title: Fungal peritonitis in pediatric patients.
abstract: Fungal peritonitis (FP) is a rare complication of peritoneal dialysis (PD). Although treatment with fluconazole (FCZ) has improved catheter survival and preservation of the peritoneal membrane, FP still carries a high morbidity and mortality in pediatrics. High-risk factors for FP include previous usage of systemic antibiotics and recurrent bacterial peritonitis. A prospective experience in the treatment of FP was conducted at the University of Miami/Jackson Children's Hospital from 1992 to 1997. All patients received either oral or intravenous loading dose of FCZ (5-7 mg/kg) followed by intraperitoneal (i.p.) FCZ (75 mg/L). Amphotericin B (amp B) was added when clinical sepsis was present. A total of 6 patients had FP (all Candida sp.; mean age: 6 years). Two of these patients were neonates with Tenckhoff-catheter placement at less than 1 week of age. Five patients achieved sterilization of the peritoneal fluid. One patient required catheter removal (C. tropicalis). The 2 neonates were infection free for 29 and 41 days, respectively, but both died of superimposed bacterial sepsis. The remaining 4 patients survived and completed 6 weeks of FCZ treatment. Two have had preservation of the peritoneal membrane for more than 1 year. The other 2 were switched to hemodialysis. We conclude that FCZ is an effective treatment for fungal peritonitis in pediatric patients. Adjunct therapy with amp B is usually necessary if sepsis is present. Although eradication of the fungus is possible in a majority of cases, neonates and immunocompromised hosts remain at high risk for morbidity and mortality.
authors.affiliation: Department of Pediatrics, University of Miami, Jackson Memorial Children's Hospital, Florida, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Montane
authors.forename: I
authors.initials: I
authors.lastname: Mazza
authors.forename: C
authors.initials: C
authors.lastname: Abitbol
authors.forename: G
authors.initials: G
authors.lastname: Zilleruelo
authors.forename: J
authors.initials: J
authors.lastname: Strauss
authors.forename: S
authors.initials: S
authors.lastname: Coakley
authors.forename: R
authors.initials: R
authors.lastname: Diaz
mesh_terms: D000293:Adolescent; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D002177:Candidiasis / Q000188:drug therapy* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D015725:Fluconazole / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole