Summary about Disease
Fungal peritonitis is an infection of the peritoneum, the membrane lining the abdominal cavity and covering the abdominal organs, caused by fungi. It is a serious complication that most often occurs in individuals undergoing peritoneal dialysis (PD) for kidney failure, but can also occur after abdominal surgery, bowel perforation, or in immunocompromised individuals. It is a relatively rare but life-threatening condition requiring prompt diagnosis and treatment.
Symptoms
Common symptoms of fungal peritonitis include:
Abdominal pain and tenderness
Cloudy peritoneal dialysate (in PD patients)
Fever
Nausea and vomiting
Chills
General feeling of being unwell (malaise)
Abdominal distention
Causes
The most common causes of fungal peritonitis are:
Peritoneal Dialysis (PD): Contamination of the PD catheter, dialysate fluid, or exit site during exchanges.
Abdominal Surgery: Postoperative infections, especially after bowel surgery.
Gastrointestinal Perforation: Leakage of intestinal contents into the peritoneum.
Immunocompromised State: Conditions like HIV/AIDS, organ transplantation (with immunosuppressant drugs), chemotherapy, or long-term corticosteroid use.
Intravenous Catheters: Catheter-related bloodstream infections can lead to seeding of the peritoneum.
Antimicrobial Use: Prolonged or broad-spectrum antibiotic use can disrupt the normal bacterial flora and allow fungal overgrowth.
Fungal translocation: From the gut of patients with severe illness The most common fungal species involved are Candida species (e.g., Candida albicans, *Candida parapsilosis*, *Candida glabrata*), but other fungi, such as Aspergillus, can also cause peritonitis.
Medicine Used
Antifungal medications are the primary treatment for fungal peritonitis. Common medications used include:
Azoles: Fluconazole, voriconazole, itraconazole, posaconazole (oral or IV, depending on severity and species)
Echinocandins: Caspofungin, micafungin, anidulafungin (IV only; often used as first-line, especially in critically ill patients or those with azole-resistant Candida)
Amphotericin B: (IV; used in severe cases or when other antifungals are ineffective, but carries a higher risk of side effects) In addition to antifungal medications, removal of the PD catheter is often necessary in PD patients. Surgical debridement may be required in cases involving abscesses or extensive peritoneal involvement.
Is Communicable
Fungal peritonitis is generally not communicable from person to person. It's usually due to opportunistic infections in susceptible individuals or contamination during medical procedures.
Precautions
Precautions to help prevent fungal peritonitis include:
Strict aseptic technique during peritoneal dialysis exchanges.
Proper hygiene: Thorough handwashing before and after handling PD catheters or dialysis solutions.
Careful management of underlying conditions that increase the risk of infection (e.g., diabetes, immunosuppression).
Judicious use of antibiotics to avoid disrupting the normal flora.
Prompt treatment of any suspected infection to prevent progression to peritonitis.
For surgical patients: Prophylactic antifungals may be considered in high-risk patients undergoing abdominal surgery, especially those with bowel perforations or significant antibiotic exposure.
How long does an outbreak last?
The duration of a fungal peritonitis outbreak depends on the timeliness of diagnosis, the specific fungal species involved, the severity of the infection, the patient's overall health, and the effectiveness of treatment. With prompt diagnosis and appropriate antifungal therapy, resolution can occur within several weeks (2-6 weeks). More severe or delayed cases may require longer treatment courses.
How is it diagnosed?
Diagnosis of fungal peritonitis typically involves:
Clinical assessment: Evaluating symptoms such as abdominal pain, fever, and cloudy dialysate in PD patients.
Peritoneal fluid analysis: Examining peritoneal fluid obtained by paracentesis (needle aspiration) or from the PD catheter. This includes:
Cell count and differential (elevated white blood cells)
Gram stain (may or may not show fungi)
Culture and sensitivity testing (to identify the specific fungus and determine its susceptibility to antifungals)
Blood cultures: To rule out systemic fungal infection (fungemia).
Imaging studies: CT scans or ultrasound may be used to identify abscesses or other complications.
Timeline of Symptoms
The timeline of symptoms can vary, but generally:
Early stages: Mild abdominal pain, cloudy dialysate (in PD patients), low-grade fever.
Progression: Increasing abdominal pain and tenderness, higher fever, nausea, vomiting, chills.
Late stages: Abdominal distention, signs of sepsis (rapid heart rate, low blood pressure, confusion), potentially leading to organ failure and death if untreated. Symptoms can develop rapidly (over a few days) or more gradually depending on the underlying cause and the individual's immune status.
Important Considerations
Fungal peritonitis is a serious infection that requires prompt diagnosis and treatment.
Early diagnosis and appropriate antifungal therapy are crucial for improving outcomes.
Removal of the PD catheter is often necessary in PD patients.
Surgical intervention may be needed in cases with abscesses or other complications.
Immunocompromised individuals are at higher risk and may require more aggressive treatment.
Monitoring for potential complications (e.g., sepsis, organ failure) is essential.
Consultation with an infectious disease specialist is recommended.
Prevention strategies are crucial, especially in PD patients and those undergoing abdominal surgery.