Dr sivakajani Balakumar1, Dr Manohar Mogulla
1Royal Darwin Hospital, 105 Rocklands Dr,Tiwin NT 0810, Australia
Biography:
I am a graduate of medical studies from Sri Lanka, having received my undergraduate degree (MD) in 2014 and my postgraduate degree in 2021 (MD in Medicine). For the past 4 years, I have been working as an advanced trainee specializing in Nephrology and renal transplant medicine . Furthermore, I achieved my European Society of Nephrology qualification this year. My choice to pursue nephrology stems from my keen interest in the field that developed during my RMO period.
Background:
Pantoea is a yellow pigmented non-capsulated, non-spore-forming Gram-negative cylindrical bacterium in the Erwiniaceae family, commonly found as a colonizer in humans, plants and soil. Pantoea includes around 20 species, P. agglomerans is the most common species isolated from humans associated with opportunistic infections.
Pantoea agglomerans infrequently causes PD peritonitis which can lead to recurrent PD peritonitis. We report a case of successfully treated PD peritonitis caused by Pantoea spp initially presenting as pancolitis.
Case:
41 years old diabetic Australian aboriginal woman with end-stage kidney disease, on peritoneal dialysis presented with acute abdominal pain, fever of two days duration. Her PD fluid was cloudy, diagnosis of PD-associated peritonitis was made and empirically treated with intraperitoneal cefazolin and ceftazidime as per ISPD guidelines. Her pathology results include white blood cell count (WBC) of 8.3 x 10^9, with neutrophils constituting 79%, elevated C-reactive protein (CRP) of 332.6 mg/dL. The peritoneal fluid cell count (PCC) measured 5400 cells/µL with 89 % neutrophils. Initial CT scan of the abdomen and pelvis suggested possible pancolitis, managed conservatively with intraperitoneal antibiotics and a follow-up scan two days later showed stable findings. PD fluid analysis showed Gram negative bacilli, and cultures confirmed Pantoea spp. Following antimicrobial susceptibility testing, antibiotic regimen was modified to intraperitoneal ceftazidime for 21 days, resulting in a positive clinical outcome.
Discussion:
Pantoea associated PD peritonitis is rare, development of bacterial biofilms may lead to recurrent PD Peritonits, emphasizing the need for vigilant surveillance.