A Report of Peritonitis from Aeromonas sobria in a Peritoneal Dialysis (PD) Patient with Necrotizing Fasciitis
Jirayut Janma MD*, Patcharasarn Linasmita MD**, Siribha Changsirikulchai MD*
Affiliation : * Division of Nephrology, Department of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC), Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand ** Division of Infectious Disease, Department of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC), Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
A70-years of age, male patient with underlying type 2 diabetes mellitus, hypertension, dyslipidemia and ischemic heart disease had undergone continuous ambulatory peritoneal dialysis (CAPD) for 3 years without any episodes of peritonitis. He was diagnosed with necrotizing fasciitis and later developed peritonitis after receiving a laceration from an aquatic injury suffered during the flood disaster of 2011. The blood culture, necrotic tissue and the clear dialysate collected upon admission had shown Aeromonas sobria. The route of peritonitis may be from the hematogenous spread of A. sobria resulting in necrotizing fasciitis. A. sobria should be considered as the pathogen of peritonitis in PD patients who have history of wounds from contaminated water. We suggest that the PD patients who present with septicemia and did not meet the criteria for peritonitis, the initial dialysate effluent should be sent for culture. The benefit of this is to allow early recognition and treatment of peritonitis.
Keywords : Peritonitis, Peritoneal dialysis, Aeromonas, Necrotizing fasciitis
