Spontaneous Bacterial Peritonitis Due to Bacillus licheniformis in an Autosomal Dominant Polycystic Kidney Disease Patient on Peritoneal Dialysis: A Rare Presentation Linked to Avian Exposure.

This case report details a rare instance of Bacillus licheniformis-induced peritonitis in a 43-year-old male diagnosed with autosomal dominant polycystic kidney disease (ADPKD) undergoing peritoneal dialysis (PD). The patient presented with acute onset of severe abdominal pain and fever, prompting a microbiological investigation that revealed Gram-positive bacilli. Initial empirical treatment with ceftazidime and vancomycin was followed by targeted vancomycin therapy upon identification of B. licheniformis. The patient's clinical course showed steady improvement, corroborated by a recent history of avian contact. This case underscores the critical consideration of uncommon pathogens and environmental exposures in managing peritonitis among peritoneal dialysis patients.

The impact of shortening patient-doctor contact duration on early peritoneal dialysis-related infections.

Early peritoneal dialysis (PD)-related infection is a severe complication. This study investigated the relationship between patient-doctor contact (PDC) duration and early PD-related infection. In the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) Korea, incident dialysis patients receiving PD were divided into two groups based on PDC duration (< 15 min versus ≥ 15 min), which was defined as the duration a nephrologist typically spends with a patient receiving PD during each visit according to the facility practice pattern. Early risks of PD-related infections, such as peritonitis and catheter-related infection (onset within 3 and 12 months of PD), were compared to the PDC duration using Cox regression. The study included 276 patients (184 [66.7%] in the shorter PDC group [< 15 min] and 92 [33.3%] in the longer PDC group [≥ 15 min]). The average age did not differ between the groups. The incidences of 3- and 12-month PD-related infections were significantly lower in the longer PDC group than in the shorter PDC group (3 months: 1.1% versus 9.8%, P = 0.007; 12 months: 9.8% versus 23.4%, P = 0.007). Longer PDC was independently associated with a lower risk of PD-related infections at 3 and 12 months (3 months: adjusted hazard ratio [aHR], 0.11; 95% confidence interval [CI], 0.02-0.85, P = 0.034; 12 months: aHR, 0.43; 95% CI 0.19-0.99, P = 0.048). Overall, a longer PDC duration was associated with a significantly lower risk of early PD-related infection.

Atraumatic splenic rupture: a case report.

Background: Splenic rupture associated with trauma is common within the population, however, spontaneous splenic rupture is noted to be a rarity in clinical practice. Spontaneous splenic rupture is usually associated with hematologic, neoplastic, or infectious disorders, with infectious mononucleosis associated with Epstein-Barr virus being the most common cause worldwide. Spontaneous splenic rupture without underlying cause is thought to be exceedingly rare. In this article we present a case involving a true spontaneous splenic rupture. Case Description: We present the case of a 73-year-old female with past medical history significant for hypothyroidism, hypertension, squamous cell carcinoma of the chest, and history of tobacco use who presented to the emergency department with acute onset of left-sided flank pain radiating to her shoulder beginning three days prior. Computed tomography of the abdomen and pelvis without contrast revealed an acute splenic injury concerning for rupture with contour obscured by blood products with associated mild to moderate hemoperitoneum. The decision was made to proceed with emergent exploratory laparotomy and splenectomy. Patient received her post splenectomy vaccinations. On follow-up appointment, patient was noted to be doing well. Conclusions: This case highlights the importance of early diagnosis and treatment of atraumatic splenic rupture, as delayed diagnosis and treatment is associated with significant morbidity and mortality. Operative intervention including splenectomy remains the mainstay of treatment, in addition to appropriate resuscitation. Some authors have reported cases in which hemodynamically stable patients are able to be treated non-operatively, however, the long-term consequences are unknown. Atraumatic spontaneous splenic rupture is often low on the differential diagnoses due to its rarity. Unfortunately, it carries a high risk of morbidity and mortality, and thus timely diagnosis and intervention is imperative.

Not your typical abdominal pain: Case report of a fisherman presenting to the trauma & emergency surgery department with intestinal perforation due to an eel fish.

BACKGROUND: Traumatic intestinal perforation by foreign bodies is rare, with cases involving live fish being exceedingly uncommon, with only one reported case to date. We present a unique case of a 55-year-old fisherman who presented to the Emergency Department with traumatic intestinal perforation due to an eel fish accidentally entering his rectum. Despite initial reluctance to seek medical attention, prompt intervention was crucial to addressing peritonitis. CASE PRESENTATION: The patient presented with severe abdominal pain and signs of peritonitis. X-ray findings confirmed pneumoperitoneum. Urgent laparotomy revealed a live eel fish and a 5 cm sigmoid colon perforation, necessitating a sigmoid colostomy. DISCUSSION: Early recognition of traumatic intestinal perforation is vital for prompt management. Diagnosis can be challenging, emphasizing the need for thorough history-taking and imaging. Surgical intervention aims to repair the intestinal perforation, prevent complications and promote healing. CONCLUSION: This case highlights the importance of considering unusual causes of abdominal pain, particularly in relevant occupational history. Prompt surgical intervention is crucial for favorable clinical outcomes.

Clostridium Perfringens as a Rare Cause of Spontaneous Bacterial Peritonitis.

Spontaneous bacterial peritonitis (SBP) is a serious complication in individuals with liver cirrhosis and ascites. In this case report, we present an unusual cause of SBP in loculated ascites caused by an uncommon bacterium, Clostridium perfringens. Although SBP is typically associated with certain common pathogens, it is important to recognize that less frequent organisms can also trigger it. C. perfringens is typically associated with other environmental sources, but in this instance, the infection's origin was suspected to be either nosocomial, from prior paracentesis, or due to a microscopic bowel perforation that was undetectable on imaging. Remarkably, the patient responded well with an improvement of symptoms, and the ascitic fluid bacterial growth resolved on subsequent cultures.

Peritoneal Dialysis Catheter-Associated Peritonitis Caused by Mycobacterium abscessus: A True Infection?

A nine-year-old male with trisomy 21, end-stage renal disease (ESRD) due to reflux nephropathy presented with suspected peritoneal dialysis (PD) catheter-associated peritonitis. One week after receiving an intraperitoneal antibiotic, he presented again with persistent peritonitis symptoms and bloody PD fluid. He underwent exploratory laparotomy, abdominal washout, and PD catheter removal. Mycobacterium abscessus (M. abscessus) was found in the intraoperative peritoneal fluid culture. After the catheter removal, the child's symptoms significantly improved without antimicrobial medications. He was maintained on hemodialysis three times a week and underwent a successful kidney transplant eight months after this episode. Non-tuberculous mycobacterial peritonitis should be considered in patients with culture-negative peritonitis when there is no intraperitoneal antibiotic response. M. abscessus is a rapidly growing atypical Mycobacterium found in the environment and can contaminate medical devices. Our case involved an infection from a contaminated PD catheter since the patient's symptoms improved after PD catheter removal.

Tuberculosis Peritonitis Resulting in Small Bowel Obstruction.

Tuberculosis (TB) peritonitis resulting in a small bowel obstruction is uncommon and can be a challenging infectious disease to diagnose. It often has an insidious onset with non-specific symptoms. Today we report a rare case of a 30-year-old woman who recently traveled to Vietnam and presented with worsening upper and lower gastrointestinal symptoms. CT scan revealed an ill-defined mass in the terminal ileum with prominent mucosal enhancement and wall thickening, which ultimately led to subsequent colonoscopy and Quantiferon Gold testing, revealing a positive result. Biopsy of the mass demonstrated noncaseating granulomatous colitis with rare acid-fast positive bacillus consistent with mycobacterial infection. As a result, the patient was ultimately initiated on antituberculosis therapy. Shortly thereafter, she was readmitted with clinical features suggestive of a bowel obstruction. The patient was managed with supportive care and did not require surgical intervention. However, approximately two months following the readmission, she presented to the emergency department once again with a mechanical bowel obstruction that ultimately required surgery. This case underscores the importance of TB testing in patients with insidious, worsening gastrointestinal symptoms and highlights the potential complications of TB peritonitis, even in those undergoing antituberculosis treatment.

Percutaneous Insertion of Peritoneal Dialysis Catheters.

Patients with end-stage renal disease undergoing hemodialysis encounter significant challenges in care coordination and experience higher complication rates. Peritoneal dialysis (PD) is an evidence-based alternative that significantly improves patients' quality of life.Peritoneal dialysis catheter insertion methods include open surgical, laparoscopic, peritoneoscopic, and percutaneous image-guided approaches. Despite comparable success rates and cost-effectiveness, the US healthcare system underutilizes the percutaneous method.This article aims to provide an overview of the essential components of the technique of percutaneous peritoneal dialysis catheter insertion, as well as address patient selection nuances and considerations for urgent-start dialysis. Additionally, it reviews the outcomes and complications associated with image-guided percutaneous PD catheter placement, advocating for its wider adoption.

Clinical outcomes in peritoneal dialysis with refractory peritonitis: significance of the day 5 cell count.

BACKGROUND: Peritoneal dialysis-associated peritonitis is a common and severe complication of peritoneal dialysis, associated with high morbidity and mortality. However, there's a lack of research on refractory peritonitis, which is difficult to manage and has a poor prognosis. Our study aimed to investigate factors affecting clinical outcomes in peritoneal dialysis patients with refractory peritonitis over a 12-year period at a medical faculty hospital in Turkey. METHODS: We conducted a retrospective study at a single center from January 2009 to December 2020, involving 135 patients with 236 episodes of refractory peritonitis. The average age of the patient cohort was 53.0 ± 15.9 years, and 72 (53.4%) of the patients were male. The leading identified causes of end-stage kidney disease were glomerulonephritis, hypertensive glomerulosclerosis, and diabetic nephropathy. Data on microbiological etiology, dialysate white blood cell counts, and patient demographics were analyzed to identify catheter removal risk factors. Statistical significance was set at p ≤ 0.05. RESULTS: Comparative analysis between patients with and without catheter loss revealed no significant differences in gender, age, presence of diabetes, prior hemodialysis, or duration of peritoneal dialysis. However, multivariate logistic regression analysis showed that a dialysate white blood cell count exceeding 1000/mm3 on day 5 and hospitalization had a positive association with catheter loss, while the presence of gram-positive bacterial growth had an inverse correlation. CONCLUSION: Our study shows that fifth-day dialysate white blood cell count predicts refractory peritonitis outcomes. Future research should focus on developing tools to manage catheter removal proactively and enhance patient prognosis.

Validation of a species-specific probe-based qPCR for detection of Setaria yehi (Filarioidea: Onchocercidae) in Alaskan moose (Alces alces gigas).

Northern ungulates contend with Setaria yehi and Rumenfilaria andersoni, filarioid nematodes that are transmitted by ectoparasitic blood-feeding arthropods, which can result in animal and population level impacts. Setaria yehi microfilariae can be detected in fresh blood samples using a modified Knott's test, or by postmortem detection by genetic sampling or through the retrieval of adult specimens in the peritoneal cavity. In this study we validated a novel qPCR for detection of S. yehi DNA in blood samples of moose (Alces alces). Additionally, we compared quantitative values from modified Knott's test to detect both S. yehi and R. andersoni from both fresh and frozen blood samples. Species-specific primers targeting a 121-base pair fragment of the cytochrome oxidase c subunit 1 (cox1) of S. yehi, and a species-specific probe were designed. The qPCR had a detection threshold of 0.157 pg/µL of parasite DNA. We collected 166 blood samples from wild moose captured on the Kenai Peninsula, Alaska from 2019 to 2022. Matching blood aliquots were tested by modified Knott's test and subjected to DNA extraction for subsequent qPCR. Quantitatively, blood samples had an average S. yehi microfilaremia (mf) of 472.2 mf/mL (0-14,490 mf/mL) and R. andersoni of 72.9 mf/mL (0.0-5071.5 mf/mL). Qualitatively, 32.53% (n = 54) of samples tested positive for S. yehi in each of the tests, and 37.35% (n = 62) when both tests were combined, with very good agreement between the results from Knott's test and qPCR (kappa = 0.90). The validation of the qPCR test for S. yehi allows for faster, less labor-intensive diagnosis and epidemiological surveillance of this emerging parasite in moose and other cervid hosts.

Spontaneous Bacterial Peritonitis: A Rare Incidence by Achromobacter xylosidans.

Liver cirrhosis results from progressive hepatic fibrosis and is generally considered irreversible. One of the many consequences of cirrhosis is spontaneous bacterial peritonitis. This typically presents in patients with decompensated cirrhosis due to bacterial translocation, most commonly from the intestinal bacterial flora seeding into the ascitic fluid. We present a rare case of spontaneous bacterial peritonitis caused by Achromobacter xylosidans. This bacterium is mostly associated with nosocomial infections, and due to its multidrug-resistant nature, treatment options are often limited. This case highlights a rare cause of spontaneous bacterial peritonitis to consider in the setting of recent hospitalization, and the importance of recognizing spontaneous bacterial peritonitis versus secondary bacterial peritonitis.

Tuberculous peritonitis complicated by an intraperitoneal tuberculous abscess: A case report.

BACKGROUND: Tuberculous peritonitis (TBP) is a chronic, diffuse inflammation of the peritoneum caused by Mycobacterium tuberculosis. The route of infection can be by direct spread of intraperitoneal tuberculosis (TB) or by hematogenous dissemination. The former is more common, such as intestinal TB, mesenteric lymphatic TB, fallopian tube TB, etc., and can be the direct primary lesion of the disease. CASE SUMMARY: We present an older male patient with TBP complicated by an abdominal mass. The patient's preoperative symptoms, signs and imaging data suggested a possible abdominal tumor. After surgical treatment, the patient's primary diagnosis of TBP complicating an intraperitoneal tuberculous abscess was established by combining past medical history, postoperative pathology, and positive results of TB-related laboratory tests. The patient's symptoms were significantly reduced after surgical treatment, and he was discharged from the hospital with instructions to continue treatment at a TB specialist hospital and to undergo anti-TB treatment if necessary. CONCLUSION: This case report analyses the management of TBP complicated by intraperitoneal tuberculous abscess and highlights the importance of early definitive diagnosis in the hope of improving the clinical management of this type of disease.

Development of feline infectious peritonitis diagnosis system by using CatBoost algorithm.

This study employed machine learning techniques to predict the rate of feline infectious peritonitis (FIP) diagnoses, with a specific focus on mutations in the spike protein gene of the feline coronavirus (FCoV). FIP is a fatal viral disease affecting the peritoneum of cats and is primarily caused by mutations in FCoV. Its diagnosis largely relies on evaluations of various biomarkers and clinical symptoms. The current analysis of FCoV spike protein gene mutations exhibits certain limitations. To address this problem, the present study employed a large dataset-comprising information on FCoV copy numbers, spike protein mutation outcomes, and related clinical data-and used machine learning models to analyze the association between spike protein gene mutations and FIP diagnosis. Various algorithms were used to establish highly accurate predictive models, namely logistic regression, random forest, decision tree, neural network, support vector machine, gradient boosting tree, and categorical boosting (CatBoost) algorithms. The model obtained using the CatBoost algorithm was discovered to have accuracy of 0.9541. Accordingly, a highly accurate predictive model was developed to enable early diagnosis of FIP and improve the rate of survival in cats. The application of machine learning technology in this study yielded research findings that provide veterinarians with effective tools for managing and preventing FIP, a painful and deadly disease for cats. This study is a pioneering work in the systematic application of multiple machine learning models to the prediction of FIP and comparison of performance results to improve diagnostic accuracy and efficiency. This study is the first of its kind in the field of FIP.

Ultrasound microvascular flow imaging: evaluating fetal mesenteric blood flow and predicting postnatal surgery in meconium peritonitis.

OBJECTIVE: This study explored the characteristics of fetal mesenteric blood flow perfusion across various gestational weeks and evaluated the efficacy of Microvascular Flow (MV-Flow) imaging technology in assessing intestinal wall blood flow in fetuses with meconium peritonitis (MP). METHOD: In this retrospective study, we analyzed 35 fetuses with MP and 160 healthy fetuses. We examined the correlation between the Vascular Index (VI) of mesenteric perfusion and gestational age, conducted an analysis comparing MP operative and non-operative groups, and developed a predictive model for surgical intervention. RESULTS: The VI value demonstrated no significant change with increasing gestational age (correlation coefficient = 0.005, p = 0.946). For healthy fetuses, VI ranged approximately from 34.66% to 67.26% using the automatic ellipse method. The MP operative group exhibited significantly more cesarean deliveries (100% vs. 52.9%, p = 0.003), shorter gestational periods (34.76 ± 2.16 weeks vs. 37.48 ± 1.55 weeks, p < 0.001), lower birth weights (2762.14 ± 452.76 g vs. 3225.88 ± 339.98 g, p = 0.003), more persistent ascites (92.9% vs. 52.9%, p = 0.021), more frequent intestinal wall echo reductions (57.1% vs. 5.9%, p = 0.004), and lower VI (18.57 ± 5.51% vs. 39.41 ± 7.02%, p < 0.001). A predictive model was established: Logit (P)=8.86 - (0.37* VI) + (1.49* ascites), yielding an area under the curve of 0.857, with 78.6% sensitivity and 88.2% specificity. The VI value was significantly associated with the need for postnatal surgery (OR = 0.689, 95% confidence interval: 0.511 - 0.929, p = 0.015). A Receiver Operating Characteristic curve analysis for VI in predicting postnatal surgery showed an area under the curve of 0.971, with an optimal cutoff value of 35%, achieving 91% sensitivity and 94.4% specificity. CONCLUSION: MV-Flow imaging effectively quantified fetal bowel wall blood flow perfusion. There was no significant change in VI across different gestational weeks. Significantly lower VI values in MP fetuses indicated an increased risk of intestinal wall necrosis and the potential need for postnatal surgical intervention.

Development and characterization of reverse genetics systems of feline infectious peritonitis virus for antiviral research.

Feline infectious peritonitis (FIP) is a lethal, immune-mediated disease in cats caused by feline infectious peritonitis virus (FIPV), a biotype of feline coronavirus (FCoV). In contrast to feline enteric coronavirus (FECV), which exclusively infects enterocytes and causes diarrhea, FIPV specifically targets macrophages, resulting in the development of FIP. The transmission and infection mechanisms of this complex, invariably fatal disease remain unclear, with no effective vaccines or approved drugs for its prevention or control. In this study, a full-length infectious cDNA clone of the wild-type FIPV WSU79-1149 strain was constructed to generate recombinant FIPV (rFIPV-WT), which exhibited similar growth kinetics and produced infectious virus titres comparable to those of the parental wild-type virus. In addition, the superfold green fluorescent protein (msfGFP) and Renilla luciferase (Rluc) reporter genes were incorporated into the rFIPV-WT cDNA construct to generate reporter rFIPV-msfGFP and rFIPV-Rluc viruses. While the growth characteristics of the rFIPV-msfGFP virus were similar to those of its parental rFIPV-WT, the rFIPV-Rluc virus replicated more slowly, resulting in the formation of smaller plaques than did the rFIPV-WT and rFIPV-msfGFP viruses. In addition, by replacing the S, E, M, and ORF3abc genes with msfGFP and Rluc genes, the replicon systems repFIPV-msfGFP and repFIPV-Rluc were generated on the basis of the cDNA construct of rFIPV-WT. Last, the use of reporter recombinant viruses and replicons in antiviral screening assays demonstrated their high sensitivity for quantifying the antiviral effectiveness of the tested compounds. This integrated system promises to significantly streamline the investigation of virus replication within host cells, enabling efficient screening for anti-FIPV compounds and evaluating emerging drug-resistant mutations within the FIPV genome.

Effectiveness of a Customized Peritoneal Dialysis Training Program in Reducing Infection and Dropout Rates: Insights From a Singapore Hospital.

Introduction Peritoneal dialysis (PD) is an essential home-based treatment for end-stage kidney disease, known for enhancing patients' quality of life and being more cost-effective compared to hemodialysis. However, in Singapore, PD education lacks of standardization, with each unit adopting varied methods based on their own experiences and resources. To address this, our hospital developed a tailored four-day PD training program guided by the International Society for Peritoneal Dialysis guidelines, adapted to meet local needs and resource availability. Methodology This study employed a retrospective cohort design, including all incident adult patients aged 18 years and above who initiated PD at our hospital from September 2018 to July 2023. Data on PD dropout rates and PD-related infection rates, such as PD peritonitis and exit site infection rates, were obtained from electronic medical records. Results This study comprised 99 patients who began PD and completed their PD training program at our hospital between September 2018 and July 2023. Our tailored PD training program successfully reduced dropout rates and maintained infection rates within the International Society for Peritoneal Dialysis guidelines. Specifically, exit site infection rates fluctuated between 0.18 and 0.29 episodes per year, PD peritonitis rates ranged from 0.2 to 0.26 episodes per patient-year, and dropout rates significantly improved from 40% in 2019 to 7% in 2023 (OR = 0.45, 95% CI = 0.49 to 0.84, p = 0.010). Conclusions The tailored PD training program at our hospital effectively reduced PD-related infections and dropout rates among end-stage kidney disease patients. These findings suggest that structured, locally adapted training programs can substantially improve patient outcomes in PD.

Postoperative Outcomes Following Surgical Management of Secondary Peritonitis in a Referral Hospital in Eastern Venezuela.

Background Secondary peritonitis (SP) arises from direct contamination of the peritoneum by spillage from the gastrointestinal or urogenital tracts. Objective This research aimed to evaluate the clinical and epidemiological characteristics of patients with SP undergoing surgical management and to study potential factors associated with morbidity and mortality in a reference hospital in Eastern Venezuela. Methodology A retrospective cross-sectional study was conducted on patients aged 18 to 80 undergoing surgical treatment for SP at "Dr. Luis Razetti" University Hospital in Barcelona, Anzoátegui state, Venezuela, between January and December 2022. We calculated odds ratios to assess mortality risks based on the presence of postoperative complications. Results Analysis of 168 adult patients revealed a predominantly male population (n=110, 65.5%) with a mean age of 35.63 years (SD=14.34). Generalized peritonitis was observed in 126 cases (75%), primarily originating from the appendix (n=117, 69.6%). Postoperative complications occurred in 18 patients (10.7%); sepsis represented the most common associated complication (n=10, 43.5%). Patients with secondary peritonitis associated with acute appendicitis had a lower mortality rate (p=0.042). Additionally, laparotomy was associated with higher frequencies of complications (p=0.001) and mortality (p=0.025), while open appendectomy showed lower frequencies of complications (p=0.002) and mortality (p=0.035). Notably, patients experiencing postoperative complications had a significantly elevated risk of mortality (OR=98, 95% confidence interval = 21.74 - 441.69). Conclusion The most common source of SP was appendicular. Patients undergoing exploratory laparotomy for the management of SP had a higher frequency of complications and mortality, whereas those undergoing open appendectomy had lower rates of complications and mortality.

Acute peritonitis caused by a ruptured urachal cyst accompanied by omphalitis in an adult: a case report and literature review.

Omphalitis is an infection of the umbilicus that can cause inflammation to spread. Omphalitis is rare in adults; however, it can occasionally occur owing to urachal remnants. A 61-year-old male patient with abdominal pain and umbilical pus was admitted to the emergency room. Abdominal computed tomography revealed peritonitis with multiple intra-abdominal abscesses. The patient was diagnosed with peritonitis resulting from urachal cyst rupture. Laparoscopic drainage of the abscesses and excising of the umbilicus and intra-abdominal fistula tract were performed. Antibiotics were administered, and the patient was discharged uneventfully. The rarity of peritonitis caused by infection and urachal cyst rupture can make diagnosing omphalitis challenging. Therefore, in this case report and literature review, we discuss the diagnosis and treatment of complicated omphalitis, which rarely progresses to peritonitis owing to ruptured urachal cysts.

Clinical practice guideline for the prevention and management of peritoneal dialysis associated infections in children: 2024 update.

Infection-related complications remain the most significant cause for morbidity and technique failure in infants, children and adolescents who receive maintenance peritoneal dialysis (PD). The 2024 update of the Clinical Practice Guideline for the Prevention and Management of Peritoneal Dialysis Associated Infection in Children builds upon previous such guidelines published in 2000 and 2012 and provides comprehensive treatment guidance as recommended by an international group of pediatric PD experts based upon a review of published literature and pediatric PD registry data. The workgroup prioritized updating key clinical issues contained in the 2012 guidelines, in addition to addressing additional questions developed using the PICO format. A variety of new guideline statements, highlighted by those pertaining to antibiotic therapy of peritonitis as a result of the evolution of antibiotic susceptibilities, antibiotic stewardship and clinical registry data, as well as new clinical benchmarks, are included. Recommendations for future research designed to fill important knowledge gaps are also provided.