RESUMEN
A 68-year-old man on peritoneal dialysis (PD) was hospitalized with the clinical picture of peritonitis. The patient was diagnosed with peritonitis caused by nontuberculous mycobacteria (NTM) according to positive Ziehl-Neelsen staining and negative Mycobacterium tuberculosis polymerase chain reaction results. Oral levofloxacin and clarithromycin, and later intraperitoneal imipenem were started. According to the anti-NTM susceptibility test results, oral minocycline was administered. The patient was treated for 6 months. He recovered without PD catheter removal; thus, PD was successfully continued. A genetic analysis identified the isolate as Mycobacterium iranicum. This is the first report of PD-related peritonitis caused by M. iranicum.
Asunto(s)
Infecciones por Mycobacterium no Tuberculosas/etiología , Infecciones por Mycobacterium no Tuberculosas/microbiología , Diálisis Peritoneal/efectos adversos , Peritonitis/etiología , Peritonitis/microbiología , Anciano , Claritromicina/uso terapéutico , Humanos , MasculinoRESUMEN
A 32-year-old man on peritoneal dialysis (PD) was hospitalized for seven days due to fever. A diagnosis of yeast-like fungal peritonitis was made by Gram staining. The patient was started on intravenous micafungin and oral fluconazole therapy following removal of the PD catheter. A fungal pathogen was isolated from the peritoneal fluid and identified as Cryptococcus species. Based on antifungal susceptibility testing, the treatment was changed to voriconazole and continued for 3 months. A genetic analysis identified the isolate as Cryptococcus laurentii (C. laurentii). This patient was diagnosed with C. laurentii PD-related peritonitis and was successfully treated with voriconazole and removal of the PD catheter.
Asunto(s)
Antifúngicos/administración & dosificación , Cryptococcus/aislamiento & purificación , Equinocandinas/administración & dosificación , Fluconazol/administración & dosificación , Lipopéptidos/administración & dosificación , Micosis/etiología , Diálisis Peritoneal/efectos adversos , Peritonitis/etiología , Adulto , Cateterismo , Catéteres de Permanencia/efectos adversos , Catéteres de Permanencia/microbiología , Remoción de Dispositivos , Humanos , Masculino , Micafungina , Micosis/tratamiento farmacológico , Micosis/microbiología , Peritonitis/tratamiento farmacológico , Peritonitis/microbiologíaRESUMEN
PURPOSE: The usefulness of skin perfusion pressure (SPP) measurement in the assessment of critical ischemia of the lower limb has previously been established. This study investigated whether finger SPP measurement is useful to evaluate hypoperfusion distal to arteriovenous vascular access in dialysis patients. METHODS: Seventeen asymptomatic hemodialysis patients with upper extremity arteriovenous access and 17 non-dialysis control patients were prospectively examined. SPP in the thumb, the middle finger and the little finger of both hands was measured. The bilateral difference of the mean SPP of the three fingers was evaluated. RESULTS: The mean difference of SPP between the contralateral and the arteriovenous access sides among hemodialysis patients (33±2 5 mmHg) was significantly larger than the mean difference of SPP between the left and the right hands among control patients (1.0±6.0 mmHg, p<0.01). CONCLUSIONS: This report shows the potential usefulness of SPP measurement to evaluate hypoperfusion distal to arteriovenous vascular access.