Severe Mycobacterium fortuitum infection due to inappropriate exit-site care using mountain spring water in a patient on continuous ambulatory peritoneal dialysis (CAPD)

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  • Miyasato Yoshikazu
    Department of Nephrology, Kumamoto University Graduate School of Medical Sciences
  • Adachi Masataka
    Department of Nephrology, Kumamoto University Graduate School of Medical Sciences
  • Fujie Yasuyuki
    Department of Nephrology, Kumamoto University Graduate School of Medical Sciences
  • Nakashima Yoshimi
    Department of Nephrology, Kumamoto University Graduate School of Medical Sciences
  • Yamasaki Tomoko
    Department of Nephrology, Kumamoto University Graduate School of Medical Sciences
  • Watanabe Maya
    Department of Nephrology, Kumamoto University Graduate School of Medical Sciences
  • Sakanashi Aya
    Department of Nephrology, Kumamoto University Graduate School of Medical Sciences
  • Tasaki Haruna
    Department of Nephrology, Kumamoto University Graduate School of Medical Sciences
  • Mizumoto Teruhiko
    Department of Nephrology, Kumamoto University Graduate School of Medical Sciences
  • Onoue Tomoaki
    Department of Nephrology, Kumamoto University Graduate School of Medical Sciences
  • Uchimura Kohei
    Department of Nephrology, Kumamoto University Graduate School of Medical Sciences
  • Shiraishi Naoki
    Department of Nephrology, Kumamoto University Graduate School of Medical Sciences
  • Tomita Kimio
    Department of Nephrology, Kumamoto University Graduate School of Medical Sciences
  • Kitamura Kenichiro
    Department of Nephrology, Kumamoto University Graduate School of Medical Sciences

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Other Title
  • 湧水を用いた不適切な出口部ケアにてMycobacterium fortuitum出口部感染を発症した腹膜透析患者の1例
  • 症例報告 湧水を用いた不適切な出口部ケアにてMycobacterium fortuitum出口部感染を発症した腹膜透析患者の1例
  • ショウレイ ホウコク ワキミズ オ モチイタ フテキセツ ナ デグチブ ケア ニテ Mycobacterium fortuitum デグチブ カンセン オ ハッショウ シタ フクマク トウセキ カンジャ ノ 1レイ

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Abstract

A 54-year-old woman with end-stage renal disease secondary to immunoglobulin A nephropathy presented with purulent discharge from the exit site. She had been undergoing continuous ambulatory peritoneal dialysis for three years. Mountain spring water was used as a cleaning solution for the exit site for one year. Mycobacterium fortuitum grew on culture of the purulent discharge. Acid-fast staining of the water revealed acid-fast bacilli (Gaffky 2). The patient was treated with oral levofloxacin and clarithromycin. After six weeks of therapy, the exit-site infection showed no improvement. Therefore, the peritoneal catheter was removed and renal replacement therapy was switched to hemodialysis. This is the first report in which a definite infection source was determined in M. fortuitum exit-site infection. Source of infection and weakness of the exit-site skin barrier are regarded as important to establish M. fortuitum exit-site infection. Routine evaluation and re-education for exit-site care would have prevented M. fortuitum exit-site infection and the additional catheter surgery.

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