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LETTER TO EDITOR
Year : 2013  |  Volume : 23  |  Issue : 6  |  Page : 464-465
 

Peritonitis due to nontuberculous mycobacterium


1 Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
2 Department of Nephrology, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Andhra Pradesh, India

Date of Web Publication24-Oct-2013

Correspondence Address:
R Ram
Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati - 517502, Andhra Pradesh,
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.120350

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How to cite this article:
Ram R, Naidu G D, Swarnalatha G, Dakshinamurty K V. Peritonitis due to nontuberculous mycobacterium. Indian J Nephrol 2013;23:464-5

How to cite this URL:
Ram R, Naidu G D, Swarnalatha G, Dakshinamurty K V. Peritonitis due to nontuberculous mycobacterium. Indian J Nephrol [serial online] 2013 [cited 2021 Nov 30];23:464-5. Available from: https://www.indianjnephrol.org/text.asp?2013/23/6/464/120350


Sir,

Between 1998 and June 2012, 650 end-stage renal disease (ESRD) patients were initiated on peritoneal dialysis (PD) at our institute. During this 14-year period, there were 276 bacterial, 16 tuberculous, 68 fungal, nine nontuberculous mycobacterium (NTM), and 141 culture-negative peritonitis episodes. The cumulative follow-up of 650 patients was 13,710 months. We diagnosed nine cases as peritonitis due to NTM. Hence, the incidence of bacterial, tuberculous, NTM, and fungal peritonitis was one episode per 49.6, 856.8, 1523.3, and 201.6 patient-months, respectively. The patients of peritonitis presented in two clusters-in 2005 and 2012. The mean age was 51.11 years. There were eight males. All patients had growth identified as Runyon class IV: Rapid growers. There was growth on Löwenstein-Jensen medium between 4 and 11 days. The organisms were differentiated from Mycobacterium tuberculosis by BACTEC NAP test. [1]

We compared the clinical and laboratory features of patients of peritonitis due to NTM and those of PD patients with bacterial peritonitis reported during these two years. We could not compare with peritonitis due to M. tuberculosis, for there were only three such patients during this period. The data are reported in [Table 1].
Table 1: Patients of NTM peritonitis

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Only fever was found to be significantly associated with peritonitis due to NTM peritonitis when compared to bacterial peritonitis. An index of suspicion for NTM peritonitis would be an episode of peritonitis appearing early after placement of the catheter. Only one previous study [2] identified fever to be present in a higher percentage of patients of NTM peritonitis than in other peritonitis.

During the same months of NTM peritonitis, there were reports of infection due to NTM in other surgeries performed at our institute. Culture of tap water and scrapings from the walls of operating room did not yield any growth. However, rapidly growing mycobacteria can be recovered from soil and natural water supplies, and are the most common NTM associated with nosocomial disease. Investigations of nosocomial outbreaks or pseudo-outbreaks caused by these species have demonstrated that tap water, ice prepared from tap water, processed tap water used for dialysis, and distilled water used for preparing solutions such as gentian violet are the usual nosocomial sources of the organisms. [3]

In a recent review [4] of 41 articles, 57 patients of PD-associated NTM peritonitis were reported. In this review, only patients of NTM peritonitis among PD patients who were confirmed by culture of the peritoneal fluid were included. At least 21 articles were excluded in this review, as NTM was not identified to the species level. At our institute, we do not have the facility to identify the NTM species.

 
  References Top

1.Laszlo A, Siddiqi SH. Evaluation of a rapid radiometric differentiation test for the Mycobacterium tuberculosis complex by selective inhibition with p-nitro-α-acetylamino-β-hydroxypropiophenone. J Clin Microbiol 1984;19:694-8.  Back to cited text no. 1
    
2.Dunmire RB 3 rd , Breyer JA. Nontuberculous mycobacterial peritonitis during continuous ambulatory peritoneal dialysis: Case report and review of diagnostic and therapeutic strategies. Am J Kidney Dis 1991;18:126-30.  Back to cited text no. 2
    
3.Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association. Am J Respir Crit Care Med 1997;156:S1-25.  Back to cited text no. 3
    
4.Song Y, Wu J, Yan H, Chen J. Peritoneal dialysis-associated nontuberculous mycobacterium peritonitis: A systematic review of reported cases. Nephrol Dial Transplant 2012;27:1639-44.  Back to cited text no. 4
    



 
 
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