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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Peritonitis is an inflammation of the peritoneal membrane caused by infection&#44; generally bacterial&#46; It remains the most significant complication deriving from the dialysis technique itself&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Shewanella putrefaciens</span> is an oxidase-positive&#44; facultative anaerobic&#44; non-fermenting&#44; Gram-negative bacillus found mainly in marine environments&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is an uncommon pathogen in human beings&#44; mainly causing skin and soft-tissue infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We report a case of <span class="elsevierStyleItalic">S&#46; putrefaciens</span> peritonitis in a 40-year-old woman with Takayasu arteritis and stage 5 chronic kidney disease in automated peritoneal dialysis &#40;PD&#41; since February 2009&#46; In June 2014&#44; she visited the emergency department owing to fever and abdominal pain for the last 12<span class="elsevierStyleHsp" style=""></span>h&#46; Mesenteric ischaemia was ruled out by means of a CT scan&#46; Subsequently&#44; the peritoneal fluid was drained and peritoneal fluid with a cloudy&#44; yellowish appearance was observed&#46; A physical examination revealed diffuse abdominal pain&#44; and an inspection of the catheter outlet revealed no signs of local infection&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A peritoneal fluid count showed 20&#44;160<span class="elsevierStyleHsp" style=""></span>cells with 81&#37; polymorphonuclear cells&#44; and samples were collected for culture&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Blood clinical chemistry showed neutrophilia&#44; normochromic normocytic anaemia and high levels of acute-phase reactants and procalcitonin&#46; She was admitted given her compromised general condition and persistent fever&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Antibiotic therapy was started with intraperitoneal vancomycin and ceftazidime&#44; according to our hospital&#39;s protocol&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Multisensitive <span class="elsevierStyleItalic">S&#46; putrefaciens</span> and <span class="elsevierStyleItalic">Klebsiella oxytoca</span> were isolated in a peritoneal fluid culture&#46; Blood cultures were negative&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">After identification of the responsible pathogen&#44; treatment with vancomycin was suspended&#44; treatment with intraperitoneal ceftazidime was maintained and oral ciprofloxacin and fluconazole were added&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The patient progressed satisfactorily&#59; she became afebrile and asymptomatic and her laboratory parameters returned to normal&#46; She was discharged and remained in PD&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Shewanella</span> genus is found throughout numerous geographic areas with moderate climates&#44; mainly in humid environments &#40;saltwater&#44; freshwater and wastewater&#41;&#46; However&#44; it is also present in natural energy reserves &#40;petroleum and gas&#41;&#44; dairy products&#44; meat and human samples&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">It tends to isolate itself by becoming a part of a mixed bacterial flora&#59; therefore&#44; its clinical significance may be obscured by the other microorganisms&#46; It causes various types of syndromes&#44; and is found in patients with infectious endocarditis&#44; bacteraemia&#44; lower limb abscesses&#44; soft-tissue or intra-abdominal infections in patients in PD&#44; pneumonia associated with the use of mechanical ventilation&#44; eye infections and brain abscesses&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">S&#46; putrefaciens</span> pathogen tends to be sensitive to aminoglycosides&#44; carbapenems&#44; erythromycin and quinolones&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The pathogenesis and the site of entry of the infection remain poorly established&#46; Proximity to seawater or tap water renders these media potential sources of infection&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">There are 6 published cases of <span class="elsevierStyleItalic">S&#46; putrefaciens</span> peritonitis in patients in PD &#8211; Taiwan&#44; Australia&#44; Israel and the United States<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> &#8211; with a variety of clinical manifestations&#44; concomitant bacteraemia and&#44; sometimes&#44; a fatal outcome&#44; as in the case of peritonitis with necrotising fasciitis in Korea&#44; the case of peritonitis with spleen abscess from the Australian group&#44; and even other cases with fulminant periorbital &#8211; facial cellulitis&#44; biliary tract infection&#44; empyema or perianal abscess&#46; The majority of these patients had factors such as malignant neoplasm&#44; hepatobiliary disease&#44; neutropenia&#44; etc&#46; Renal failure may also represent a risk factor&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The case presented seems to be the first documented case in Spain&#46; After an exhaustive medical history we were unable to identify a clear source of exposure&#46; Our only clue was that the patient had a high level of exposure to seawater&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Whatever the mechanism&#44; it seems wise to warn patients in PD of the importance of properly covering the catheter outlet and any potential site of infection such as ulcers&#46; In addition&#44; although this type of peritonitis is uncommon&#44; a potentially serious cause of peritonitis should be considered and a skin lesion or portal of entry should be heeded as a potential warning&#44; especially in patients with a history of exposure to seawater&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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