Paracoccus yeei에 의한 복막투석 관련 복막염 1예
A Rare Case of Peritoneal Dialysis-Related Peritonitis Caused by Paracoccus yeei
가톨릭대학교 의과대학 서울성모병원 진단검사의학과1, 신장내과2
Departments of Laboratory Medicine1 and Nephrology2, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, KoreaCorrespondence to:
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Lab Med Online 2023; 13(1): 31-35
Published January 1, 2023
Copyright © The Korean Society for Laboratory Medicine.
Organisms of the genus
Here, we describe a case of peritoneal dialysis-related peritonitis caused by
A 39-year-old male with end-stage renal failure due to focal segmental glomerulosclerosis had been on continuous ambulatory peritoneal dialysis since 2012. He was seen at the PD peritoneal dialysis unit on March 21, 2021 reporting cloudy peritoneal fluid in the absence of fever or abdominal pain. Microscopic examination of the peritoneal fluid showed 1,750/μL of white blood cells (WBCs), with 46% of those being neutrophils. Other laboratory tests such as complete blood cell count or C-reactive protein (CRP) were not performed.
A peritoneal fluid sample of approximately 5 mL was inoculated in a BACTEC Plus Aerobic/F and Plus Anaerobic/F broth (Becton Dickinson, Meylan, France) and incubated at 37°C in a BACTEC blood culture system (Becton Dickinson). Bacterial growth was detected in the aerobic bottle after 30 hours of incubation. This was subsequently subcultured onto blood, McConkey, and chocolate agar. After 48 hours of incubation, shiny, brownish white colonies were observed on the blood and chocolate agars (Fig. 1A and 1B). Gram staining of these colonies showed the presence of gram-negative diplococci with a central halo shaped like a doughnut (Fig. 2). This strain (
Figure 1. (A) Colonies of
Paracoccus yeeion a blood agar plate after 24 hours of incubation in a 37°C incubator with 5% CO2. (B) Colonies of P. yeeion a blood agar plate after 48 hours of incubation. Note the shiny brownish white colonies.
Figure 2. Microscopic description of
Paracoccus yeeiwith Gram stain. Note the gram-negative diplococci with peripheral staining (O-shaped).
Recently, Lasek et al.  characterized the species-specific genes of
Figure 3. 1.5% agarose gel electrophoresis results from the amplification of putative virulence genes. Lane L contains the ladder and lane N contains the negative control with primer and no
Paracoccus yeeiDNA. Lane P contains the KPC gene product with a KPC-specific primer (873 bp). Lanes 1–10 contain virulence genes ( PY32053_00730, PY32053_00015, PY32053_00016, PY32053_00072, PY32053_00902, PY32053_04123, PY32053_04125, PY32053_04669, PY32053_04670, PY32053_04680).
After administration of intraperitoneal cefazolin and gentamicin, the turbidity of the peritoneal fluid gradually cleared and the WBC count was normalized. Although the negative conversion of peritoneal dialysis fluid culture was achieved after 3 days, the patient received intraperitoneal administration of gentamicin for 3 weeks according to the ISPD peritonitis recommendations .
In this study, we used PCR to identify the presence of virulence genes as analysis of the virulence gene profile is important for infection prognosis and understanding the epidemiological prevalence. We investigated the presence of each of the five determinants in the chromosome and extrachromosomal replicons by PCR and sequencing. The
We reviewed 5 other cases of peritoneal dialysis-related peritonitis caused by
Cases like this can often be misinterpreted as caused by coagulase-negative staphylococcus (CoNS), which is the most common cause of peritoneal dialysis-related peritonitis. Misdiagnosis of a
The 2016 ISPD peritonitis recommendations  state that for empiric antibiotic selection, gram-negative organisms should be covered by third-generation cephalosporin or an aminoglycoside. However, after identification of the organisms, while
Supplementary Table 1. Primer information for virulence gene PCR
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