Section 15
Chapter 14,297

Vibrio vulnificus peritonitis after eating raw sea fish in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD)

Jung, E.Y.; Kim, D.W.; Lee, D.W.; Cho, H.S.; Chang, S.-H.; Park, D.J.

Nephrology Dialysis Transplantation Official Publication of the European Dialysis and Transplant Association - European Renal Association 22(5): 1487


ISSN/ISBN: 0931-0509
PMID: 17205959
DOI: 10.1093/ndt/gfl736
Accession: 014296043

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An episode of peritonitis in a continuous ambulatory peritoneal dialysis (CAPD) patient caused by Vibrio vulnificus after eating raw sea fish is reported. The patient was a 63-year-old man receiving CAPD for 5 years admitted to a hospital in Korea Republic for abdominal pain and cloudy peritoneal fluid. The underlying cause of his end-stage renal disease (ESRD) was diabetes mellitus and he had no history of peritonitis. He was a non-drinker and had no known history of liver disease. He was treated with erythropoietin, but had no iron therapy. Three days prior to presentation, he ate raw butterfish harvested from the Pacific coast; abdominal pain and vomiting started the next day. He was subjected to routine physical and laboratory evaluations. He had tenderness in the lower abdomen, and the exit site of the peritoneal catheter was clean. The peripheral WBC count was 8130/mm3 and polymorphonuclear leukocytes (PMN) was 92.8%. The haemoglobin level was 6.2 g/dl, with serum iron measurement showing the following values: iron 19 mg/dl, transferrin saturation 6.9%, ferritin 235.54 micro g/litre. The liver function test results were normal and viral markers for hepatitis B and C were negative. The peritoneal effluent contained >1000 WBCs/mm3, of which 91% were PMNs and 9% were lymphocytes. The patient was treated empirically with intraperitoneal cefazolin 1000 mg and tobramycin 40 mg. Soon after the start of empirical antibiotic therapy, the abdominal pain improved and the peritoneal effluent gradually cleared. Peritoneal effluent culture showed V. vulnificus sensitive to ampicillin, ceftriaxone, ciprofloxacin, piperacillin and imipenem, intermediate sensitivity to gentamicin, tobramycin and resistant to amikacin. After receiving the culture result, intraperitoneal cefazolin was discontinued, and oral doxycycline was added to intraperitoneal tobramycin regimen. Antibiotic therapy was continued for 2 weeks; the patient recovered completely without complication.

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