong SAR, PR China.
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Karakala N, Steed LL, Ullian ME. Peritonitis from Mycobacterium wolinskyi in a chronic peritoneal dialysis patient. Int Urol Nephrol 2011; 45:289-91. [PMID: 22127408 DOI: 10.1007/s11255-011-0093-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 11/12/2011] [Indexed: 10/15/2022]
Abstract
We report the case of acute peritonitis caused by a rapidly growing mycobacterium in a chronic peritoneal dialysis patient, whose renal failure had been caused by diabetic glomerulosclerosis. The organism cultured from the peritoneal dialysis fluid was Mycobacterium wolinskyi. Peritonitis caused by M. wolinskyi in a chronic peritoneal dialysis patient has never been reported before.
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Affiliation(s)
- Nithin Karakala
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 629, Charleston, SC 29425-6290, USA
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21
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Successful Tigecycline Combination Therapy for Mycobacterium abscessus Infection of a Total Hip Arthroplasty. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2010. [DOI: 10.1097/ipc.0b013e3181d04a09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Garrison A, Morris M, Doblecki Lewis S, Smith L, Cleary T, Procop G, Vincek V, Rosa-Cunha I, Alfonso B, Burke G, Tzakis A, Hartstein A. Mycobacterium abscessusinfection in solid organ transplant recipients: report of three cases and review of the literature. Transpl Infect Dis 2009; 11:541-8. [DOI: 10.1111/j.1399-3062.2009.00434.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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23
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Kameyama H, Mori Y, Kimura T, Sugishita C, Adachi T, Sonomura K, Kusaba T, Tanda S, Kishimoto N, Okigaki M, Hatta T, Matsubara H. A Case Report of Mycobacterium Abscessus Peritonitis in a Peritoneal Dialysis Patient. Ther Apher Dial 2007; 11:449-51. [DOI: 10.1111/j.1744-9987.2007.00526.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
While nontuberculous mycobacterial peritonitis is uncommon among peritoneal dialysis (PD) patients, these infections have serious consequences. They present a significant diagnostic and therapeutic challenge for clinicians. Diagnosis can be delayed due to the slow growth rate of some mycobacterial species. These organisms can also be overlooked when adequate culture media are not used in the microbiological evaluation process. The choice of antimicrobial therapy depends upon isolation and speciation of the infecting Mycobacterium species, and prompt catheter removal is essential. Because serious intra-abdominal complications may follow infection, identifying patient risk factors for nontuberculous mycobacterial peritonitis and initiating prompt diagnosis and treatment are essential. We report three cases of peritonitis associated with Mycobacterium chelonae and Mycobacterium gordonae, each with a unique presentation, and discuss the appropriate diagnosis and treatment strategies for the management of PD-associated mycobacterial infections.
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Affiliation(s)
- Mira Rho
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8029, USA
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Ehrich JHH, Eke FU. Malaria-induced renal damage: facts and myths. Pediatr Nephrol 2007; 22:626-37. [PMID: 17205283 DOI: 10.1007/s00467-006-0332-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 08/24/2006] [Accepted: 08/31/2006] [Indexed: 11/30/2022]
Abstract
Malaria infections repeatedly have been reported to induce nephrotic syndrome and acute renal failure. Questions have been raised whether the association of a nephrotic syndrome with quartan malaria was only coincidental, and whether the acute renal failure was a specific or unspecific consequence of Plasmodium falciparum infection. This review attempts to answer questions about "chronic quartan malaria nephropathy" and "acute falciparum malaria nephropathy". The literature review was performed on all publications on kidney involvement in human and experimental malarial infections accessible in PubMed or available at the library of the London School of Hygiene and Tropical Medicine. The association of a nephrotic syndrome with quartan malaria was mostly described before 1975 in children and rarely in adult patients living in areas endemic for Plasmodium malariae. The pooled data on malaria-induced acute renal failure included children and adults acquiring falciparum malaria in endemic areas either as natives or as travellers from non-tropical countries. Non-immunes (not living in endemic areas) had a higher risk of developing acute renal failure than semi-immunes (living in endemic areas). Children with cerebral malaria had a higher rate and more severe course of acute renal failure than children with mild malaria. Today, there is no evidence of a dominant role of steroid-resistant and chronic "malarial glomerulopathies" in children with a nephrotic syndrome in Africa. Acute renal failure was a frequent and serious complication of falciparum malaria in non-immune adults. However, recently it has been reported more often in semi-immune African children with associated morbidity and mortality.
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Affiliation(s)
- Jochen H H Ehrich
- Children's Hospital, Hannover Medical School, Carl Neuberg Str. 1, 30625, Hannover, Germany.
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