Lessons from Peritoneal Dialysis-Related Brucella Peritonitis A 16-Year Review

Introduction Peritoneal dialysis (PD)-related peritonitis is a significant complication that can lead to PD failure, but Brucella peritonitis remains an extremely rare occurrence. A recently published case report and literature review shed light on the challenges of diagnosing and managing PD-related Brucella peritonitis, highlighting key takeaways for nephrologists and healthcare professionals.

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Understanding PD-Related Brucella Peritonitis

• Brucellosis Background: Brucellosis, commonly found in Mediterranean regions, North Africa, and the Middle East, is a zoonotic infection that can cause a variety of systemic complications. While rare, it has been identified as a cause of peritonitis in both PD and non-PD patients.
• Incidence & Case Review: Over the last 16 years, only eight cases (including the latest report) of PD-related Brucella peritonitis have been documented, with the majority originating from the Middle East and Turkey.

Clinical Presentation & Challenges in Diagnosis

• Symptoms: Patients typically present with fever, abdominal pain, vomiting, and diarrhea, mimicking more common gastrointestinal infections.
• Diagnostic Hurdles: Blood and PD fluid cultures require prolonged incubation periods, often delaying definitive diagnosis. The use of automated culture systems, such as BacT/Alert 3D, has improved detection rates.

Management & Treatment Outcomes

• Standard Treatment Protocol: Combination therapy with rifampicin and doxycycline is the most commonly used regimen. Alternative antibiotics, such as ciprofloxacin or minocycline, may be required in cases of intolerance.
• PD Catheter Removal Considerations: Approximately 50% of documented cases required catheter removal due to refractory infection, a rate higher than that observed in fungal peritonitis. Decisions on catheter removal should align with international guidelines, considering patient preference and clinical response.

Broader Implications & Recommendations The American College of Radiology (ACR) emphasizes the need for early detection and proper antimicrobial stewardship in preventing complications from infections like Brucellosis in immunocompromised patients. This aligns with recommendations to improve diagnostic accuracy in PD peritonitis cases.

Conclusion & Future Directions Brucella peritonitis remains a rare but significant challenge in PD patients. This case review underscores the importance of early suspicion, advanced culture techniques, and patient-centered decision-making regarding PD continuation. Future studies are needed to establish clearer guidelines for managing this uncommon but serious infection.

For further reading, access the full study at https://doi.com/10.29328/journal.jcn.1001020.

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