Anusha Rohit

Rare occurrence of fatal Candida haemulonii peritonitis in a diabetic CAPD patient.

Abstract A 68-year-old diabetic chronic kidney disease patient on continuous ambulatory peritoneal dialysis for two years developed Candida haemulonii peritonitis without any predisposing factors. There is no effective treatment for this fungus. A peritoneal biopsy showed morphological changes of acute inflammation and chronicity.

Simultaneous detection of Salmonella pathogenicity island 2 and its antibiotic resistance genes from seafood.

Salmonella enterica serovars are virulent pathogens of humans and animals with many strains possessing multiple drug resistance traits. They have been found to carry resistance to ampicillin, chloramphenicol, florfenicol, streptomycin, sulfonamides, and tetracycline (ACSSuT-resistant). A rapid and sensitive multiplex PCR (mPCR)-based assay was developed for the detection of Salmonella serovars from seafood. Six sets of primers which are one primer pair targeting Salmonella specific gene invA (284 bp), two Salmonella pathogenicity island 2 (SPI-2) genes ssaT (780 bp) and sseF (888 bp) and three antibiotic resistance genes floR (198 bp), sul1 (425 bp), tetG (550 bp) were used for the study. The specificity and sensitivity of the assay were tested by spiking shrimp/fish/clam homogenate with viable cells of Salmonella. This assay allows for the cost effective and reliable detection of pathogenic Salmonella enterica from seafood. The mPCR developed in the present study proved to be a potent analytical tool for the rapid identification of multidrug-resistant Salmonella serovars from seafood.

Microbiology, Clinical Spectrum and Outcome of Peritonitis in PatientsUndergoing Peritoneal Dialysis in India: Results from a Multicentric,Observational Study

Background: Peritoneal dialysis related peritonitis is a major risk factor for drop out of patients on Continuous ambulatory peritoneal dialysis (CAPD) and Automated peritoneal dialysis (APD). Factors affecting PD related peritonitis and center specific microbiological data are lacking in India. A multicentric prospective observational study was designed to overcome the gaps in the existing data regarding causative organism and outcome. Methods: The present study was a prospective, uncontrolled, open-label; observational study conducted in 21 centers representing all the four geographical regions (North, South, East and West) of India between April 2010 and December 2011. Results: A total of 244 patients on chronic PD with peritonitis were enrolled in the study from 21 centres covering the different geographical areas of India. A total of 244 episodes (patients 244) were identified to meet the criteria for the definition of peritonitis. Climatically, 44 (18.1%) episodes occurred during winter and 35 (14.3%) in summer. Amongst the 85 samples that were culture positive, 38 (44.7%) were in the monsoon season followed by 23 (27.1%) in the postmonsoon, 18 (21.2%) during winter and 11 (12.9%) during summer. Maximum culture positivity (72.7%) was observed with an automated technique. Micro-organisms could be isolated in only 85 cases (35.3%) while the remaining samples were culture negative (156/241, 64.7% of samples). Organisms isolated were Gram negative in 47.8%, Gram positive in 36.7%, fungal in 13.3% and Mycobacterium tuberculosis in 2.2%. Conclusion: This large multicenter study of peritonitis offers insights into the etiology and outcomes of infectious complications of PD in India that are germane to clinical decision making.

Diagnostic dilemma of ultrafiltration failure in a continuous ambulatory peritoneal dialysis patient.

A 42-year-old male with chronic kidney disease (CKD), stage 5 on continuous ambulatory peritoneal dialysis (CAPD) using a swan-neck double-cuff Tenckhoff catheter presented with abdominal pain, vomiting, nausea and reduced appetite for 1 month, along with a poor dialysate outflow and ultrafiltration failure (< 400mL/day) for 20 days. As stated by the patient, dialysate effluent was clear. Abdominal examination was unremarkable. After a 6-hour dwell, the dialysate showed a leucocyte count of 0.17 x 109/L (170 cells) with 0.75 (75%) neutrophils and 0.24 (24%) lymphocytes, Gram stain negative, acid-fast bacilli (AFB) smear negative and no growth on Lowenstein and Jensen culture medium. The Mantoux test done was unremarkable. Blood urea nitrogen was 12 mmol/L (33 mg/dL), serum creatinine 954 μmol/L (10.8 mg/dL), hemoglobin (Hb) 88 g/L (8.8 g/dL), erythrocyte sedimentation rate (ESR) 140 mm/hr, serum albumin 24 g/L(2.4 g/dL), electrolytes were normal. As the outflow was slow, an erect X-ray of the abdomen showed migration of the catheter (Figure 1), and a laproscopic examination showed intraperitoneal catheter with fibrinous exudates and adhesions (Figure 2), which were released. A peritoneal biopsy was done that showed granuloma with Langhans’ type giant cell suggestive of tuberculosis (Figure 3), and the biopsy specimen stained with Ziehl Neelsen stain showed acid-fast tubercle bacillus (Figure 4). A computed tomography (CT) of the chest showed left basal pulmonary scarring, small calcified right apical nodule, and calcified mediastinal nodules suggestive of pulmonary tuberculosis sequelae. The patient was initiated on rifampicin 450 mg OD, pyrazinamide 750 mg BID, ciprofloxacin 500 mg BID, isoniazid 150 mg OD, along with vitamin B6. Dialysate flow and ultrafiltration improved 7 days after starting the medication and the dialysate cell count returned to normal.

Culture-Negative Aspergillus Peritonitis Diagnosed by Peritoneal Biopsy

and that the damage progresses with time on PD (1,3). Accumulating evidence suggests that several factors contribute to peritoneal damage in PD patients, including chronic uremia, peritonitis, and long-term use of bioincompatible fluids (1–3). Recent approaches to improve PD technique survival in Japan involve the introduction of combination therapy with HD, especially for anuric patients; prevention of peritonitis through patient education; and use of biocompatible dialysis solutions (lower concentrations of GDPs and neutral pH). Recently, Tejde et al. reported 2 patients who developed encapsulating peritoneal sclerosis, a severe form of peritoneal damage, in spite of using neutral-pH dialysate (7). However, in both cases, the patients had experienced repeated peritonitis episodes and were rapid peritoneal transporters who required icodextrin. Our patient was treated for the first 6 years with conventional glucose solution having a signif icant GDP content and low pH. She had achieved good fluid management and did not develop peritonitis, and her peritoneal function remained stable throughout PD therapy (0.4 – 0.5 by peritoneal equilibration test). Those factors might collectively exert a favorable effect on peritoneal morphology despite long-term PD.

Peritoneal dialysis related peritonitis due to Mycobacterium spp.: A case report and review of literature

Mycobacterium tuberculous peritonitis is a less common cause of peritoneal dialysis related infection in developed countries. As both CAPD and APD are being used as renal replacement therapy in developing countries of South Asia, Mycobacterium tuberculous peritonitis are being reported. Any culture negative peritonitis should be investigated for this entity. In this manuscript, we report an index case and our experience with literature review of Mycobacterium tuberculous peritonitis. The diagnostic techniques, management and outcome are described.

Microbiology, clinical spectrum and outcome of peritonitis in patients undergoing peritoneal dialysis in India: Results from a multicentric, observational study

Background: Peritoneal dialysis (PD)-related peritonitis is a major risk factor for drop out of patients on continuous ambulatory PD (CAPD) and automated PD (APD). Factors affecting PD-related peritonitis and centre-specific microbiological data are lacking in India. A multicentric prospective observational study was designed to overcome the gaps in the existing data regarding causative organism and outcome. Methodology: The present study was a prospective, uncontrolled, open-label; observational study conducted in 21 centres representing all the four geographical regions (North, South, East and West) of India between April 2010 and December 2011. Results: A total of 244 patients on chronic PD with peritonitis were enrolled in the study (CAPD and APD), who met the inclusion criteria, from 21 centres covering the different geographical areas of India. Amongst the 85 samples that were culture positive, 38 (44.7%) were in the monsoon season followed by 23 (27.1%) in the post-monsoon, 18 (21.2%) during winter and 11 (12.9%) during summer. Maximum culture positivity (72.7%) was observed with automated culture technique. Microorganisms could be isolated in only 85 cases (35.3%) while the remaining samples were culture negative (156/241, 64.7% of samples). Organisms isolated were Gram-negative in 47.8%, Gram-positive in 36.7%, fungal in 13.3% and Mycobacterium tuberculosis in 2.2%. Conclusion: This large multicentre study of peritonitis offers insights into the aetiology and outcomes of infectious complications of chronic PD in India that are germane to clinical decision-making.

Draft Genome Sequence of Campylobacter fetus MMM01, Isolated from a Chronic Kidney Disease Patient with Sepsis.

ABSTRACT Campylobacter fetus is a Gram-negative bacterium that has caused several cases of human and animal disease. Here, we report the draft genome sequence of C. fetus MMM01, isolated from the blood of a 60-year-old patient with type II diabetes and chronic kidney disease. The sequence has a total length of 1,740,393 bp and an average G+C content of 33.1%. The availability of the draft genome sequence of C. fetus MMM01 isolated from a case of chronic kidney disease will contribute to a better understanding of the pathophysiological mechanisms of this organism.

Production of neuraminidase in relation with biofilm formation among clinical and healthy skin isolates of Acinetobacter species.

patients with pulmonary complaints in Chennai, South India. J Infect 2006;53:325-30. 4. Ching YT, Yang YH, Chiang BL. The significance of rapid cold hemagglutination test for detecting M. pneumoniae infection in children with asthma exacerbation. J Microbiol Immunol Infect 2006;39:28-32. 5. Kwan YS, Dong IW, Min HC. Flow Cytometric Measurement of Cold Agglutinins for Diagnosing Mycoplasma pneumoniae Pneumonia. Lab Med 2012;43:68-73.

Case Report: Rare occurrence of Pseudomonas aeruginosa osteomyelitis of the right clavicle in a patient with IgA nephropathy.

We describe the case of a 47 year old patient with proven primary IgA nephropathy who presented with osteomyelitis of the medial end of the right clavicle. The patient was not on immunosuppressive medications. He underwent aspiration curettage and CT scan of the clavicle which yielded pus that grew Pseudomonas aeruginosa. Following treatment with appropriate antibiotic therapy the patient presented a complete recovery of the lesion with no loss of renal function. This case highlights the importance of positive cultures in the choice of the appropriate therapy in an extremely rare case of an immunocompetent patient with osteomyelitis of the clavicle.