Fungal Peritonitis: A Case Series Detailing Clinical Presentations, Diagnostic Challenges, and Management Strategies

Authors

DOI:

https://doi.org/10.57125/FEM.2025.06.30.03

Keywords:

Peritonitis, Fungal Peritonitis, Comorbidity, Candida albicans

Abstract

Aims: to present the features of fungal peritonitis.

Methodology: The case series comprised three patients: a 52-year-old male with a post-splenectomy subdiaphragmatic abscess, a 64-year-old male with post-operative peritonitis following a perforated duodenal ulcer repair, a 68-year-old female with primary peritonitis. The clinical history, physical examination findings, laboratory and imaging results, surgical reports, and treatment outcomes are presented.

Results: All patients exhibited comorbidities. Non-specific symptoms characterized clinical presentations. Imaging modalities were valuable diagnostic tools. Candida albicans was identified as the causative organism in all cases.

Conclusion: Fungal peritonitis is a clinically challenging condition with non-specific clinical and laboratory manifestations.

References

Bassetti M, Righi E, Ansaldi F, et al. A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality. Intensive Care Med. 2015;41(9):1601-10. doi:10.1007/s00134-015-3866-2

Fiore M, Leone S. Spontaneous fungal peritonitis: Epidemiology, current evidence and future prospective. World J Gastroenterol. 2016;22(34):7742-7. doi:10.3748/wjg.v22.i34.7742

Nyumura Y, Tsuboi K, Suzuki T, et al. Pathophysiology and surgical outcomes of patients with fungal peritonitis from upper gastrointestinal tract perforation: a retrospective study. Surg Today. 2024;54(11):1345-52. doi:10.1007/s00595-024-02851-9

Casadevall A. Immunity to Invasive Fungal Diseases. Annu Rev Immunol. 2022;40:121-41. doi:10.1146/annurev-immunol-101220-034306

Burgess TB, Condliffe AM, Elks PM. A Fun-Guide to Innate Immune Responses to Fungal Infections. J Fungi (Basel). 2022;8(8):805. doi:10.3390/jof8080805

Garnacho-Montero J, Barrero-García I, León-Moya C. Fungal infections in immunocompromised critically ill patients. J Intensive Med. 2024;4(3):299-306. doi:10.1016/j.jointm.2024.01.005

Montravers P, Blot S, Dimopoulos G, et al. Therapeutic management of peritonitis: a comprehensive guide for intensivists. J Intensive Care Med. 2016;42(8):1234-47. doi:10.1007/s00134-016-4307-6

Xu Z, Qiao S, Qian W, et al. Card9 protects fungal peritonitis through regulating Malt1-mediated activation of autophagy in macrophage. Int Immunopharmacol. 2022;110:108941. doi:10.1016/j.intimp.2022.108941

Bajaj JS, Reddy RK, Tandon P, et al. Prediction of Fungal Infection Development and Their Impact on Survival Using the NACSELD Cohort. Am J Gastroenterol. 2018;113(4):556-63. doi:10.1038/ajg.2017.471

Kanjanabuch T, Nopsopon T, Saejew T, et al. Serum Galactomannan: A Predictor of Poor Outcomes in Peritoneal Dialysis Patients With Fungal Peritonitis. Kidney Int Rep. 2023;9(2):287-95. doi:10.1016/j.ekir.2023.11.002

Liu L, Xie K, Yin M, et al. Serum potassium, albumin and vitamin B(12) as potential oxidative stress markers of fungal peritonitis. Ann Med. 2021;53(1):2132-41. doi:10.1080/07853890.2021.1999489

Bassetti M, Giacobbe DR, Agvald-Ohman C, et al. Invasive Fungal Diseases in Adult Patients in Intensive Care Unit (FUNDICU): 2024 consensus definitions from ESGCIP, EFISG, ESICM, ECMM, MSGERC, ISAC, and ISHAM. Intensive Care Med. 2024;50(4):502-15. doi:10.1007/s00134-024-07341-7

De Waele JJ, Coccolini F, Lagunes L, et al. Optimized Treatment of Nosocomial Peritonitis. Antibiotics (Basel). 2023;12(12):1711. doi:10.3390/antibiotics12121711

Li R, Zhang D, He J, et al. Characteristics Analysis, Clinical Outcome and Risk Factors for Fungal Peritonitis in Peritoneal Dialysis Patients: A 10-Year Case-Control Study. Front Med (Lausanne). 2021;8:774946. doi:10.3389/fmed.2021.774946

Cho Y, Chow KM, Kam-Tao Li P, Runnegar N, Johnson DW. Peritoneal Dialysis-Related Infections. Clin J Am Soc Nephrol. 2024;19(5):641-9. doi:10.2215/CJN.0000000000000280

Li B, Yang C, Qian Z, Huang Y, et al. Spontaneous Fungal Ascites Infection in Patients with Cirrhosis: An Analysis of 10 Cases. J Infect Dis Ther. 2021;10(2):1033-43. doi:10.1007/s40121-021-00422-w

Gonzalez-Cordero AF, Malavé-Sánchez M, Vergara-Gómez M, Franqui-Rivera H. Spontaneous Fungal Peritonitis: A Rare Complication of Heart Failure. JACC Case Rep. 2019;1(3):372-5. doi:10.1016/j.jaccas.2019.07.036

Reque J, Arlandis R, Panizo N, Pascual MJ, Perez-Alba A. Candida auris Invasive Infection after Kidney Transplantation. Case Rep Nephrol. 2022;2022:6007607. doi:10.1155/2022/6007607

Berger JM, Lötsch F, Berghoff AS, et al. A case of fungal peritonitis in a patient with paramalignant ascites. Med Mycol Case Rep. 2024;45:100660. doi:10.1016/j.mmcr.2024.100660

Bichovsky Y, Koyfman L, Friger M, et al. The Clinical Outcome of Postoperative Invasive Fungal Infections Complicating Laparoscopic Sleeve Gastrectomy. Obes Surg. 2018;28(10):3268-75. doi:10.1007/s11695-018-3347-0

Lock JF, Eckmann C, Germer CT. Characteristics of postoperative peritonitis. Chirurg. 2016;87(1):20-5. doi:10.1007/s00104-015-0110-0

Launey Y, Duteurtre B, Larmet R, et al. Risk factors for mortality in postoperative peritonitis in critically ill patients. World J Crit Care Med. 2017;6(1):48-55. doi:10.5492/wjccm.v6.i1.48

Montravers P, Grall N, Kantor E, et al. Microbiological profile of patients treated for postoperative peritonitis: temporal trends 1999-2019. World J Emerg Surg. 2023;18(1):58. doi:10.1186/s13017-023-00528-1

Yokoe T, Shiraga H, Ikeura T, Kita M. Transgastric drainage for subdiaphragmatic abscess secondary to perforation of the sigmoid colon after cytoreductive surgery for advanced ovarian cancer. BMJ Case Rep. 2024;17(3):e259172. doi:10.1136/bcr-2023-259172

Ogonowski Bizos AK, White M, Fagan J, Pretorius V. Fungal abscess of the parotid gland - the value of microbiological assessment. S Afr J Surg. 2023;61(2):83-5. doi:10.36303/SAJS.3899

Successful treatment of disseminated fungal abscess-type lesions in the brain and lungs in the course of aspergillosis in a kidney transplant recipient. Pol Arch Intern Med. 2024;134(7-8):16745. doi:10.20452/pamw.16745

Lopes JP, Lionakis MS. Pathogenesis and virulence of Candida albicans. Virulence. 2022;13(1):89-121. doi:10.1080/21505594.2021.2019950

Tanba C, Saleh N. Fungal Peritonitis Secondary to Aspergillosis in a Peritoneal Dialysis Patient. J Community Hosp Intern Med Perspect. 2022;12(6):113-5. doi:10.55729/2000-9666.1115

Kumar A, Chauhan N. Rhodotorula mucilaginosa: Rare Cause of Fungal Peritonitis. Indian J Nephrol. 2023;33(1):77-8. doi:10.4103/ijn.ijn_79_22

Bovy MA, Beckers P, Defawe F, et al. Aspergillus fumigatus Postoperative Fasciitis and Peritonitis. Mycopathologia. 2024;189(4):57. doi:10.1007/s11046-024-00858-x

Na Ra Yun. Fungal Infection in Patients with Diabetes Mellitus. J Korean Diabetes. 2017;18(1):20. doi:10.4093/jkd.2017.18.1.20

Sohail MU, Mashood F, Oberbach A, Chennakkandathil S, Schmidt F. The role of pathogens in diabetes pathogenesis and the potential of immunoproteomics as a diagnostic and prognostic tool. Front Microbiol. 2022;13:1042362. doi:10.3389/fmicb.2022.1042362

Poradzka A, Jasik M, Karnafel W, Fiedor P. Clinical aspects of fungal infections in diabetes. Acta Pol Pharm. 2013;70(4):587-96.

Gupta AK, Shemer A, Economopoulos V, Talukder M. Diabetic Foot and Fungal Infections: Etiology and Management from a Dermatologic Perspective. J Fungi (Basel). 2024;10(8):577. doi:10.3390/jof10080577

Benabed A, Bechade C, Ficheux M, et al. Effect of assistance on peritonitis risk in diabetic patients treated by peritoneal dialysis: report from the French Language Peritoneal Dialysis Registry. Nephrol Dial Transplant. 2016;31(4):656-62. doi:10.1093/ndt/gfw011

Sartelli M, Coccolini F, Kluger Y, et al. WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections. World J Emerg Surg. 2021;16(1):49. doi:10.1186/s13017-021-00387-8

Huston JM, Barie PS, Dellinger EP, et al. The Surgical Infection Society Guidelines on the Management of Intra-Abdominal Infection: 2024 Update. Surg Infect (Larchmt). 2024;25(6):419-35. doi:10.1089/sur.2024.137

Molina JC, Guerrero-Morán JD, González-Espinosa C. Alcohol: Immunomodulatory Effects and Cancer. Rev Invest Clin. 2023;75(3):129-42. doi:10.24875/RIC.23000116

Jackman RP. Immunomodulation in transfused trauma patients. Curr Opin Anaesthesiol. 2013;26(2):196-203. doi:10.1097/ACO.0b013e32835d7160

Germer CT, Eckmann C. Peritonitis. Der Chirurg. 2016;87(1):5-8. doi:10.1007/s00104-015-0118-5

Hranjec T, Watson CM, Sawyer RG. Peritonitis: Definitions of Primary, Secondary, and Tertiary. In: Vincent JL, Hall JB, editors. Encyclopedia of Intensive Care Medicine. Berlin: Springer; 2012. doi:10.1007/978-3-642-00418-6_84

Abbas AK, Lichtman AH, Pillai S. Cellular and molecular immunology. 10th ed. International edition. Philadelphia: Elsevier/Saunders; 2020. 545 p.

Sanders DL, Pawlak MM, de Beaux AC. European Hernia Society incisional hernia guidelines. Br J Surg. 2023;110(3):343. doi:10.1093/bjs/znac456

Deerenberg EB, Henriksen NA, Antoniou GA, et al. Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies. Br J Surg. 2022;109(12):1239-50. doi:10.1093/bjs/znac302

Lozada Hernández EE, Hernández Bonilla JP, Hinojosa Ugarte D, et al. Abdominal wound dehiscence and incisional hernia prevention in midline laparotomy: a systematic review and network meta-analysis. Langenbecks Arch Surg. 2023;408(1):268. doi:10.1007/s00423-023-02954-w

Downloads

Published

2025-05-24

How to Cite

Grynchuk, F., Grynchuk, A., & Grynchuk Jr, F. (2025). Fungal Peritonitis: A Case Series Detailing Clinical Presentations, Diagnostic Challenges, and Management Strategies. Futurity Medicine, 4(2). https://doi.org/10.57125/FEM.2025.06.30.03