Author/Editor		Pleskovič, Alojz; Bren, Andrej
Title		Laparoscopy for diagnosis and treatment of severe Paecilomyces varioti peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD)
Translated title		Laparoskopija v diagnostiki in zdravljenju Paecilomyces varioti peritonitisa pri bolnici na peritonealni dializi
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 2, št. 3
Publication year		1997
Volume		str. 27-32
Language		eng
Abstract		Paecilomyces varioti is a rare human pathogen. In the literature, solely nine cases of peritonitis in patients on CAPD have been described so far. We report on severe peritonitis in a 53-year-old woman undergoing CAPD since November 1994. Paecilomyces varioti was isolated from the culture of peritoneal effluent. Intravenous (i. v.) therapy with amphotericin B 1 mg/kg was instituted and the peritoneal catheter was removed. Despite the therapy, the clinical and laboratory signs of inflammation persisted and the patient's mental status deteriorated. At laparoscopy diffuse white intraabdominal formations were noted. Three drainage catheters were inserted during the procedure. A 2.25% glucose solution containing amphotericin B in a concentration of 1 mg/L was used for perfusion of the abdominal cavity at a rate of of 300 ml/hour. The patient's mental status and laboratory signs of inflammation normalised rapidly. After twelve days of drainage we removed the catheters. As the patient's fungal cultures were negative, amphotericin was stopped and she was placed on long-term prophylactic antifungal therapy with intraconazole. In conclusion, i. v. administration of amphotericin B in a therapeutic dosage and simultaneous perfusion of the abdominal cavity with low-concentration amphotericin B has proved an effective modality for treating severe Paecilomyces varioti peritonitis. This approach to the treatment of severe fungal peritonitis has not yet been described in the literature.
Summary		Paecilomyces varioti je zelo redek povzročitelj peritonitisa pri bolnikih na peritonealni dializi. Do sedaj je v literaturi opisanih le devet takih primerov. Poročamo o 53 letni bolnici, ki je bila od novembra 1994 na peritonealni dializi in pri kateri se je razvil peritonitis. Iz peritonealnega izpirka so izolirali glivo Paecilomyces varioti. Peritonealni kateter smo odstranili in prešli na hemodializo. Kljub intravenozni terapji z amphotericinom B se je stanje bolnice slabšalo, zaradi česar smo se odločili za laparoskopijo. Ugotovili smo difuzni peritonitis s številnimi glivičnimi oblogami. V trebušno votlino smo vstavili tri abdominalne drene za perfuzijo. Trebušno votlino smo izpirali s 300 ml/h z 2,25% raztopino glukoze, ki je vsebovala amphotericin B v koncentraiji 1 mg/L. Splošno stanje bolnice se je zelo hitro izboljšalo in tudi laboratorijski znaki vnetja so se normalizirali. Dvanajst dni po vstavitvi smo abdominalne drene odstranili. Ko smo prejeli negativne rezultate glivičnih kultur, smo ukinili amphotericin B in prešli na prolongirano profilaktično antimikotično terapijo z itrakonazolom. V zaključku lahko ugotovimo, da je intravenozno zdravljenje z istočasnim izpiranjem trebušne votline z amphotericinom B v nizki koncentraciji lahko uspešno pri zdravljenju hude oblike peritonitisa, katerega povzročitelj je Paecilomyces varioti. Tak način zdravljenja v literaturi še ni bil opisan.
Descriptors		PERITONITIS PERITONEAL DIALYSIS, CONTINUOUS AMBULATORY LAPAROSCOPY PAECILOMYCES DRAINAGE MIDDLE AGE MYCOSES AMPHOTERICIN B