Salmonella enteritidis Causing
CAPD Peritonitis
with CAPD (3). This unusual complication of S.
Editar: A 23-year-old woman, on enteritidis gastroenteritis may have been due to
continuous ambulatory immunosuppression secondary to the patient's
peritoneal dialysis (CAPD) for end-stage renal renal failure, or possibly trans-serosal spread
failure secondary to hemolytic uremic syndrome, following the use of an antispasmodic agent.
was admitted to hospital complaining of a 5-day Although there was some response to
history of lethargy, postural hypotension and intraperitoneal aztreonam and oral ciprofloxacin,
anorexia. the patient's peritonitis was not resolved until the
Two days before admission she developed PD catheter was removed and CAPD abandoned.
watery diarrhea. Her general practitioner This case highlights the importance of forma l
prescribed an antispasmodic agent, and the identification of all organisms isolated from cases
diarrhea resolved within 24 hours of starting of CAPD peritonitis and adds salmonella species
treatment. On the day of admission she developed to the etiological agents implicated.
abdominal pain, nausea, vomit ing, and rigors. On
admission she was pyrexic (temperature 38.1°C), ACKNOWLEDGME
hypotensive (blood pressure 88/54 mm Hg,
lying), and clinically dehydrated. Her peritoneal NT
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dialysis (PD) effluent was cloudy, with a white
cell count of 5.8 x 109/L. We wish to thank the Division of Enteric
Rehydration was commenced, and she was Pathogens, Public Health Laboratory Service,
started empirically on intraperitoneal vancomycin Colindale, England, for identifying the salmonella
(25 mg/L) and aztreonam ( 125 mg/L) , together isolates.
with single doses of intravenous vancomycin (1
g) and aztreonam (500 mg). Gram staining of a K. E. Orr
spun deposit of the PD effluent revealed the R. Wilkinsonl
presence of numerous leukocytes, but no F.K. Gould
organisms were seen.
Culture of the saponized specimen (I) yielded Departments of Microbiology and N
the growth of a nonlactose fermenting coliform, ephrology 1
sensitive to aztreonam and ciprofloxacin by a Freeman Hospital
comparative disk diffusion method. This was N ewcastle upon Tyne, England
provisionally identified as a salmonella species by
AP120E (API System SA) and was later fully
identified as S. enteritidis phage type 4. A similar REFERENCES
organism was subsequently isolated from a feces
specimen, although she suffered no further 1. Gould FK, Freeman R, Law D, Moriarty T.
episodes of diarrhea during her admission. Lysis in
After 48 hours her clinical condition had detection of intracellular organisms. Lancet
improved significantly, and the intraperitoneal 1988; ii:461.
vancomycin was discontinued in light of the 2. Malik R, Kamath U, Levendoglu H.
culture result. Her abdominal pain had completely Asymptomatic Salmonella enteritidis bacterial
resolved after 7 days, but the PD fluid remained ascites. Ann Int Med 1988; 109:253-4.
cloudy, although culturenegative. At this stage, 3. Ladron de Guevara C, Selgas R, Garcia-
oral ciprofloxacin (500 mgtds) was commenced PereaA. Anew case of peritonitis due to
in addition to the intraperitoneal aztreonam. Campylobacter jejuni in CAPD. Perit Dial Int
Fifteen days after admission her PD effluent 1992; 12:268-9.
became clear, and she was discharged on in-
traperitoneal aztreonam and oral ciprofloxacin.
Four days after discharge, however, her PD
effluent became cloudy again, and she was
readmitted. Microscopy of a sample of PD
effluent revealed numerous leukocytes on Gram
staining, but the cultures were negative despite
enrichment. She failed to respond to empirical
treatment with intraperitoneal vancomycin and
aztreonam (dosages as above), and 3 days after
admission her PD dialysis catheter was removed,
and she was commenced on hemodialysis.
Peritonitis remains a major complication
ofCAPD. To our knowledge this is the first report
of Salmanella enteritidis causing CAPD
peritonitis, although salmonella peritonitis has
been described in patients with cirrhotic ascites
(2), and Campylabacter jejuni peritonitis has been