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Kidney Week

Abstract: TH-PO351

Neisseria zoodegmatis: An Interesting Cause of Peritoneal Dialysis (PD)-Related Peritonitis

Session Information

  • Home Dialysis - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Sarwal, Amara, University of Utah Health, Salt Lake City, Utah, United States
  • Ramkumar, Nirupama, University of Utah Health, Salt Lake City, Utah, United States
  • Abraham, Josephine, University of Utah Health, Salt Lake City, Utah, United States
Introduction

Neisseria zoodegmatis is a zoonotic pathogen that has typically been associated with cats and dogs. In humans, infection with this organism is usually through cat or dog bites. It was originally termed Eugonic Fermenter(EF)-4b by the Centers for Disease Control, however has since been renamed as Neisseria zoodegmatis [1]. To the best of our knowledge, we present the second reported case of PD-related peritonitis due to Neisseria zoodegmatis [2].

Case Description

A 35 year old female with ESRD due to ADPKD, on peritoneal dialysis (PD) presented to our Emergency Department for abdominal pain. She had recently started on PD three months ago, and had not had any issues with her dialysis. She denied any cloudy effluent or peritonitis in the past. Preliminary workup revealed a potassium of 3.3 mmol/L, BUN of 48 mg/dL, serum creatinine of 6.98 mg/dL, calcium of 8.0 mg/dL, phosphorus of 4.4 mg/dL and albumin of 3.8g/dL. Contrasted imaging of the abdomen revealed enlarged kidneys with numerous cysts due to ADPKD as well as pneumoperitoneum likely due to the PD catheter.

Upon further discussion, the patient mentioned that her cat chewed her PD tubing two weeks prior to presentation. Peritoneal fluid analysis revealed turbid yellow fluid along with 300 RBCs/uL, 14625 total nucleated cells/uL with 92% polymorphonuclear neutrophils and 2% lymphocytes. Anaerobic culture was negative however aerobic culture was significant for Neisseria zoodegmatis (formerly CDC group EF-4b).
The infectious disease service was consulted, who recommended intraperitoneal (IP) ceftriaxone. As ceftriaxone dosing >2 grams in PD patients has not been well tested, we planned for ceftriaxone 1 gram during a long, daytime dwell. Patient was discharged on a course of IP ceftriaxone with resolution of her symptoms.

Discussion

In this case, the patient’s history was key to raising a high clinical suspicion for an unusal pathogen. Neisseria zoodegmatis is often misidentified as Pasteurella, dismissed as skin contaminant or not recognized at all [3]. We were able to identify this microbe and promptly treat with appropriate antibiotic with resolution of infection.

Neisseria zoodegmatis is a pathogen that can cause peritonitis, especially in patients with household pets. Patient education regarding maintenance of PD equipment and exercising extreme caution when pets are near should be of utmost importance.