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High magnification of the replicate section of Figure 1, but stained by hexamine–silver clearly demonstrated fragmented, occa- sionally branched and septate, narrow hyphae of a varying size. Fewer silver-impregnated structures arranged in short chains suggest budding of the fungal cells. Grocott hexamine–silver, × 250. (Original magnification × 105).
Contexts in source publication
Context 1
... peritoneal biopsy revealed chronic active of 3-7-mm structures suggesting fungal cell budding ( Figure 2). necrotizing exudative and granulomatous fibroprolif- erative peritonitis associated with the fungal infection On the control abdominal ultrasound examination, newly formed intrahepatic liquid formation was found. ...
Context 2
... eroded peritoneal surface was found to be covered by exudate and necrotic cell debris, An exploratory tap was made and liquid sample cultivated. After reaching the cumulative dose of including embedded fungal elements made visible only by the Grocott hexamine-silver staining technique amphotericin B (2.5 g) it was replaced by amphotericin B coloidal dispersion (AmfocilA) which was stopped ( Figure 2). Peritoneal stroma was demonstrated to be fully replaced by irregular or to some extent toward after 18 days when negative results on the fungal cultures from intrahepatic liquid formation were the surface perpendicularly orientated proliferating fibroblasts and mixed, predominantly mononuclear received. ...
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Citations
... Paecilomyces species are also saprophytic and are uncommon pathogens that can produce serious infectious in immunocompromised patients. P. variotii is a common occurring species in compost, air, food and is also associated with many types of human infections, such as fungemia, endocarditis peritonitis and osteomyelitis [35][36][37]. Recently a patient with refractory lymphoma who underwent allogenic haematopoletic cell transplant developed pneumonia due P. variotii [38]. ...
... However, some species such as P. varioti, P. marquandii and P. lilacinus are emerging as causative agents of hyalohyphomycosis in the immunocompromised host. [7] P. varioti have been reported to cause pyelonephritis, [8] e n d o p h t h a l m i t i s , [9,10] h a i r y -c e l l l e u k e m i a , [11] cerebrospinal shunt infection, [12] and prosthetic valve endocarditis. [13,14] The most important risk factors for fungal peritonitis are prolonged use of antibiotics and previous bacterial peritonitis episodes. ...
... The conventional antifungal regimens include fluconazole, Amphotericin B, and flucytosine alone or in combination, based on fungal sensitivities. P. varioti is usually very sensitive to Amphotericin B. [7] We used intravenous Amphotericin B for our patient who responded dramatically with cumulative dose of 1.5 g. ...
Peritonitis is one of the most common and important complications in patients on continuous ambulatory peritoneal dialysis (CAPD). Fungal peritonitis isreported in 4-8% of peritonitis episodes. Fungal peritonitis due to Paecilomyces species is not common. We report a case of CAPD peritonitis due to P. varioti. We immediately removed the CAPD catheter and IV amphotericin was administered for 4 weeks along with temporary hemodialytic support followed by successful catheter reinsertion
... Paecilomyces is of clinical interest because of its pathogenicity and resistance to antifungal agents. Paecilomyces variotii is a commonly occurring species in air and food, and it is also associated with many types of human infections, such as fungemia, endocarditis, peritonitis, and osteomyelitis [2][3][4][5][6][7][8][9]. Pneumonia due to Paecilomyces variotii has been rarely reported in the medical literature. ...
Paecilomyces variotii is a commonly occurring species in air and food, and it is also associated with many types of human infections. Pneumonia due to Paecilomyces variotii has been rarely reported in the medical literature. The authors report a 48-year-old patient with refractory lymphoma who underwent allogenic hematopoietic cell transplantation and developed pneumonia due to Paecilomyces variotii. They also review the published case reports of pneumonia caused by this fungus.
... Catheters were probably colonized by skin flora, which can either migrate down the external portion of the catheter tunnel or colonize the cuff, gaining access to the internal surface of the catheter (20). In all our patients, antibiotics were given intravenously; only in one patient low-dose amphotericin B intraperitoneal flushing was used for a short time with improvement and no worsening in the clinical picture (15,21). ...
Encapsulating peritoneal sclerosis (EPS) is a rare complication in patients on peritoneal dialysis (PD), the prevalence of which increases with the time spent on PD. Various causative factors have been proposed, but the pathogenesis still remains unclear. The aim of our retrospective study was to analyze the basic clinical characteristics and outcomes of five patients diagnosed with EPS out of 423 patients treated with PD between January 1983 and December 2003. One patient was admitted due to ultrafiltration failure of the peritoneal membrane, and four patients were admitted for acute peritonitis. All of our patients presented with clinical symptoms suggestive of obstructive ileus. We confirmed the diagnosis of EPS with a computer tomography scan, a diagnostic laparotomy or laparoscopy, and a biopsy of the parietal peritoneum. We treated all of our patients with catheter removal, transferal to hemodialysis, antibiotics, complete parenteral nutrition, methylprednisolone, and tamoxifen for 6 months. One patient was treated with surgical enterolysis and died of septic complications, another patient died of sudden cardiac death during treatment. Three patients were doing well for 4-7 months after the treatment was started. The incidence of EPS was 1.2% and the mortality rate was 40%. EPS is a rare complication in longstanding PD patients in our institution. Despite treatment with hemodialysis, complete parenteral nutrition, steroids, tamoxifen and surgical intervention, the mortality rate is high and comparable to other reports.
... In fungal infections, it is important to identify the pathogen to species level, not only because of their different susceptibilities to antifungal agents, but because of their distinct clinical outcomes. In the review of treatment of Paecilomyces peritonitis in CAPD patients, oral 5-fluorocytosine, ketoconazole and amphotericin B have been reported to be effective in P. variotii peritonitis (Kovac et al., 1998;Prasad & Gupta, 2005). Data are limited regarding the in vitro antifungal susceptibility of P. lilacinus (Pastor & Guarro, 2006). ...
Fungal peritonitis (FP) is a serious complication in patients on continuous ambulatory peritoneal dialysis (CAPD). We report a case of CAPD-related FP caused by Paecilomyces lilacinus in a 15-year-old uraemic boy. The infection was successfully treated by combination therapy consisting of oral voriconazole and terbinafine, which has not been previously reported in the treatment of FP.
... The first case was reported in 1990 by Lye (16). Since then only 14 additional cases have been published, 13 of which were identified as P. variotii (1,3,6,8,12,(15)(16)(17)(18)22). Paecilomyces peritonitis is associated with substantial morbidity. ...
... Paecilomyces peritonitis is associated with substantial morbidity. Ten of 14 reported patients had to be removed from CPD and were placed on hemodialysis (1,6,8,12,(16)(17)(18); however, no fatalities were associated with Paecilomyces peritonitis. This stands in contrast with the high mortality rate (up to one-third of cases) reported in CPD-related peritonitis due to other fungi (4). ...
... The optimal approach for the treatment of Paecilomyces peritonitis is difficult to derive from the published data. Removal of the Tenckhoff catheter was the rule in the majority of the patients (1,3,6,8,12,(16)(17)(18); however, the antifungal regimens differed widely among the patients, even within the same center (17). Of note, one patient did not receive any antifungal therapy (18) (1,3,17), and only two of ten to fluconazole (1, 3, 8, 12, 17, 22; Bibashi et al., Abstr. ...
The first case of human disease due to the thermophilic ascomyceteThermoascus taitungiacus (the teleomorph ofPaecilomyces taitungiacus) is presented. T. taitungiacus was recovered from four dialysate fluid specimens of a 57-year-old patient undergoing chronic peritoneal dialysis. Identification
was based upon cylindrical conidia, reddish orange nonostiolate ascomata, lack of growth at 20°C, thermotolerance, and ascospores
that appeared pale yellow, elliptical, thick walled, and predominately echinulate by light microscopy but irregularly verrucose
by scanning electron microscopy.
Paecilomyces variotii is a ubiquitous environmental saprophyte with worldwide distribution. Commonly found in soil and decomposing organic material [1, 2], P. variotii can also be isolated from drinking water [3] and indoor and outdoor air [4–6]. In immunocompetent hosts, P. variotii has been reported as a cause of locally invasive disease including prosthetic valve endocarditis [7, 8], endophthalmitis [9, 10], rhinosinusitis [11, 12], and dialysis-associated peritonitis [13, 14]. In contrast, disseminated infections are more commonly reported in immunocompromised patients, including those with chronic granulomatous disease [15], solid malignancy [16], acute leukemia [17], lymphoma [18], multiple myeloma [19], and after stem cell transplant for myelodysplasia [20]. In 1 case series examining invasive infections by non-Aspergillus molds, P. variotii was the most common cause after Fusarium spp. [21]. Here, we present the case of an immunocompetent patient with extensive intravascular infection involving prosthetic material. We describe successful induction therapy with combination antifungals and extended suppression with posaconazole with clinical quiescence and eventual normalization of serum fungal biomarkers.
RESUMEN La peritonitis es una de las complicaciones más graves de la diálisis peritoneal. Las bacterias son las responsables de la mayoría de los casos. La infección fúngica es infre-cuente, pero se asocia con una alta morbilidad, con la imposibilidad de continuar en el programa de diálisis y con un importante índice de mortalidad. Su incidencia varía del 1% al 10% de los episodios de peritonitis en ni-ños y del 1% al 23% en adultos. Su presentación clínica es similar a la de la peritonitis bacteriana. Los factores pre-disponentes de peritonitis fúngica no han sido establecidos con claridad; los episodios previos de peritonitis bacteriana y el tratamiento con antibióticos de amplio espectro han sido descritos a menudo en la literatura. Las especies de Candida son los patógenos más habituales y Candida albi-cans la más frecuente, pero en la última década se ha ob-servado una alta prevalencia de Candida parapsilosis. El diagnóstico microbiológico es fundamental para determi-nar la etiología y prescribir el tratamiento, que suele re-querir, además de la terapia antifúngica, la retirada del catéter peritoneal y la consecuente transferencia a hemo-diálisis. Fluconazol y anfotericina B son los antifúngicos recomendados; los nuevos fármacos como voriconazol y caspofungina han demostrado tener también una gran utilidad. El propósito de esta revisión sistemática ha sido analizar los aspectos clínicos y microbiológicos de la peri-tonitis fúngica, los cuales son poco conocidos y han cam-biado en los últimos años. ABSTRACT Peritonitis is one of the most serious complications of peritoneal dialysis. Pathogenic bacteria cause the majority of cases of peritonitis. Fungal infection is rare but it is associated with high morbidity, the inability to continue on the dialysis program and a high mortality rate. Its incidence varies from 4% to 10% of all peritonitis episodes in children and from 1% to 23% in adults. Its clinical presentation is similar to bacterial peritonitis. Until now, predisposing factors of fungal peritonitis have not been clearly established; the history of bacterial peritonitis episodes and treatment with broad-spectrum antibiotics have been often reported in literature. Candida species were the most common pathogens and Candida albicans was the most frequent, but high prevalence of Candida parapsilosis has been observed in the last decade. Microbiological findings are essential to determine the etiology of peritonitis. Successful management of fungal peritonitis requires antifungal therapy, the removal of the peritoneal catheter and the subsequent transfer to hemodialysis. Fluconazole and amphotericin B are recommended as antifungal agents. New drugs such as voriconazole and caspofungin are very effective. The aim of this systematic review has been to analyse the clinical and microbiological aspects of fungal peritonitis, as they are not well known and have changed in the last few years.
Peritonitis is one of the most serious complications of peritoneal dialysis. Pathogenic bacteria cause the majority of cases of peritonitis. Fungal infection is rare but it is associated with high morbidity, the inability to continue on the dialysis program and important mortality. Its incidence varies from 4% to 10% of all peritonitis episodes in children and from 1% to 23% in adults. Its clinical presentation is similar to bacterial peritonitis. Until now, predisposing factors of fungal peritonitis have not been clearly established; history of bacterial peritonitis episodes and treatment with broad-spectrum antibiotics have been often reported in the literature. Candida species were the most common pathogens and Candida albicans was the most frequent, but high prevalence of Candida parapsilosis has been observed in the last decade. Microbiological findings are essential to to determine the etiology of peritonitis. Successful management of fungal peritonitis requires antifungal therapy, the removal of peritoneal catheter and the subsequent transfer to hemodialysis. Fluconazole and amphotericin B are recommended as antifungal agents. New drugs as voriconazole and caspofungin are very effective. The aim of this systematic review has been to analyse the clinical and microbiological aspects of fungal peritonitis, as they are not well known and have changed in the last few years.
