Alternaria Peritonitis After Contact with a Cat

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