[CIS-PAGID] peritonitis in a PD patient

[Nelson, Robert P Jr]

agree with Mel.  Also may want to check mannose binding lectin.  Bob
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From: pagid-bounces at list.clinimmsoc.org [pagid-bounces at list.clinimmsoc.org] on behalf of Berger, Melvin [Melvin.Berger at UHhospitals.org]
Sent: Wednesday, June 22, 2011 8:45 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS-PAGID] peritonitis in a PD patient

The different episodes of peritoneal infection in a patient on peritoneal dialysis most likely suggest to me problems with sterile technique/hygiene and/or the dialysis solutions. I have seen several cases of pneumococcal peritonitis in children on peritoneal dialysis, and I don't think that's a common contaminant. Of course, there are always bad strains of staph, but to have sepsis and osteomyelitis suggests at least the possibility of a defect in clearing the blood stream- I suggest checking C3 and C4 levels and function of both the classical and alternative pathways of complement.

Mel

Melvin Berger, M.D., Ph.D.
Adjunct Professor of Pediatrics and Pathology
Case Western Reserve University
Cleveland, OH 44106

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From: pagid-bounces at list.clinimmsoc.org on behalf of Donald Cuong Vinh, Dr
Sent: Wed 6/22/2011 8:27 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS-PAGID] peritonitis in a PD patient



I agree. Polymicrobial peritonitis suggests a bowel source/leak.
If these have been recurrent, monomicrobial, spontaneous bacterial peritonitis, how is the liver (function, portal vein flow, etc)?
Don


Donald C. Vinh, MD
Assistant Professor
Division of Infectious Diseases,
Division of Allergy & Clinical Immunology
Dept of Medicine; Dept of Medical Microbiology
McGill University Health Centre - Montreal General Hospital
1650 Cedar Ave, Rm A5-156
Montreal, Quebec,  Canada H3G 1A4
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From: pagid-bounces at list.clinimmsoc.org [pagid-bounces at list.clinimmsoc.org] On Behalf Of Conley, Mary Ellen [maryellen.conley at STJUDE.ORG]
Sent: Monday, June 20, 2011 3:19 PM
To: 'pagid at list.clinimmsoc.org'
Subject: Re: [CIS-PAGID] peritonitis in a PD patient

Something smells a little fishy.  Does the child have multiple organisms at the same time?  I would worry about some kind of fistula or Munchausen by proxy.
Mary Ellen






Mary Ellen Conley, MD
Department of Immunology/ Mail Stop 351
St. Jude Children's Research Hospital
262 Danny Thomas Place
Memphis, TN 38105-3678
FAX  901-595-3977
TEL  901-595-2576



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From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Richard Wasserman
Sent: Monday, June 20, 2011 11:58 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS-PAGID] peritonitis in a PD patient

He has a normal inflammatory response with fever and leukocytosis. I was thinking about TLR pathways but the absence of any other infections was a question.
Richard Wasserman

On Mon, Jun 20, 2011 at 8:57 AM, Jyonouchi, Soma C <JYONOUCHI at email.chop.edu<mailto:JYONOUCHI at email.chop.edu>> wrote:
Any problems mounting fevers or elevations of inflammatory markers?  I typically also think of TLR pathway defects (IRAK4, MyD88, NEMO) with disseminated gram+ve and –ve organisms.  A TLR assay may be useful.

Best,

SJ

From: pagid-bounces at list.clinimmsoc.org<mailto:pagid-bounces at list.clinimmsoc.org> [mailto:pagid-bounces at list.clinimmsoc.org<mailto:pagid-bounces at list.clinimmsoc.org>] On Behalf Of Richard Wasserman
Sent: Monday, June 20, 2011 9:53 AM
To: PAGID
Subject: [CIS-PAGID] peritonitis in a PD patient

I have been asked to evaluate a two year old who has been on peritoneal dialysis since 12 days of age because of recurrent peritonitis with unusual organisms. Cultures have grown Xylosoxidans, gamma hemolytic strep, pseudomonas, strep viridans, strep pneumoniae, group b strep, staph aureus. Most recently, the staph aureus peritonitis disseminated and he had an associated osteomyelitis of the knee and several inflammed lymph nodes one of which grew staph aureus on biopsy. He has never had sinusitis, pneumonia or a cutaneous abscess. There have been a few episodes of otitis media.

IgA [H] 126 mg/dL (24-121), IgG 846 mg/dL (533-107), IgM 73 mg/dL (26-218). Neutrophil oxidative burst assay showed 94% of cells positive (transport control was 83%).

I'd don't know that there are additional tests that will contribute. Suggestions?
Thanks,
Richard Wasserman

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Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
7777 Forest Lane, Suite B-332
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--
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211

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