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Case Reports
. 2022 Aug 9;23(1):279.
doi: 10.1186/s12882-022-02898-1.

Peritonitis after exposure to biocontrol-agent fumes containing Talaromyces flavus: a case report in peritoneal dialysis patient

Phanit Sookto  1 , Talerngsak Kanjanabuch  2   3   4   5 , Tamonwan Chamroensakchai  6 , Nisa Thongbor  1 , Somchai Eiam-Ong  7
Affiliations
Case Reports

Peritonitis after exposure to biocontrol-agent fumes containing Talaromyces flavus: a case report in peritoneal dialysis patient

Phanit Sookto et al. BMC Nephrol. .

Abstract

Background: The first case of Taralomyces flavus infection in human and peritoneal dialysis (PD) patient after exposure to biocontrol agent fumes is reported here.

Case presentation: A 77-year-old Thai female farmer with kidney failure presented with peritonitis and PD catheter obstruction from fungal biofilms. The potential root cause of infection was associated with exposure to biocontrol-agent fumes containing pathogen during agricultural work in her garden. This source of infection has not been mentioned previously. Showering and changing clothes right after outdoor activity with a high density of fungal matters or dust should be added to the routine aseptic technique before performing PD bag exchange to prevent the system contamination. Although the patient received early treatment with liposomal amphotericin B, itraconazole, and catheter removal, according to the ISPD Guideline 2016 and the Global Guideline 2021, the outcome was unfavorable. Antifungal susceptibility testing later revealed that the pathogen was only susceptible to voriconazole. Thus, antifungal susceptibility should be tested if the patient fails or slowly responds to the primary antifungal regimen.

Conclusions: T. flavus peritonitis is reported here after exposure to biocontrol-agent fumes containing the pathogen. This work also alerts and reiterates nephrology peers to be aware of this overlooked source of peritonitis, the exposure to dusty environments, specifically containing biocontrol-agent fumes.

Keywords: Biocontrol agents; Fungal peritonitis; Non-marneffei Talaromyces; Peritoneal dialysis; Talaromyces flavus.

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Conflict of interest statement

T.K. has received consultancy fees from VISTERRA as a country investigator and current recipient of the National Research Council of Thailand and received speaking honoraria from Astra Zeneca and Baxter Healthcare. All other authors declare that they have none.

Figures

Fig. 1
Fig. 1
A Fungal colonization inside PD catheter lumen. Microscopic examination of the fungal colonization depicts fungal hyphae on Lactophenol blue (B) and KOH (C). Macroscopic finding on SDA, 25 °C after 14 days of incubation (D). Microscopic examination of the colonies demonstrated a classic feature of the Penicillium genus, including conidiophores and conidia (E–H) on wet smear (G × 400) and Lactophenol blue stains (E × 200, F × 400, H × 1000)
Fig. 2
Fig. 2
The patient’s clinical course. Abbreviations: Amp, amphotericin B; Cath, PD catheter; HD, hemodialysis; ITZ, itraconazole; MKD, milligram/kilogram body weight/day; and UF, ultrafiltration
See this image and copyright information in PMC

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