title: Peritoneal Dialysis-Related Peritonitis Due to Melioidosis: A Potentially Devastating Condition.
abstract: ♦ BACKGROUND: Melioidosis, an infectious disease caused byBurkholderia pseudomallei, is endemic in Southeast Asia and Northern Australia. Although a wide range of clinical manifestations from this organism are known, peritonitis associated with peritoneal dialysis (PD) has rarely been reported. ♦ PATIENTS AND METHODS: Peritoneal dialysis patients from all regions in Thailand were eligible for the study if they had peritonitis and either peritoneal fluid or effluent culture positive forB. pseudomallei. Patient data obtained included baseline characteristics, laboratory investigations, treatments, and clinical outcomes. When possible, PD fluid and removed Tenckhoff (TK) catheters were submitted for analyses of minimal inhibitory concentration (MIC) and microbial biofilm, respectively. ♦ RESULTS: Twenty-six patients were identified who were positive for peritonealB. pseudomalleiinfection. The recorded mean age was 50 ± 15 (24 - 75) years, and the majority (58%) were female. Most of the cases were farmers living in Northeastern and Northern Thailand. Almost half of the cases had diabetes. Infections were reported commonly during the monsoon season and winter. The clinical presentations of peritonitis were similar to the manifestations from other microorganisms. Nine patients (41%) died (7 from sepsis), 6 fully recovered, and 7 switched to permanent hemodialysis. The mortality was potentially associated with sepsis (p= 0.007), infection during the monsoon season (p= 0.017), high initial dialysate neutrophils (p= 0.045), and high hematocrit (p= 0.045). Although no antibiotic resistance to ceftazidime and carbapenems was detected, approximately 50% of patients died with this treatment. Microbial biofilms were identified on the luminal surface of 4 out of 5 TK catheters, but the removal of the catheter did not alter the outcomes. ♦ CONCLUSION: Peritoneal dialysis-related peritonitis due to melioidosis is uncommon but highly fatal. Increased awareness, early diagnosis, and optimal management are mandatory.
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand golfnephro@hotmail.com.|Kidney and Metabolic Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.|Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Talerngsak
authors.initials: T
authors.lastname: Kanjanabuch
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Nuttha
authors.initials: N
authors.lastname: Lumlertgul
authors.affiliation: Systems Biology Center, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Lachlan J
authors.initials: LJ
authors.lastname: Pearson
authors.affiliation: Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Tanittha
authors.initials: T
authors.lastname: Chatsuwan
authors.affiliation: Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.|Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Krit
authors.initials: K
authors.lastname: Pongpirul
authors.affiliation: Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Asada
authors.initials: A
authors.lastname: Leelahavanichkul
authors.affiliation: Sappasit Prasong Hospital, Ubon Ratchathani, Thailand.
authors.forename: Nisa
authors.initials: N
authors.lastname: Thongbor
authors.affiliation: Amnat Charoen Hospital, Amnat Charoen, Thailand.
authors.forename: Gunticha
authors.initials: G
authors.lastname: Nuntawong
authors.affiliation: Roi Et Hospital, Roi Et, Thailand.
authors.forename: Laksamon
authors.initials: L
authors.lastname: Praderm
authors.affiliation: Yasothon Hospital, Yasothon, Thailand.
authors.forename: Pantiwa
authors.initials: P
authors.lastname: Wechagama
authors.affiliation: Udonthani Hospital, Udonthani, Thailand.
authors.forename: Surapong
authors.initials: S
authors.lastname: Narenpitak
authors.affiliation: Udonthani Hospital, Udonthani, Thailand.
authors.forename: Apinya
authors.initials: A
authors.lastname: Wechpradit
authors.affiliation: Uttaradit Hospital, Uttaradit, Thailand.
authors.forename: Worauma
authors.initials: W
authors.lastname: Punya
authors.affiliation: Phayao Hospital, Phayao, Thailand.
authors.forename: Guttiga
authors.initials: G
authors.lastname: Halue
authors.affiliation: Mukdahan Hospital, Mukdahan, Thailand.
authors.forename: Phetpailin
authors.initials: P
authors.lastname: Naka
authors.affiliation: Phichit Hospital, Phichit, Thailand.
authors.forename: Somboon
authors.initials: S
authors.lastname: Jeenapongsa
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Somchai
authors.initials: S
authors.lastname: Eiam-Ong
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology*; D002423:Cause of Death; D016638:Critical Illness / Q000401:mortality; D003430:Cross-Sectional Studies; D020878:Device Removal; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008554:Melioidosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Burkholderia pseudomallei; Peritonitis; melioidosis; peritoneal dialysis