A peritoneal dialysis patient with fatal culture-negative peritonitis.
Culture-negative peritoneal inflammation accounts for between 5 and 20% of cases of peritonitis in peritoneal dialysis patients. Diagnostic yields may be enhanced considerably by reculturing dialysate effluents using appropriate collection methods and optimal laboratory techniques (including prolonged low-temperature and anaerobic incubations). In patients with persistent culture-negative peritonitis, consideration should be given to the possibilities of unusual or fastidious microorganisms (especially fungi and mycobacteria) and non-infective causes (especially drug reactions, malignancy, visceral inflammation and retroperitoneal inflammation). In this paper, an illustrative case of persistent culture-negative peritonitis is presented followed by a discussion of the investigative approach to such patients, with particular emphasis on differential diagnosis and the limitations of currently available tests.
Johnson
David W
DW
University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia. david_johnson@health.qld.gov.au
Gray
Nick
N
Snelling
Paul
P
D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010538:Peritonitis / Q000175:diagnosis* / Q000209:etiology