FUNGAL PERITONITIS-CURRENT STATUS 1998

F ungal peritonitis (FP) is an uncommon but important complication of peritoneal dialysis. It is associated with high morbidity and mortality. Removal of Tenckhoff catheter and failure to continue peritoneal dialysis because of peritoneal adhesion or loss of ultrafiltration not uncommonly follows FP. The reported incidence varies from 2.7 %-15 % of all peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD), with most reported series between 3 % and 7%. Table 1 summarizes the incidence ofFP in major reported series in the last 10 years (1-10). Its occurrence rate basically follows the peritonitis rate, and the incidence (per-centage of all peritonitis episodes) does not seem to vary among different connection systems (6). Over 90 % of FP cases are caused by yeast organisms, mainly candida species (more than 75%). Candida albicans and C. parapsilosis are the most common organisms. Other candida species include C. tropicalis, C. guilliermondii, C. pseudotropicalis, C. lipolytica, C. famata, C. kusei, and others. Other yeast organisms included Torulopsis glabrata, Rhodotorula rubra, Geotrichum candidum. Sporadic cases of filamentous fungi peritonitis are seen. ETIOLOG Y Prior antibiotic exposure, particularly for treatment of bacterial peritonitis, is the most commonly identified predisposing factor. The incidence of such exposure before FP is summarized in Table 2 (2-12). Broad-spectrum antibiotic therapy can lead to gastrointestinal candida colonization (13), and isolation of candida from fecal flora following antimicrobial therapy in CAPD patients has been reported (14). Bu