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Alternaria Peritonitis After Contact with a Cat

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Author(s)
N.H. RyooJ.S. HaD.S. JeonJ.R. KimE.A. Hwang
Keimyung Author(s)
Ryoo, Nam HeeHa, Jung SookJeon, Dong SeokKim, Jae RyongHwang, Eun Ah
Department
Dept. of Laboratory Medicine (진단검사의학)
Dept. of Internal Medicine (내과학)
Journal Title
Peritoneal Dialysis International
Issued Date
2009
Volume
29
Issue
2
Abstract
Alternaria is a saprophytic fungus that is widespread
in the environment. It is an opportunistic pathogen and
causes disease in humans and domestic animals by entry
promptly treated with an intravenous fluconazole. The
peritoneal drainage device was removed following arteriovenous
fistula replacement. The patient was stable
during his hospital stay and has remained asymptomatic
without recurrence for the past 10 months.
Fungal peritonitis accounts for approximately 10% of
CAPD peritonitis and is caused primarily by prior histories
of bacterial or fungal peritonitis and preceding
broad-spectrum antibiotic therapies for peritonitis (2,3).
The most common pathogen causing fungal peritonitis
is Candida spp, followed by Aspergillus spp. So far, only
two cases of Alternaria peritonitis have been reported in
the literature (4,5). According to the previous cases, histories
of bacterial peritonitis and prior broad-spectrum
antibiotic treatment were considered the primary risk
factors for Alternaria peritonitis. Unlike those patients,
our patient had not received broad-spectrum antibiotic
treatment within a month before admission, nor had he
experienced any episode of peritonitis over the previous
year. When this patient was questioned for other
possible causes of the CAPD peritonitis, he recalled that
he had contact with his neighbor’s cat several days before
the episode. According to two studies evaluating the
fungal flora of cats, Penicillium, Aspergillus, Alternaria,
and Cladosporium spp were the most frequently isolated
saprophytes in both stray and pet cats (6,7); Alternaria
was found in 29% – 45% of the studied cats. Unfortunately,
our staff could not examine the cat believed to
be the cause of this patient’s episode to confirm whether
it had Alternaria. However, we prudently believe that contact
with the cat could be a salient cause of this particular
fungal peritonitis in this patient since he had been in
stable condition for over a year and was without any
other known predisposing factors. Prompt removal of his
catheter and provision of antifungal therapy showed successful
outcomes in our patient, as in the case reported
by Vogelgesang et al. (5).
Based on our case, we conclude that having direct or
skin contact with a cat may be a potential cause of fungal
peritonitis, with or without any predisposing factors.
Further study is strongly recommended to confirm the
relation and to investigate the underlying infection
mechanism in Alternaria peritonitis.
of fungal spores into the host through skin lesions
(1). We report a case of fungal peritonitis caused by
Alternaria in an end-stage renal failure patient after contact
with a domestic cat.
A 45-year-old man with an history of hypertension
and end-stage renal failure had been undergoing continuous
ambulatory peritoneal dialysis (CAPD) for
3 years. Except for an episode of peritonitis over a year
ago, the patient had been in stable condition until the
recent episode. The patient stated that he touched the
PD exit site with his bare hands due to insufficient PD
drainage 10 days before hospital admission. A few days
prior to admission to this hospital, the patient experienced
abdominal discomfort and turbid dialysis effluent.
Initial analysis of the effluent showed 630 white
blood cells (WBCs)/mL, with 80% segmented neutrophils,
followed by 880, 950, and 760 WBCs/mL with an average
of 75% neutrophils in the subsequent analyses. The dialysis
effluent was taken for bacterial culture and Alternaria
alternata was isolated. Follow-up effluent culture
also revealed Alternaria. Based on the culture results, the
patient was diagnosed with Alternaria peritonitis and was
Keimyung Author(s)(Kor)
류남희
하정숙
전동석
김재룡
황은아
Publisher
School of Medicine
Citation
N.H. Ryoo et al. (2009). Alternaria Peritonitis After Contact with a Cat. Peritoneal Dialysis International, 29(2), 235–236.
Type
Article
ISSN
0896-8608
Source
http://www.pdiconnect.com.proxy.dsmc.or.kr/cgi/pmidlookup?view=long&pmid=19293364
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/33659
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
1. School of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학)
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