持续动态腹膜透析的儿童发生土曲霉性腹膜炎:巴基斯坦1例报告

Safia Moin, K. Moorani, H. Qureshi
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摘要

背景:曲霉性腹膜炎是一种罕见的、潜在致命的持续性非卧床腹膜透析并发症。由曲霉属引起的真菌性腹膜炎(FP)在世界范围内已有报道;然而,来自巴基斯坦的数据却很少。在这里,报告了一例先天性肾病综合征患者,她在8岁时发展为5期慢性肾病,通过CAPD和其他支持性疗法进行治疗。患者出现FP,尽管进行了适当的治疗,但最终还是死亡。因此,早期诊断和仔细解释培养结果对这些患者的治疗很重要。病例介绍:本病例报告中概述的患者患有先天性肾病综合征,5期慢性肾脏疾病,正在接受CAPD治疗。她表现为腹膜炎。最初,开始使用广谱抗生素,腹膜样本没有产生任何生长。后来,从患者身上连续采集的腹膜样本生长出土曲霉,在样本的直接涂片上可以看到有间隔的菌丝。立即开始使用伏立康唑,并取出患者的导管。然而,患者的病情恶化,经过长时间的重症监护和高强度的呼吸机支持,患者死亡。结论:A.terreus是一种罕见且致命的病原体,对常用的抗真菌治疗(如两性霉素B)没有反应。CAPD相关FP的治疗需要早期诊断并使用新的药物,如伏立康唑或卡泊芬净。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Aspergillus terreus Peritonitis in a Child on Continuous Ambulatory Peritoneal Dialysis: A Case Report from Pakistan
Background: Aspergillus peritonitis is a rare, potentially fatal complication of continuous ambulatory peritoneal dialysis (CAPD). Several cases of fungal peritonitis (FP) caused by Aspergillus species have been reported worldwide; however, there is a paucity of data from Pakistan. Here, a case of congenital nephrotic syndrome is reported in a patient who progressed to Stage 5 chronic kidney disease when she was 8 years old, which was managed by CAPD and other supportive therapies. The patient developed FP and later succumbed to death despite appropriate management. Early diagnosis and careful interpretation of culture results are, therefore, important for the treatment of these patients. Case presentation: The patient outlined in this case report had congenital nephrotic syndrome, Stage 5 chronic kidney disease, and was on CAPD. She presented with peritonitis. Initially, broad spectrum antibiotics were started, and peritoneal samples did not yield any growth. Later, consecutive peritoneal samples taken from the patient grew Aspergillus terreus, with septate hyphae seen on a direct smear from the sample. Voriconazole was started immediately, and the patients’ catheter was removed. However, the patient’s condition deteriorated and, after prolonged intensive care and high ventilator support, the patient expired. Conclusion: A. terreus is an uncommon and deadly pathogen that does not respond to the commonly used antifungal treatments such as amphotericin B. The treatment of CAPD-related FP requires early diagnosis and the use of newer drugs such as voriconazole or caspofungin.
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