Abstract: FR-PO644
Rapid Diagnosis of Fungal Peritonitis in a Peritoneal Dialysis Patient using a Multiplex PCR-based Identification Panel
Session Information
- Trainee Case Reports - IV
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 703 Dialysis: Peritoneal Dialysis
Authors
- Shankaranarayanan, Divya, Weill Cornell Medicine, New York CIty, New York, United States
- Lee, John Richard, Weill Cornell Medicine, New York CIty, New York, United States
- Westblade, Lars, Weill Cornell Medicine, New York City, New York, United States
- Jenkins, Stephen G., Weill Cornell Medicine, New York City, New York, United States
- Srivatana, Vesh, Weill Cornell Medicine, New York CIty, New York, United States
Introduction
Fungal peritonitis can be difficult to detect using conventional culture methods and delayed diagnosis can lead to significant morbidity and mortality. The FilmArray® blood culture identification panel (BCID; BioFire Diagnostics, LLC.) is an US FDA approved test for rapid identification of common bacterial and fungal pathogens in positive blood culture broths. We present a case of peritoneal dialysis (PD) peritonitis with Candida albicans that was detected using the BCID panel prior to conventional fungal culture results.
Case Description
The patient is a 50-year-old female with history of end stage renal disease (ESRD) secondary to membranoproliferative glomerulonephritis on PD for 7 years. She was admitted with abdominal pain and cloudy PD fluid concerning for peritonitis. She had been discharged ten days prior after being treated for Clostridioides difficile colitis. She reportedly had a breach in aseptic techniques while performing PD exchanges since her hospital discharge. On presentation, her PD effluent had 5,150 white blood cells (WBC/µL) with 94% polymorphonuclear (PMN) cells. She was started on empiric intraperitoneal antibiotics as well as oral fluconazole for prophylaxis for fungal peritonitis. Initially, her WBC count in the PD fluid and clinical condition improved and PD fluid cultures were negative. However, on the 5th hospital day she had worsening symptoms and increasing WBC count in the PD fluid. The BCID panel was able to detect Candida albicans on a PD fluid sample that was saved at the time of her presentation. Treatment was escalated to intraperitoneal antifungal therapy, and subsequent PD fluid cultures confirmed Candida Albicans peritonitis. Her PD catheter was eventually removed on the 7th day of her hospitalization and she was switched to hemodialysis.
Discussion
Rapid diagnosis of fungal peritonitis in PD patients can lead to life saving therapy and definitive PD catheter removal. In this case, initial conventional PD fluid cultures were non diagnostic, but the BCID enabled rapid identification of a Candida albicans infection. This case illustrates a potential use and supports future studies on rapid PCR based diagnostic techniques for diagnosing PD peritonitis.