Fungal Peritonitis Caused by the Dematiaceous Fungus Phialemonium obovatum in a Continuous Ambulatory Peritoneal Dialysis Patient

Keimyung Medical Journal 2012;31(1):126-134.

CAPD 환자에서 발생한 유색진균 Phialemonium obovatum 에 의한 진균성 복막염

여상목; 박성배; 김상진; 백진혁; 김예림; 장미현; 황은아; 한승엽; 류남희; 신종희

Abstract

The genus Phialemonium was described by Gams and McGinnis in 1983 as filamentous fungi with morphological features intermediate between the genera Acremonium and Phialophora. Phialemonium species are reporting cause of an opportunistic fungal pathogen of human. The majority of Phialemonium infections are including endocarditis, osteomyelitis, peritonitis, and cutaneous infection in burn wounds. A small number of reports have described the role of Phialemonium species in invasive phaeohypomycosis. We report a case of fungal peritonitis caused by Phialemonium obovatum in a continuous ambulatory peritoneal dialysis patient. A 47-year-old man on continuous ambulatory peritoneal dialysis for 8 years due to chronic glomerulonephritis was admitted for diffuse abdominal pain with turbid dialysate effluent. A month prior to this episode, he received antibiotics administration due to bacterial peritonitis. The patient was given amphotericin B and fluconazole for two weeks after peritoneal catheter remove. Identification of Phialemonium obovatum based on sequences of internal transcribed spacer (ITS) regions by directly sequencing polymerase chain reaction amplified fragments. ITS 1 and ITS 2 and the intervening 5.8S ribosomal RNA regions were amplified with primers ITS-F and ITS-R, which were designed from conserved regions of the 18S and 28S rRNA genes respectively. The D1/D2 domains of the 28S rRNA were amplified and sequenced with the primers, NL1 and NL4. Overall sequence similarities were 99.0% in both compared with standard strain of Phialemonium obovatum (CBS 279.76, CBS 730.97). This patient developed encapsulating peritoneal sclerosis 4 months after transfer to maintenance hemodialysis therapy.

Key Words: Continuous ambulatory peritoneal dialysis, Dematiaceous fungus, Encapsulating peritoneal sclerosis, Fungal peritonitis, Phaeohypomycosis, Phialemonium obovatum