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Abstract: FR-PO482

Streptococcus canis: A Rare Cause of Peritonitis in a Peritoneal Dialysis Patient

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Thoonkuzhy, Christina E., University of Michigan, Ann Arbor, Michigan, United States
  • Sukul, Nidhi, University of Michigan, Ann Arbor, Michigan, United States
Introduction

Peritoneal dialysis (PD) is an effective form of renal replacement therapy, but peritonitis can be a serious complication . The most common peritonitis-causing organisms are gram-positive bacteria, specifically Staphylococcus aureus and coagulase-negative Staphylococcus species. Bacteria of zoonotic origin are a rare, but well-described cause of peritonitis. While the typical zoonotic culprit pathogen is Pasteurella multocida, we present a case of peritonitis secondary to isolated Streptococcus canis, a group G streptococcus that colonizes the skin and genital and gastrointestinal tracts of dogs and cats.

Case Description

A 66-year-old female with end-stage renal disease on PD presented with a one-day history of abdominal pain, nausea, and purulent drainage from her PD catheter site. She was hemodynamically stable, but her exam demonstrated diffuse abdominal tenderness and erythema surrounding her PD catheter site. Her serum white blood cell count (WBC) was 12,800/uL and peritoneal fluid WBC was 9,300/uL with 84% neutrophils. She was empirically started on intraperitoneal (IP) vancomycin and ceftazidime and admitted for further management. Her final cultures speciated to S. canis, and she was initiated on IP ceftriaxone. Repeat peritoneal fluid studies obtained on day 3 of treatment showed a WBC of 91/uL with no bacterial growth. She was discharged with a 2-week course of IP ceftriaxone.

Discussion

To the best of our knowledge, this is the first case of isolated S. canis peritonitis in a PD patient. S. canis is transferred primarily from companion animals such as dogs and cats, though has been isolated from a myriad of other animals as well, and has been implicated in a wide variety of human infections, typically susceptible to penicillin or 3rd generation cephalosporins. Our patient later endorsed having 11 dogs at home, which were not kept out of her bedroom when performing her PD treatments, with conflicting reports of the presence of a bedroom door. This case reinforces the importance of thorough screening of the home environment of PD patients and education that pets need to be kept away during PD treatments and away from dialysis supplies. Fortunately, she experienced rapid clinical improvement with ceftriaxone, and catheter removal was deemed unnecessary. The patient continues to tolerate PD well with no further episodes of peritonitis.