Fulminant peritonitis presumably caused by Panton-Valentine leukocidin-positive Staphylococcus aureus in a girl on peritoneal dialysis.
Peritonitis is a significant complication of peritoneal dialysis (PD) and the most common cause of technique failure. Panton-Valentine leukocidin (PVL), a cytotoxin produced by certain strains of Staphylococcus aureus (SA), causes destruction of neutrophils, and is associated with severe invasive infections. We present a 2.5-year-old girl on PD, who presented suddenly with an unusually fulminant and protracted course of peritonitis. Only a few hours after the onset of clinical signs, septic shock developed. PVL-positive methicillin-sensitive SA (MSSA) was grown and initial empiric antibiotic treatment changed to flucloxacillin and rifampicin in order to minimize toxin production. In spite of adequate antibiotic treatment and PD-catheter removal, recovery was slow. No PD-related peritonitis in children associated with PVL-producing strains have been reported so far and no specific recommendation exists for treatment. We speculate that PVL contributed to the severity and outcome of peritonitis in our patient.
Department of Pediatric Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Nina
N
Battelino
Marko
M
Pokorn
Nataša
N
Švent-Kučina
Veronika
V
Križan-Hergouth
Gregor
G
Novljan
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001427:Bacterial Toxins / Q000096:biosynthesis; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000382:microbiology*; D002675:Child, Preschool; D005098:Exotoxins / Q000096:biosynthesis; D005260:Female; D006801:Humans; D007956:Leukocidins / Q000096:biosynthesis; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification
D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin
Children; Panton-Valentine leukocidin; Peritoneal dialysis; Peritonitis; Staphylococcus aureus