Fungal Peritonitis pada Pasien Continuous Ambulatory Peritoneal Dialysis (CAPD) - Adilistya, Tika; S. Timan, Ina (PT. Kalbe Farma Tbk., 2019)
Pendahuluan. Fungal peritonitis hanya terjadi pada 3-6% kasus dialysis-related peritonitis, namun mortalitasnya sangat tinggi. Gambaran klinis tidak spesifik, sehingga sulit dibedakan dengan peritonitis bakterial. Analisis dan biakan cairan dialisat berperan penting sebagai pedoman terapi antimikroba. Kasus. Laki-laki usia 22 tahun, menjalani CAPD selama 10 tahun, datang ke RS dengan nyeri perut berat saat inflow dan outflow cairan. Pada analisis cairan didapatkan makroskopis kuning keruh, hitung leukosit 2.580 sel/Î¼L dengan PMN sebanyak 90%, dan kadar protein total 1,0 mg/dL. Pada pemeriksaan biakan ditemukan Candida tropicalis. Diskusi. Analisis cairan dialisat peritoneal belum lazim dilakukan dansampai saat ini belum ada nilai rujukan. Pada pasien ini dijumpai cairan keruh, jumlah leukosit lebih dari 100 sel/Î¼L dengan dominasi PMN, serta biakan positif, sehingga memenuhi kriteria diagnosis fungal peritonitis (International Society of Peritoneal Dialysis, 2009). Pada pasien ini dijumpai kadar protein total 1,0 g/dL. Dalam keadaan normal, cairan dialisat tidak mengandung protein. Adanya peritonitis menyebabkan pembukaan pori besar pada membran peritoneum sehingga terjadi kebocoran makromolekul. Simpulan. Analisis cairan dialisat penting dilakukan pada kecurigaan infeksi. Diagnosis fungal peritonitis dapat ditegakkan melalui pemeriksaan analisis cairan serta dipastikan melalui pemeriksaan biakan.Introduction. Fungal peritonitis accounts for 3-6% of dialysis-related peritonitis with high mortality rates. Clinical signs and symptoms are nonspecific and similar to bacterial peritonitis. Dialysate fluid analysis and culture test have an important role as a guideline for antimicrobial therapy. Case. A 22-years-old male with a history of ESRD who had been on CAPD for 10 years was admitted to hospital with severe abdominal pain. The dialysate fluid was cloudy, contained 2.580 leucocytes/Î¼L with 90% polymorphonuclear cells and fluid total protein level was 1,0 mg/dL. Fluid culture test was positive for Candida tropicalis. Discussion. Dialysate fluid analysis is not common and unlike other fluid analysis, there is no reference range for this test panel. Cloudy dialysate, increased leucocyte count more than 100 cells/Î¼L with polymorphonuclear cells predominant are consistent with fungal peritonitis guideline by International Society of Peritoneal Dialysis. Normally, dialysate fluid does not contain protein but in this case, fluid total protein was 1,0 g/dL. Opening of large pores in the capillaries causes a markedly increased leakage of macromolecules. Conclusion. Dialysate fluid analysis has an important role in cases with high suspicion of dialysis-related peritonitis. Diagnosis of fungal peritonitis is made by fluid leucocyte count, differential count, and confirmed by culture test.