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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#58;</p><p class="elsevierStylePara">Saccharomyces cerevisiae &#40;S&#46; cerevisiae&#41; is a yeast used habitually in breadmaking and alcoholic fermentation&#46;<span class="elsevierStyleSup">1</span> Its isolation as a pathogen in humans is infrequent&#46; This bears relation to its capacity to colonise the digestive tract and to its use as a probiotic in the treatment and prevention of diarrhoea associated with Clostridium difficile&#44; and in other illnesses&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara"><span class="elsevierStyleSup"></span>We describe a case of peritonitis caused by S&#46; cerevisiae in an ambulatory peritoneal dialysis patient&#46; The case concerns a 59 year old male diagnosed 25 years ago with type 2 diabetes mellitus with photocoagulated retinopathy&#44; arterial hypertension and asymptomatic nephrolithiasis in the lower pole of the left kidney which had evolved into advanced renal failure&#44; for which the patient was included in a programme of peritoneal dialysis&#46;</p><p class="elsevierStylePara">The patient attended the Emergency Unit presenting with retrosternal pain&#44; nausea&#44; vomiting&#44; dysphagia with solid foods and diffuse abdominal pain&#46; Fifteen days previously a diagnosis of peritonitis with negative cultures had been made by the nephrology department&#46; This was treated empirically with vancomycin and ceftazidime&#46; Cloudy liquid persisted over the following days&#46; The patient was admitted and peritoneal liquid was sent to the biochemistry and microbiology departments&#44; where it was cultured using the usual means&#46; The cellular count was 350 leukocytes&#44; 46&#37; of which were polymorphonuclear&#46;</p><p class="elsevierStylePara">After 24 hours the microbiology lab sent a preliminary report showing a result of Candida sp&#46; with species pending&#59; the nephrology department was also informed by telephone&#46; The patient was initially treated with fluconazole and 5-fluorocytosine&#46;</p><p class="elsevierStylePara">The following day the yeast was identified&#44; using the VITEK 2 system&#44; as S&#46; cerevisiae&#46; This identification was confirmed using the API ID 32C system &#40;both from BioMerieux&#41;&#46; In addition&#44; an antimycogram was carried out using the SENSITITRE system&#44; it being sensitive to all the tested antifungal drugs &#40;amphotericin B&#44; fluconazole&#44; itraconazole&#44; ketoconazole&#44; 5-fluorocytosine&#44; voriconazole and caspofungin&#41;&#44; and this provided a definitive report&#46; When we reported the isolation of this fungus to nephrology&#44; they informed us that the patient was a baker&#46;</p><p class="elsevierStylePara">Given this result&#44; antifungal treatment was modified&#44; suspending fluconazole and treating the infection with 5-fluorocytosine &#40;500mg every 12 hours&#44; following a loading dose of 2g on the first day&#41; and lipsomal amphotericin B &#40;70mg ev&#46; on the first day&#44; 150mg ev&#46; on the second and 200mg ev&#46; from the third day&#41;&#44;&#46; The patient showed a good level of tolerance to the treatment&#46; After five days the liquid cell count was lower&#44; and after fourteen days it was normal&#44; with liquid showing as clear&#46; Following twenty days of treatment the patient was healthy&#44; and was discharged&#46;</p><p class="elsevierStylePara">Although S&#46; cerevisiae is not a common pathogen&#44; it has been principally involved in various clinical processes such as fungaemia associated with catheters&#44; arthritis&#44; peritonitis&#44; disseminated infection in advanced AIDS and in neutropaenia&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">We have found three published cases of peritonitis caused by this yeast in ambulatory peritoneal dialysis patients&#46;<span class="elsevierStyleSup">4-6</span></p><p class="elsevierStylePara">Our patient could have been infected by this yeast&#44; given that he and his wife were in daily contact with the fungus through being bakers&#46; In the published cases&#44; no reference is made as to what could have been the source of the infection&#46;</p><p class="elsevierStylePara">Amphotericin B is the drug of choice in empirical treatment&#46;<span class="elsevierStyleSup">7</span> Our strain was susceptible&#44; in vitro&#44; to all the tested antifungal drugs&#46; According to the bibliography consulted&#44; S&#46; cerevisiae is usually susceptible in vitro to amphotericin B and 5-fluorocytosine&#44; whereas there are some strains which are resistant or potentially resistant to the action of derived azoles&#46;<span class="elsevierStyleSup">8</span> Therefore&#44; when this yeast is isolated&#44; it is advisable to modify treatment if it has been started with any derived azole&#44; as was done in the case of our patient&#46; The data referring to treatment of this fungus is scarce&#44; since&#44; as we have said&#44; its isolation is uncommon&#46;</p><p class="elsevierStylePara">Although fungal peritonitis in peritoneal dialysis patients at times requires the withdrawal of the peritoneal catheter&#44; in our case this was not necessary&#44; since following the treatment the patient developed well&#46;<br></br></p>"
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Peritonitis caused by Saccharomyces cerevisiae in an ambulatory peritoneal dialysis patient
PERITONITIS POR SACCHAROMYCES CEREVISIAE EN UN PACIENTE SOMETIDO A DIALISIS PERITONEAL AMBULATORIA
Bárbara Gomila Sarda, Carlos José Téllez-Castilloa, Hector García Péreza, Rosario Moreno Muñoza
a Servicio de Microbiología y servicio de Nefrología, Hospital General de Castellón Castellón, Castellón, España,
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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#58;</p><p class="elsevierStylePara">Saccharomyces cerevisiae &#40;S&#46; cerevisiae&#41; is a yeast used habitually in breadmaking and alcoholic fermentation&#46;<span class="elsevierStyleSup">1</span> Its isolation as a pathogen in humans is infrequent&#46; This bears relation to its capacity to colonise the digestive tract and to its use as a probiotic in the treatment and prevention of diarrhoea associated with Clostridium difficile&#44; and in other illnesses&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara"><span class="elsevierStyleSup"></span>We describe a case of peritonitis caused by S&#46; cerevisiae in an ambulatory peritoneal dialysis patient&#46; The case concerns a 59 year old male diagnosed 25 years ago with type 2 diabetes mellitus with photocoagulated retinopathy&#44; arterial hypertension and asymptomatic nephrolithiasis in the lower pole of the left kidney which had evolved into advanced renal failure&#44; for which the patient was included in a programme of peritoneal dialysis&#46;</p><p class="elsevierStylePara">The patient attended the Emergency Unit presenting with retrosternal pain&#44; nausea&#44; vomiting&#44; dysphagia with solid foods and diffuse abdominal pain&#46; Fifteen days previously a diagnosis of peritonitis with negative cultures had been made by the nephrology department&#46; This was treated empirically with vancomycin and ceftazidime&#46; Cloudy liquid persisted over the following days&#46; The patient was admitted and peritoneal liquid was sent to the biochemistry and microbiology departments&#44; where it was cultured using the usual means&#46; The cellular count was 350 leukocytes&#44; 46&#37; of which were polymorphonuclear&#46;</p><p class="elsevierStylePara">After 24 hours the microbiology lab sent a preliminary report showing a result of Candida sp&#46; with species pending&#59; the nephrology department was also informed by telephone&#46; The patient was initially treated with fluconazole and 5-fluorocytosine&#46;</p><p class="elsevierStylePara">The following day the yeast was identified&#44; using the VITEK 2 system&#44; as S&#46; cerevisiae&#46; This identification was confirmed using the API ID 32C system &#40;both from BioMerieux&#41;&#46; In addition&#44; an antimycogram was carried out using the SENSITITRE system&#44; it being sensitive to all the tested antifungal drugs &#40;amphotericin B&#44; fluconazole&#44; itraconazole&#44; ketoconazole&#44; 5-fluorocytosine&#44; voriconazole and caspofungin&#41;&#44; and this provided a definitive report&#46; When we reported the isolation of this fungus to nephrology&#44; they informed us that the patient was a baker&#46;</p><p class="elsevierStylePara">Given this result&#44; antifungal treatment was modified&#44; suspending fluconazole and treating the infection with 5-fluorocytosine &#40;500mg every 12 hours&#44; following a loading dose of 2g on the first day&#41; and lipsomal amphotericin B &#40;70mg ev&#46; on the first day&#44; 150mg ev&#46; on the second and 200mg ev&#46; from the third day&#41;&#44;&#46; The patient showed a good level of tolerance to the treatment&#46; After five days the liquid cell count was lower&#44; and after fourteen days it was normal&#44; with liquid showing as clear&#46; Following twenty days of treatment the patient was healthy&#44; and was discharged&#46;</p><p class="elsevierStylePara">Although S&#46; cerevisiae is not a common pathogen&#44; it has been principally involved in various clinical processes such as fungaemia associated with catheters&#44; arthritis&#44; peritonitis&#44; disseminated infection in advanced AIDS and in neutropaenia&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">We have found three published cases of peritonitis caused by this yeast in ambulatory peritoneal dialysis patients&#46;<span class="elsevierStyleSup">4-6</span></p><p class="elsevierStylePara">Our patient could have been infected by this yeast&#44; given that he and his wife were in daily contact with the fungus through being bakers&#46; In the published cases&#44; no reference is made as to what could have been the source of the infection&#46;</p><p class="elsevierStylePara">Amphotericin B is the drug of choice in empirical treatment&#46;<span class="elsevierStyleSup">7</span> Our strain was susceptible&#44; in vitro&#44; to all the tested antifungal drugs&#46; According to the bibliography consulted&#44; S&#46; cerevisiae is usually susceptible in vitro to amphotericin B and 5-fluorocytosine&#44; whereas there are some strains which are resistant or potentially resistant to the action of derived azoles&#46;<span class="elsevierStyleSup">8</span> Therefore&#44; when this yeast is isolated&#44; it is advisable to modify treatment if it has been started with any derived azole&#44; as was done in the case of our patient&#46; The data referring to treatment of this fungus is scarce&#44; since&#44; as we have said&#44; its isolation is uncommon&#46;</p><p class="elsevierStylePara">Although fungal peritonitis in peritoneal dialysis patients at times requires the withdrawal of the peritoneal catheter&#44; in our case this was not necessary&#44; since following the treatment the patient developed well&#46;<br></br></p>"
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Article information
ISSN: 20132514
Original language: English
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