Neisseria subflava peritonitis in a type 1 diabetes patient on peritoneal dialysis

DOI Web Site 38 References
  • Kotera Nagaaki
    Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital
  • Mise Naobumi
    Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital
  • Uchida Lisa
    Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital
  • Ishimoto Yu
    Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital
  • Tanaka Mototsugu
    Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital
  • Tanaka Shinji
    Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital
  • Kurita Noriaki
    Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital
  • Sugimoto Tokuichiro
    Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital

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Other Title
  • Ｎｅｉｓｓｅｒｉａ　ｓｕｂｆｌａｖａ腹膜炎を発症した１型糖尿病の腹膜透析患者の１例
  • 症例報告 Neisseria subflava腹膜炎を発症した1型糖尿病の腹膜透析患者の1例
  • ショウレイ ホウコク Neisseria subflava フクマクエン オ ハッショウ シタ 1ガタ トウニョウビョウ ノ フクマク トウセキ カンジャ ノ 1レイ

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Abstract

A 34-year-old male with end-stage renal failure due to type1 diabetes started peritoneal dialysis (PD) via a double-cuffed Tenckhoff catheter in April 2008. He was using a double-bag system with manual connectology and underwent nocturnal intermittent PD. In January 2009, he developed his first episode of peritonitis, presenting with slight fever, abdominal pain, diarrhea, vomiting and cloudy dialysate. Physical examination demonstrated abdominal rebound tenderness. Drained dialysate was cloudy with an elevated cell count of 2,500/μL (96% polymorphonuclear leukocytes). He was admitted to the hospital and successfully treated with 8 days of intraperitoneal or intravenous cefazolin and ceftazidime, followed by oral cefotiam for 6 days. There was no recurrence of peritonitis thereafter. Neisseria subflava was isolated from the dialysate and was identified as the pathogen causing peritonitis. Neisseria subflava is commensal in the upper respiratory tract, but may rarely cause infections, such as endocarditis and meningitis. A few cases of Neisseria peritonitis have been reported in PD patients, even in those without concomitant diseases. In the present case, contamination by a droplet from the mouth was considered the most probable cause of peritonitis, because the patient did not wear a mask during bag exchanges. The importance of wearing a mask for infection control during PD bag exchanges was reconfirmed.

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