ABSTRACT
Peritoneal dialysis (PD) is increasingly being utilized for renal replacement therapy in end stage renal disease (ESRD). Its benefits include lower cost and usage convenience. However’ PD associated peritonitis is a common and serious complication of peritoneal dialysis and a major cause of PD failure. Pasturella multocida is a rare cause of peritonitis but highly specific for domestic pet exposure being the causative factor. We present a case of peritonitis being caused by the contamination of dialysis circuit by a cat. A 55 year old female with ESRD on PD for 3 years presented due to abdominal discomfort’ low grade fever’ nausea’ vomiting’ and rigors for 3 days. PD fluid was obtained for analysis and showed 215 cells/mm3 with 192 neutrophils/mm3’ diagnostic of PD peritonitis. PD fluid culture grew Pasteurella multocida. Given the strong correlation of the organism with cats’ she was questioned about her living situation. She admitted that her daughter’ along with her 13 cats’ had moved in with her recently due to the COVID pandemic. The cats were likely responsible for inadvertent contamination of the PD circuit. She completed a 21 day course of intraperitoneal ceftriaxone with resolution of symptoms and infection. Pasturella multocida is an aerobic gram negative coccobacillus and forms the normal flora of the oral cavity of dogs and cats. Pet bites and scratches to the dialysis tubing can cause translocation of bacteria to the peritoneal cavity causing peritonitis. There are no clinical trials specifically looking at Pasteurella peritonitis but most of the previously reported cases have been known to respond to penicillin’ amoxicillin’ or 3rd generation cephalosporins. This case demonstrates the ever-evolving and vulnerable social situations of many PD patients. It underlies the importance of assessing the home situation at every visit as the source of infection might not be obvious on initial history taking and often requires more careful questioning. Patient education on strict hygiene and keeping pets away from the dialysis room plays a crucial role in preventing re-infection. Pasteurella infection does not necessarily require PD catheter removal if the inciting factor can be removed as in our case.