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LETTER TO EDITOR
Year : 2017  |  Volume : 27  |  Issue : 6  |  Page : 488-489
 

Streptococcus gallolyticus subsp. pasteurianus peritonitis in a patient on continuous ambulatory peritoneal dialysis


1 Department of Nephrology, Hospital Serdang, Selangor, Malaysia
2 Nephrology Unit, Universiti Putra Malaysia, Selangor, Malaysia

Date of Web Publication14-Nov-2017

Correspondence Address:
C.T.S. Lim
Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia 43400, Serdang
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijn.IJN_245_16

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How to cite this article:
Shanmuganathan M, Goh B L, Lim C. Streptococcus gallolyticus subsp. pasteurianus peritonitis in a patient on continuous ambulatory peritoneal dialysis. Indian J Nephrol 2017;27:488-9

How to cite this URL:
Shanmuganathan M, Goh B L, Lim C. Streptococcus gallolyticus subsp. pasteurianus peritonitis in a patient on continuous ambulatory peritoneal dialysis. Indian J Nephrol [serial online] 2017 [cited 2021 Dec 6];27:488-9. Available from: https://www.indianjnephrol.org/text.asp?2017/27/6/488/212890


Sir,

We report the first case of Streptococcus gallolyticus subsp. pasteurianus peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). A 63-year-old male of Indian origin, on CAPD since April 2013, presented to us with CAPD peritonitis. He was admitted and initiated on intraperitoneal (IP) cloxacillin and ceftazidime as per International Society of Peritoneal Dialysis guidelines. His laboratory investigations were as follows: C-reactive protein 47 mg/L, total white cell count 4.3 × 109/L, peritoneal dialysate (PD) cell count was 200 cells/mm 3 with predominant polymorphs. Dialysate fluid cleared up on day 2 of treatment with subsequent cell count of 25 cells/mm 3, and corresponding negative cell counts repeated twice. Preliminary reports revealed Gram-positive cocci in the dialysate fluid; therefore, IP ceftazidime was discontinued and IP cloxacillin maintained. However, on day 4 of treatment, PD culture grew S. gallolyticus subsp. pasteurianus, which was resistant to clindamycin, erythromycin, trimethoprim/sulfamethoxazole, and tetracycline but sensitive to cephalexin and penicillin G. IP cloxacillin was then changed to IP penicillin G 50,000 U per 2 L dialysate bag. He remained asymptomatic and was discharged, to complete 2 weeks of IP penicillin G on an outpatient basis.

Streptococcus has over 50 species in its genus. A serotype classification called Lancefield grouping was used to further classify beta-hemolytic streptococci based on specific carbohydrates present on the bacterial cell wall. S. gallolyticus subsp. pasteurianus is a newly classified group D Streptococcus species previously known as Streptococcus bovis type II/2. S. bovis has 2 biotypes: I and II. This new classification is due to their unique ability to be able to decarboxylate gallic acid.[1] Its unique genetic diversity has resulted in many subspecies that have been associated with an array of clinical implications.[2] They frequently inhabit the gastrointestinal tract of human and animals such as horses, cattle, pigs, and sheep. Besides its association with endocarditis and colorectal carcinoma, S. gallolyticus subsp. pasteurianus has been linked as a causative agent for meningitis and septicemia in patients with colonic carcinoma, cirrhosis, and chronic liver disease.[3],[4] Immunocompromised patients have been known to succumb fatally to septicemia caused by S. gallolyticus subsp. pasteurianus.[5]

Our timely initiation of IP ceftazidime and cloxacillin and prompt revision of antibiotics therapy according to antibiogram on day 4 with IP penicillin G led to the successful treatment of peritonitis. Our experience and literature review suggests that S. gallolyticus subsp. pasteurianus infection must not be taken lightly. Awareness regarding the threat posed by this organism is important to ensure the prompt initiation of antimicrobial therapy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Osawa R, Fujisawa T, Sly L. Streptococcus gallolyticus sp nov.: Gallate degrading organisms formerly assigned to Streptococcus bovis. Syst Appl Microbiol 1995;18:74-8.  Back to cited text no. 1
    
2.
Yap DY, To KK, Yip TP, Lui SL, Chan TM, Lai KN, et al. Streptococcus bovis peritonitis complicating peritoneal dialysis – A review of 10 years' experience. Perit Dial Int 2012;32:55-9.  Back to cited text no. 2
[PUBMED]    
3.
Gold JS, Bayar S, Salem RR. Association of Streptococcus bovis bacteremia with colonic neoplasia and extracolonic malignancy. Arch Surg 2004;139:760-5.  Back to cited text no. 3
[PUBMED]    
4.
Sturt AS, Yang L, Sandhu K, Pei Z, Cassai N, Blaser MJ. Streptococcus gallolyticus subspecies pasteurianus (Biotype II/2), a newly reported cause of adult meningitis. J Clin Microbiol 2010;48:2247-9.  Back to cited text no. 4
[PUBMED]    
5.
Alex D, Garvin DF, Peters SM. Streptococcus pasteurianus septicemia. Indian J Med Microbiol 2013;31:310-2.  Back to cited text no. 5
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