Aspergilllus fumigatus 에 의한 CAPD 복막염후 도관내강의 초형태학적 변화

• Published in: The Korean journal of medicine Vol. 51; no. 3; pp. 392 - 395
• Main Authors: 박성배, Sung Bae Park, 이태희, Tae HeeLee, 권진경, Jin Kyung Kwon, 주일, Il Joo, 김현철, Hyun Chul Kim, 김교한, Kyo Han Kim
• Format: Journal Article
• Language: Korean
• Published: 대한내과학회 01.09.1996
• Subjects: Aspergillus fumigotus; Fluconazole; Fungal peritonitis
• ISSN: 1738-9364

Recently, dialysis-related fungal peritonitis have been increasingly reported, accounting for 5% of all cases of peritonitis. Most of these infections were caused by Candida species, Aspergillus species are an extremely rare cause of peritonitis in CAPD patients. Aspergillus peritonitis in CAPD patients have been fatal. We examined luminal surface of removed Tenckhoff peritaneal catheter in a patient on CAPD with Aspergillus peritonitis by scanning electron microscopy to study the morphology of fungal adherence. A 53-year-old female with an end-stage renal disease and hypertension had been on CAPD for 14 months. The patient experienced sudden onset of fever, diffuse abdominal pain, and cloudy dialysate effluent. She was initially treated as an outpatient with intraperitoneal cefazoline and netilmicin, Three days later, there was no resolution of her symptoms and the patient was admitted. The dialysate effluent was cloudy with 468 leukocytes per mm3 and 70% segmented neutrophils. On the surface of inner lumen of the Tenckhoff peritoneal catheter numerous tiny small visible colonies were found. Dialysate samples were obtained for microbiological study, and found evidences of a positive fungal mycelium and spores in the KOH mount. The Tenckhoff peritoneal catheter was removed immediately and intravenous fluconazole was begun. She received continuous antifungal therapy with intravenous fluconazole over 2 weeks. All sample of dialysate grew Aspergillus fumigatus. The other symptoms improved gradually over the next week. We studied the intraperitoneal portion of the removed Tenckhoff peritoneal catheter with scanning electron microscope. Mycelium of the Aspergillus fumigata with several spores grew along the irregular patterns of shallow fissure on the luminal surface of removed Tenckhoff peritoneal catheter. Similar patterns of these picture were observed on the several place of luminal surface of the catheter. Growth of several microcolonies were found on the surface of the catheter. Cross section of fungal mass which occluded catheter lumen revealed numerous mixture of fungal mycelium and spores. In conclusion, early removal of the Tenckhoff peritoneal catheter combined with antifungal agents is important steps to cure fungal peritonitis in a patients on CAPD because of fungus adhered to on silastic catheter materials in peritoneal dialysis fluid with formation of fungal colonization and fungal mass.