An unusual case of unresolving tunnel infection in a patient on continuous ambulatory peritoneal dialysis

Atypical mycobacteria remain a rare cause of peritoneal dialysis catheter-related tunnel infection (TI) and poses serious risk because of the resistant nature to most antibiotic therapy. Non-tubercular mycobacterial infections lead to chronicity requiring peritoneal dialysis catheter removal. We report an 82-year-old male, with diabetic nephropathy who had a coinfection with Staphylococcus hominis and Mycobacterium abscessus who presented with pus discharge at exit site and TI. He was treated with relocation of the extraperitoneal part of the catheter with a new exit site without catheter removal and multidrug mycobacterial therapy.

Risk of relapse in clients with alcohol dependence syndrome in a tertiary care hospital

Alcoholism is one of the major health problems seen all over the world. The risk of relapse was estimated among 94 clients with alcohol dependence syndrome (ADS) who attended both in- and out-patient units of a tertiary care hospital. The tools used were the sociodemographic and clinical variables, Clinical Institute of Withdrawal Assessment Alcohol–revised (CIWA–Ar), Alcohol Use Disorder Identification Test (AUDIT), and Advanced Warning of Relapse (AWARE) scale. Out of the 94 clients, 63 (67.7%) were in the low-risk group for getting relapse, 26 (27.7%) were in the moderate-risk group, and 5 (5.3%) were in the high-risk group. Family history of alcohol use was significantly associated with the AWARE score (P < 0.05). Nicotine use was reported by 56 (59.6%) clients. Clients with a positive family history of alcohol use, disturbed sleep pattern, and higher total score (>20) of AUDIT scale were at higher risk of relapse.

Twenty-one episodes of peritonitis in a continuous ambulatory peritoneal dialysis patient: What is the root cause?

A 51-year-old female, with non-alcoholic liver cirrhosis, portal hypertension, type 2 diabetes mellitus, autosomal dominant polycystic kidney disease with a clipped cerebral aneurysm and chronic kidney disease stage 5 was on continuous ambulatory peritoneal dialysis (CAPD) for 6.5 years elsewhere. She came for opinion on continuation of CAPD as she had 21 episodes of peritonitis in 76 months. Her blood pressure was 80/50 mmHg. She was on haemodialysis with a temporary central access for 2 weeks. She had no abdominal tenderness, and exit site looked normal. Fluid was negative for Mycobacterium tuberculosis. Laparoscopically, we replaced the catheter with a new swan-neck Tenckhoff double-cuff catheter through a different exit site in the same sitting. Catheter-tip biofilm culture isolated Enterococcus casseliflavus. Peritoneal sampling biopsy showed evidence of fibrosis. She has adequate ultrafiltration and is currently on automated peritoneal dialysis for 5 months.