[Peritoneal dialysis catheter sterilization by urokinase administration in case of relapsing peritonitis: About four observations]

The presence of a biofilm within the peritoneal dialysis catheter where bacteria are encapsulated, protected from the action of antibiotics and insidiously liberated within the dialysate, best explains the relapse of the infectious peritonitis, when antibiotics are withdrawn. We here report a serie of four clinical cases in whom the administration of urokinase within the peritoneal catheter in addition to the current antibiotherapy, has cured relapsing peritonitis due to Staphylococcus epidermidis in two cases, Acinetobacterjohnsonii in one case and Staphylococcus haemolyticus in one case, respectively. This approach, safe and easy, allowed the infection eradication and did prevent a catheter removal and a potential transfer of the patients to hemodialysis.

[Capnocytophaga spp. peritonitis in a peritoneal dialysis: A case report]

INTRODUCTION

Capnocytophaga spp. is a slow-growing bacterium that forms a part of the normal oral flora of dogs and cats. In peritoneal dialysis, only seven cases have been reported. We report the observation of a case of peritonitis with Capnocytophaga spp. in a patient on peritoneal dialysis who lives with a cat.

CASE REPORT

A 64-year-old woman with chronic end stage renal disease due to chronic interstitial nephropathy on automated peritoneal dialysis has been admitted for diffuse abdominal pain. The dialysis fluid was cloudy with 11,250 elements/mm³, of leukocytes. Direct examination was negative. The C-reactive protein was 165mg/L. Intraperitoneal probabilistic antibiotic therapy was initiated 1g of cefazolin and 1g of ceftazidime per day. After eight days, aerobic culture was negative, the anaerobic one was positive to gram negative bacilli, but the identification could not be possible with MALDI-TOF mass spectrometry. Antibiotic therapy was continued by ceftazidime for 21 days. The evolution was marked by the improvement of the clinical and biological state of the patient. The germ was finally identified using the genomic 16S rRNA sequencing technique. This is Capnocytophaga spp. Investigation then revealed that the patient's cat sometimes entered her room at the time of connection of peritoneal dialysis.

CONCLUSION

The case of our patient once again reveals the diagnostic difficulties posed by Capnocytophaga spp. Innovative techniques, such as MALDI-TOF-MS or genomic sequencing of ribosomal RNA, should be further used in peritoneal dialysis in the diagnosis of peritonitis.

Abdominal tuberculosis in a low prevalence country

OBJECTIVE

Abdominal tuberculosis is a rare disease. The clinical and radiological manifestations are non-specific and the diagnosis is difficult. Our objective was to describe the characteristics and treatment of patients presenting with abdominal tuberculosis in a low-incidence country.

PATIENTS AND METHODS

We reviewed the clinical, diagnostic, treatment, and outcome features of patients presenting with abdominal tuberculosis diagnosed by bacteriological and/or histological results and managed in five French university hospitals from January 2000 to December 2009.

RESULTS

We included 21 patients. The mean diagnostic delay was 13 months. Twelve patients (57%) came from a low-incidence area and only two had a known immunosuppressed condition. Eighteen patients (86%) presented with abdominal symptoms. The main organs involved were the peritoneum (n=14, 66%), the mesenteric lymph nodes (n=13, 62%), and the bowel (n=7, 33%). Sixteen patients (76%) underwent surgery, including two in an emergency setting. Seventeen patients (81%) received six months or more of anti-tuberculosis treatment. Finally, 16 patients (76%) had a positive outcome.

CONCLUSION

New diagnostic procedures, and especially molecular biology, may help diagnose unusual clinical presentations of tuberculosis. Invasive procedures are frequently necessary to obtain samples but also for the treatment of digestive involvement.

[Peritonitis in pediatric patients receiving peritoneal dialysis]

BACKGROUND

Peritonitis on catheter of dialysis represents the most frequent complication of the peritoneal dialysis (PD) in the pediatric population. It remains a significant cause of morbidity and mortality. In this study, we investigated the risk factors for peritonitis in children.

METHODS

In this study, we retrospectively collected the records of 85 patients who were treated with PD within the past ten years in the service of pediatrics of the University Hospital Charles-Nicolle of Tunis.

RESULTS

Peritonitis rate was 0.75 episode per patient-year. Notably, peritonitis caused by Gram-positive organisms were more common. Analysis of infection risk revealed three significant independent factors: the poor weight (P=0.0045), the non-automated PD (P=0.02) and the short delay from catheter insertion to starting PD (P=0.02). The early onset peritonitis was significantly associated with frequent peritonitis episodes (P=0.0008). The mean duration between the first and second episode of peritonitis was significantly shorter than between PD commencement and the first episode of peritonitis. We revealed a significant association between Gram-negative peritonitis and the presence of ureterostomy (0.018) and between Gram-positive peritonitis and the presence of exit-site and tunnel infections (0.02). Transition to permanent hemodialysis was needed in many children but no death occurred in patients with peritonitis.

CONCLUSION

Considering the important incidence of peritonitis in our patients, it is imperative to establish a targeted primary prevention. Nutritional care must be provided to children to avoid poor weight. The automated dialysis has to be the modality of choice.

[Peritonitis by typhoid ileal perforation: evolutionary aspects in the Teaching Hospital of Bamako and Kati in Mali]

OBJECTIVE

The objective of this study was to determine the frequency of peritonitis by typhoid ileal perforation in the teaching hospitals of Bamako and Kati.

PATIENTS AND METHODS

We conducted a retrospective study over a 24 years period (1984-2007). Every patient admitted and operated in urgency for peritonitis by ileal perforation were listed and included in this study.

RESULTS

During the study period, 1868 acute peritonitis were operated on in the three major health centres of Bamako and Kati. We collected data concerning 543 typhoid ileal perforations which represented 29.0% of all peritonitis. The peritonitis by typhoid perforation constituted 28.5% of the peritonitis in the teaching hospital of the Point G, 30.6% in the Gabriel Touré teaching hospital and 6.4% in the teaching hospital of Kati. Among the peritonitis by typhoid perforation, 56.7% were listed in the Point G teaching hospital, 43.0% in the Gabriel Torre teaching hospital and 0.3% in the Kati teaching hospital. Between 1984-2004 we collected data from two hundred and fifty seven (257) patients suffering from peritonitis by typhoid ileal perforation, a total of 24.4% of the peritonitis recorded. Between 2005-2007, the data for two hundred eighty six (286) patients suffering from peritonitis by typhoid ileal perforation was collected, a total of 35% of the peritonitis recorded. The typhoid ileum perforation remains the 2nd overall cause of generalized peritonitis after that of appendicular origin.

CONCLUSION

Peritonitis by typhoid ileum perforation has seen a significant increase from 2004 in the teaching hospitals of Bamako and Kati.