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Original Article
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Korean J Med. 2015;88(5):593-597. Published online May 1, 2015.
DOI: https://doi.org/10.3904/kjm.2015.88.5.593
- 16s ribosomal RNA의 염기서열 분석으로 진단된 진균 감염이 합병된 Citrobacter freundii 복막투석 복막염 1예
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오태렴, 마성권, 김수완
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전남대학교 의과대학 내과학교실
- Unusual CAPD Citrobacter freundii Peritonitis Complicated by a Fungal Infection, Identified by 16s Ribosomal RNA Gene Sequencing
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Tae Ryom Oh, Seong Kwon Ma, Soo Wan Kim
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Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Corresponding author: Soo Wan Kim ,Tel: +82-62-220-6271, Fax: +82-62-225-8578, Email: skimw@chonnam.ac.kr
- Received: July 31, 2014; Revised: August 20, 2014 Accepted: September 3, 2014.
- 저자들은 16s ribosomal RNA 염기서열 분석을 통해 진단된 Citrobacter에 진균 감염이 합병된 복막투석 복막염 환자를 경험하였기에 보고하는 바이다. 환자는 항생제 단독 치료에는 충분히 반응하지 않았으며 세균성 복막염의 합병증으로 진균 감염 및 복강 내 농양이 형성되어 복막투석 카테터 제거, 항진균제 사용 및 농양 배액술을 시행한 이후 호전되었다. 빠른 진단과 적절한 치료만이 환자의 예후를 호전시킬 수 있기에 복막투석 복막염 환자에서 호전 속도가 일반적인 경우보다 느리다면 흔치 않은 원인균과 병발된 합병증에 대한 주의 깊은 검사가 임상의사에게 큰 도움을 줄 수 있을 것이다.
߽ɾ :지속적 외래 복막투석; Citrobacter; 복막염
- Abstract
- We present a case of continuous ambulatory peritoneal dialysis peritonitis caused by Citrobacter freundii complicated by a fungal infection with abscess formation. A 34-year-old woman was admitted to our hospital with abdominal pain. Isolate cultures were confirmed as Citrobacter freundii by DNA sequencing of the 16s ribosomal ribonucleic acid (RNA). Antibiotic therapy was ineffective and Candida tropicalis was isolated in follow-up blood cultures. We administered an antifungal agent and removed the peritoneal catheter. A sudden fever developed, and abdominal computed tomography showed intra-abdominal abscesses. Percutaneous drainage was performed, but no bacteria were cultured. After draining the abscesses, the patient recovered. Citrobacter species are unusual pathogens in peritonitis, and fungal peritonitis is a serious complication of bacterial peritonitis. Indwelling catheters should be removed and appropriate antibiotic therapy provided. Suspicion of a fungal infection combined with bacterial peritonitis will improve the prognosis of patients on peritoneal dialysis.
Keywords :Continuous ambulatory peritoneal dialysis, Citrobacter, Peritonitis
