Neisseria mucosa - A rare cause of peritoneal dialysis-related peritonitis: A case report

Abstract

Background: Neisseria mucosa is a gram negative diplococcus belonging to the genus Neisseria found commonly in the upper respiratory tract. It is typically a commensal organism when it is parasitic on oral and nasal mucosa. To our knowledge, it does not cause disease in healthy individuals with normal immunity, but can be pathogenic in those with impaired immune function or change in bacterial colonization site. Neisseria mucosa has been reported to cause bacterial meningitis, conjunctivitis, pneumonia, endocarditis, peritonitis and urethritis. However, peritoneal dialysis-related peritonitis caused by Neisseria mucosa is extremely rare in clinical practice, which has not previously been reported in China.

Case summary: A 55-year-old female presented to the nephrology clinic with upper abdominal pain without apparent cause, accompanied by nausea, vomiting and diarrhea for two days. The patient had a history of Stage 5 chronic kidney disease for five years, combined with renal hypertension and renal anemia, and was treated with peritoneal dialysis for renal replacement therapy. The patient was subsequently diagnosed with peritoneal dialysis-related peritonitis. Routine examination of peritoneal dialysis fluid showed abdominal infection, and the results of microbial culture of the peritoneal dialysis fluid confirmed Neisseria mucosa. Imi-penem/ cilastatin 1.0 g q12h was added to peritoneal dialysis fluid for anti-infection treatment. After 24 d, the patient underwent upper extremity arteriovenous fistulation. One month later, the patient was discharged home in a clinically stable state.

Conclusion: Peritonitis caused by Neisseria mucosa is rare. Patients with home-based self-dialysis cannot guarantee good medical and health conditions, and require education on self-protection.

Keywords: Case report; Neisseria mucosa; Peritoneal dialysis; Peritonitis.

Figure 1

Smear examination and bacterial culture results of peritoneal dialysis fluid. A: Gram staining of peritoneal dialysate specimens after centrifugation (×1000); B: Colony morphology on a blood agar plate at 35 °C, 5% CO₂ and cultured for 48 h.

Figure 2

Computed tomography results before and after treatment. A: Before treatment, computed tomography (CT) showed ascites without obvious thickening of the membrane; B: CT reexamination showed that peritoneal thickening has not been completely absorbed caused by peritonitis after treatment.