Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0341503 (bacterial peritonitis)
 1,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ca++ has been proposed as an intracellular second messenger for the activation of immune cells. An immune regulatory role for 1,25(OH)2D3 has also been suggested. We therefore evaluated the role of Ca++ and 1,25(OH)2D3 in the depressed antibacterial functions of 8 CAPD patients with relapsing bacterial peritonitis by evaluating in vitro the effects of escalating concentrations of 1,25(OH)2D3 and/or Ca++ on: 1. peritoneal macrophage (PMO) cytoplasmic Ca++; 2. PMO superoxide generation; 3. PMO leukotriene B4 release, 4. PMO bacterial killing. Results showed a dose-dependent increase in all parameters for Ca++ concentrations from 500 to 3,000 microM while with both a CA(++)-free medium and with Ca++ concentrations of 5,000 microM of medium all the aforementioned functions were abrogated. Addition of low doses of 1,25(OH)2D3 strongly potentiated the stimulatory effect of Ca++ on cell functions, while high doses were inhibitory. These in vitro data underline the importance of Ca++ and 1,25(OH)2D3 in PMO antibacterial functions in CAPD patients, and may be useful in the prophylaxis and therapy of peritonitis.
Adv Perit Dial 1989
PMID:Ca++ and 1,25(OH)2D3 enhance peritoneal macrophage (PMPhi) antimicrobial functions in CAPD. 257 89

We analyzed the in vitro effects of monophosphoryl lipid A (MPLA), a nontoxic bacterial endotoxin-derived immunomodulant, on the depressed immune functions of peritoneal lymphocytes (PLy) and macrophages (PMO) of 6 CAPD patients with relapsing bacterial peritonitis. MPLA was also tested for its capacity to stimulate the peritoneal fibroblast proliferation as determined by 3H-thymidine incorporation. In vitro incubation of PLy and PMO with escalating doses of MPLA up to 5 micrograms/ml, resulted in a dose-dependent enhancement of Gamma-Interferon (Gamma-IFN) and Interleukin-2 (IL-2) production by PLy, and Interleukin-1 (IL-1) by PMO. There was also an increase in PMO bacterial killing and membrane Fc receptor number, while no change in peritoneal fibroblast proliferation was seen with any of the MPLA concentrations tested. These results suggest that the peritoneal leukocyte abnormalities observed in some high peritonitis rate CAPD patients may be reversed, to some degree, by MPLA, without directly inducing a potentially deleterious peritoneal fibrosis.
Adv Perit Dial 1989
PMID:Effect of monophosphoryl lipid A (MPLA) on peritoneal leukocyte function. 257 98

A 41-year-old CAPD patient developed Grey-Turner's sign during the course of bacterial peritonitis due to Pseudomonas aeruginosa. At the same time a diagnosis of sclerosing peritonitis was made by CT-scanning of the abdomen. We think that Grey-Turner's flank staining could either have been caused by synthesis of proteases by the Pseudomonas bacteria or by reduced mesenteric flexibility and increased vascularization of the peritoneum due to the sclerosing peritonitis. This could have led to spontaneous mesenteric bleeding with leakage to the retroperitoneal tissues. A possible relationship with an ascites puncture is less likely.
Adv Perit Dial 1989
PMID:Grey-Turner's sign in sclerosing peritonitis. 257 36

The development of cloudy peritoneal dialysis effluent is of great concern to the patient undergoing therapy with Continuous Ambulatory Peritoneal Dialysis. As described in this study, not all cloudy fluid represents bacterial infection. We describe the occurrence of cloudy fluid in eight patients in whom culture of the dialysate did not yield any growth, and whose cell count was characterized by the presence of significant numbers of the eosinophiles. As outlined, the entity of eosinophilic peritonitis has a characteristic presentation which allows for its distinction from the more common bacterial peritonitis.
Clin Exp Dial Apheresis 1982
PMID:Eosinophilic peritonitis. 718 84

Fungal peritonitis (FP) is uncommon in patients on peritoneal dialysis (PD); it is difficult to treat and has a high mortality rate. We report 6 cases of fungal peritonitis observed between 1980 and 1992 in our center. The etiologic agents were: Candida spp., C. guilliermondi, C. parapsilosis, C. albicans, and Verticillium spp. All 6 patients had suffered at least one episode of bacterial peritonitis in the two months before the fungal infection appeared and were all treated by intraperitoneal administration of antibiotics. The catheter was removed early in 3 patients followed by antimycotic therapy, while the remaining 3 patients received antimycotic therapy, with removal of the catheter in a later stage. The result in the first group was that they all switched permanently to hemodialysis, while in the second group there were 2 deaths and 1 transfer to hemodialysis. In the light of these 6 cases, we analyzed 22 published reports to assess risk factors, therapy, and outcome of this pathology. The major predisposing factors were intraperitoneal antibiotics and bacterial peritonitis, and the best results were obtained by continuing PD plus intraperitoneal and systemic antifungal agents.
Adv Perit Dial 1994
PMID:Fungal peritonitis in peritoneal dialysis: critical review of six cases. 799 20

Twenty-one episodes of fungal peritonitis occurred over 35 months among 290 patients on CAPD, accounting for 6.3% of all peritonitis episodes. Patients with more frequent bacterial peritonitis were at higher risk of developing fungal peritonitis, and 28.6% of cases followed antimicrobial therapy. Candida species accounted for 85.7% of cases. Oral fluconazole was used as initial therapy in all patients, which was followed by catheter removal if peritonitis failed to improve. The cure rate with fluconazole therapy alone without catheter removal was 9.5%. Fluconazole plus catheter removal, the latter necessitated in 85.7% of cases, resulted in a cure rate of 66.7%. The remaining 3 (14.3%) patients responded to intravenous amphotericin given as salvage therapy. Disease-related mortality was 14.3%. Reinsertion of dialysis catheter was attempted in 15 patients and CAPD was successfully resumed in 13 (86.7%). We conclude that oral fluconazole can be safely used as initial therapy in patients with fungal peritonitis complicating CAPD. Although catheter removal was necessary in the majority of patients, this sequential approach resulted in a relatively low prevalence of peritoneal adhesions and subsequent CAPD failure.
Nephrol Dial Transplant 1994
PMID:Treatment of fungal peritonitis complicating continuous ambulatory peritoneal dialysis with oral fluconazole: a series of 21 patients. 772 19

The interruption of chronic peritoneal dialysis for a period of time is recommended for replacement of the peritoneal catheter due to tunnel infection and/or relapsing peritonitis. In pediatric patients, in the younger ones, in particular, discontinuation of peritoneal dialysis can be problematic--there are difficulties associated with vascular access and hemodialysis. Over a 5-year period 9 children (4 infants, 2 preschool, 3 school-age) required 15 peritoneal access device replacements, without interruption of continuous ambulatory peritoneal dialysis (CAPD). The reasons for catheter replacement were tunnel complications (10), relapsing bacterial peritonitis (3), and fungal peritonitis (2). All catheter removals and placements were performed by surgical method under general anesthesia in a one-step procedure. The new catheters were implanted on the opposite side of the abdominal wall in all except one child, who had a colostomy. All patients received prophylactic antibiotics in the bags. In the postoperative period the patients infused smaller exchange volumes during 2 weeks. In the older children the exchange volumes were increased overnight. This schedule resulted in low intra-abdominal pressure. No patient required interval hemodialysis. Relapse of tunnel infection occurred in one episode in the first 2 months. We did not observe, in the same period, recurrence of peritonitis. One-step catheter replacement has been demonstrated to be safe; it avoids the disruption of ongoing treatment and promotes patient maintenance on CAPD.
Adv Perit Dial 1993
PMID:One-step peritoneal catheter replacement in children. 810 55

The present study compared oral versus intraperitoneal (ip) ciprofloxacin (ciproxin) as primary treatment of bacterial peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD) in a randomized, prospective trial. A total of 54 episodes in 46 patients were recruited for study. After excluding nonbacterial episodes and those not treated according to protocol, 48 episodes evenly divided between the two treatment arms were eligible for analysis. The primary cure rate was 41.7% and 66.7%, respectively, in the oral and ip treatment group. Half of those who failed or relapsed were due to infection with resistant, mostly gram-positive bacteria, which accounted for 79% of culture-positive episodes. Of the gram-positive isolates 42.3% were either resistant or intermediately susceptible to ciproxin compared to 16.7% of gram-negative isolates. The high level of bacterial resistance to ciproxin and treatment failure rate were related to the previous exposure to fluoroquinolones. Inadequate trough peritoneal drug levels also accounted for the failures in the ip but not the oral treatment group. We conclude that oral ciproxin is ineffective as a primary treatment of CAPD peritonitis in patients previously exposed to fluoroquinolones and that when administered ip, a dose of 50 mg/L instead of 25 mg/L of ciproxin should be used as maintenance in order to achieve adequate trough peritoneal drug levels.
Perit Dial Int 1993
PMID:A randomized prospective comparison of oral versus intraperitoneal ciprofloxacin as the primary treatment of peritonitis complicating continuous ambulatory peritoneal dialysis. 1133 May 68

The purpose of this study was to analyze catheter outcome of persistent exit-site/tunnel infections (ESI/TIs) in peritoneal dialysis patients who underwent removal of the subcutaneous cuff due to persistent ESI/TI from January 1989 to June 1994. One hundred and sixty-eight patients (98 male, 70 female) from our tertiary university hospital underwent 177 double-cuff coiled Swan neck catheter implantations surgically. Nineteen patients (11%) had persistent ESI/TIs for more than 6 months. Thirteen persistent ESI/TIs responded to subcutaneous cuff removal. One hundred and fifty-four episodes of ESI/TI in 168 patients were observed over 3189 patient-months (0.58 episodes/patient-year). Nineteen patients (11%) had persistent ESI/TI with Staphylococcus aureus in 12 and Pseudomonas aeurginosa in 7 patients without episode of peritonitis except 2 patients with Staphylococcus aureus. Thirteen persistent ESI/TI resolved after subcutaneous catheter removal without catheter loss, 8 with Staphylococcus aureus and 5 with Pseudomonas. Sixteen catheters were lost due to fungal peritonitis and two secondary to recurrent bacterial peritonitis. None of the catheters were removed as a result of ESI/TI and related peritonitis. Subcutaneous cuff removal in persistent ESI/TI in peritoneal dialysis patients can significantly reduce catheter loss related to ESI/TI.
Adv Perit Dial 1995
PMID:Subcutaneous cuff removal in persistent exit-site/tunnel infections in peritoneal dialysis. 853 93

The purposes of this paper is to review the specific role of peritoneal dialysis (PD) in patients with liver disorders. We will pay attention to the confluence of liver diseases and situations for which chronic dialysis treatment is required. Hemodialysis (HD) and peritoneal membranes are safe barriers against the passage of the hepatitis C virus; consequently, while peritoneal effluent or HD ultrafiltrate drained from hepatitis B patients/carriers is infective, that from hepatitis C patients does not appear to present this risk. An important issue is horizontal transmission, which appears to occur with both viruses in HD units, and which is absent in peritoneal dialysis units. The incidence of hepatitis C among continuous ambulatory peritoneal dialysis (CAPD) patients is quite low, while it may reach almost 50%-60% of HD patients in some units. While hepatitis C transmission mechanisms are not completely understood and a vaccine is not available, PD provides some degree of protection when compared with HD, for and-stage renal disease patients. In summary, our experience and that of others, with a total of 19 PD-treated chronic liver disease patients, supports CAPD as the treatment of choice for cirrhotic patients with ascites who require chronic dialysis. Data on peritoneal diffusion of low molecular weight substances revealed a marked increase in most patients. The ultrafiltration capacity was clearly augmented with respect to noncirrhotic patients, making the use of hypertonic bags unnecessary. Hemodynamic tolerance was excellent. Complications and death were mainly related to liver disease complications. Spontaneous bacterial peritonitis (SBP), caused by gram-negative germs, is the most important complication directly related to ascites and may have some points in common with PD-related peritonitis. However, and in contrast to most PD peritonitis, two pathogenetic mechanisms have been suggested for SBP: (1) translocation of bacteria from the gut to the mesenteric lymph nodes, and (2) bacteremia in these patients is secondary to the general abnormal host defense mechanisms. Local factors such as intrahepatic shunting and the impairment of bactericidal activity in ascitic fluid favor the bacteria ascites. The hypothesis of a direct transmural contamination from bowel to ascitic fluid has been relegated to secondary bacterial peritonitis. Would cirrhotic patients with temporal or permanent renal function compromise benefit from peritoneal catheter placement and other PD practices to perform repetitive small ascitic drainages at home? Perhaps the time has arrived when hepatologists and PD nephrologists begin to work shoulder to shoulder in this particular field, as we have a common problem, the peritoneal cavity filled with fluid.
Perit Dial Int 1996
PMID:Peritoneal dialysis in liver disorders. 872 96


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