title: A peritoneal dialysis patient with fatal culture-negative peritonitis.
abstract: 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.
authors.affiliation: University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia. david_johnson@health.qld.gov.au
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Nick
authors.initials: N
authors.lastname: Gray
authors.forename: Paul
authors.initials: P
authors.lastname: Snelling
mesh_terms: D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010538:Peritonitis / Q000175:diagnosis* / Q000209:etiology