Peritonitisis a serious complication of peritoneal dialysis. A variety of microorganisms
are identified in these cases and during recent years a new one was included,
Pantoea species. In our report, we present 2 cases of patients on CCPD with a
peritonitis episode caused by this organism. The source of infection in one of
the cases was thought to be due to gardening of the plant Basil, while unknown
in the other case. In microbiologic culture, this organism was identified and
the patients were started on antibiotics with success in one case while the
other requiring catheter removal. The number of reported cases with this
organism has increased in last years and various infection localizations and
clinical progress patterns have been identified. In peritoneal dialysis
patients presenting with peritonitis, this organism must be kept in mind.
For patients on
peritoneal diaysis, peritonitis is an important cause of mortality and
morbidity. The treating physician needs to keep a high index of suspicion and
treat peritonitis early to improve outcome and reduce complications. While
usual gram positive and gram negative organisms make most of the cases,
recently one unusual environmental gram negative family appeared to be the
cause. The organism
Pantoea, belongs to the family Enterobacteriaceae and is responsible for
infectious diseases mainly from plant-thorn injuries, causing arthritis,
osteoitis, osteomyelitis to bacteremia. Until now a number of clinical cases of
peritonitis caused by this organism have been described. We present
two cases (Case A and B) of peritonitis with Pantoea species at our center,
both of which had different course and outcomes requiring different treatments.
Upon evaluation, there was diffuse abdominal tenderness but
there were no signs of exit site or tunnel infection. The PD fluid was found to
be cloudy and analysis showed White cell count of 1000 with 92% neutrophils.
Other investigations revealed serum WBC count 7.6k/ul, ESR 30mm/hr, CRP
0.4mg/dl, Lactic acid 3.1mmol/L. Patient was started on empirical treatment
including Intraperitoneal Ceftriaxone and Vancomycin. The Blood cultures were
negative; however the PD fluid culture grew Pantoea species sensitive to
Cephalosporins, Gentamycin and Tazobactam. The patient showed significant
improvement and disappearance of symptoms on the third day. The PD fluid WBC
dropped to 22k/ul with normalization of ESR and lactic acid levels and the
fluid culture became negative after 5 days of treatment. Patient was discharged
home and he completed 14 days of antibiotic therapy. Over the next one year,
patient did not have any further episodes of peritonitis, and the repeated PET
test did not show any changes on the membrane characteristics.
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