title: A retrospective study of seven cases of Candida parapsilosis peritonitis in CAPD patients: the therapeutic implications.
abstract: BACKGROUND
  Candida peritonitis accounts for the majority of fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD), but the Candida species were not routinely subtyped in previous studies. The clinical course and the outcome of Candida parapsilosis peritonitis remain unclear.
  
  
  OBJECTIVE
  To study the clinical course and outcome of C. parapsilosis peritonitis in CAPD patients.
  
  
  METHODS
  Peritoneal dialysis unit in a regional hospital.
  
  
  METHODS
  A retrospective study on seven cases of C. parapsilosis peritonitis occurring in a single center over 3 years.
  
  
  RESULTS
  The 7 patients included 4 males and 3 females. Their mean age was 62 +/- 11.5 years. Two (29%) were diabetic. Three (43%) had a history of preceding peritonitis and 5 (71 %) had received broad spectrum antibiotic within the previous 1 month. All presented with cloudy dialysate, abdominal pain, and fever. The mean dialysate white cell count was 300 +/- 168/mm3 with a predominance of neutrophils (81.4% +/- 13.1%). The mean time from onset of symptoms to diagnosis was 5.7 +/- 3.1 days. All had been treated with immediate catheter removal within 24 hours of diagnosis and antifungal therapy, including oral fluconazole, intravenous (IV) amphotericin, or their sequential combination. Environmental samplings were negative for C. parapsilosis. The overall complication rate was exceptionally high (71%), with three (43%) complicated by abscess formation requiring surgical drainage, one peritoneal adhesion (14%), and one mortality (14%). In the end, only two (29%) could resume CAPD.
  
  
  CONCLUSIONS
  The outcome of this study group appeared worse than those previously described in the literature, and the optimal treatment for this group of patients remains unclear.
authors.affiliation: Department of Medicine, Kwong Wah Hospital, Hong Kong, China. apnwong@medi.net.hk
authors.forename: P N
authors.initials: PN
authors.lastname: Wong
authors.forename: S K
authors.initials: SK
authors.lastname: Mak
authors.forename: K Y
authors.initials: KY
authors.lastname: Lo
authors.forename: G M
authors.initials: GM
authors.lastname: Tong
authors.forename: A K
authors.initials: AK
authors.lastname: Wong
mesh_terms: D002177:Candidiasis / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D012189:Retrospective Studies