SAN DIEGO—A catheter-chewing cockatoo may have led clinicians to a new tool for the treatment of peritoneal dialysis (PD)-related zygomycete peritonitis.


While these infections are rare, they carry a high mortality rate even with treatment. Now, a case study presented here at the annual meeting of the Infectious Diseases Society of America in San Diego points to posaconazole as a potentially useful for disseminated zygomycosis. A research team found that this agent is well absorbed and extensively distributed in tissues.

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They described a 57-year-old woman with autosomal dominant polycystic kidney disease. She was started on PD in October 2003. She presented with PD-related peritonitis after her pet bird—a cockatoo—bit her catheter. The PD fluid was positive for Mucor species.


The patient received high-dose IV liposomal amphotericin-B (5-10 mg/kg per day) for eight weeks. A repeat abdominal CT scan, however, revealed new intraperitoneal nodules. Surgery was performed. Histology showed a necrotizing granulomatous reaction and fungal hyphae consistent with Mucor.


Following this treatment failure, the patient received posaconazole 400 mg twice a day for 5.4 months and subsequently had a complete recovery. She has had no recurrence of zygomycosis since completing the treatment two years ago and is now being considered for renal transplantation. 


Studies have demonstrated “up to 50% to 65% of patients with zygomycete peritonitis will die with treatment,” observed J. Gavin Cotter, MD, MPH, who presented the case. According to Dr. Cotter, a transplant fellow at the Mayo Clinic in Rochester, Minn., only 15 cases of zygomycete peritonitis have been reported in the literature, and only five (33%) survived.


“This is something that is really novel,” he said of his findings. “We have a new treatment with posaconazole. The old treatment was good but amphotericin really wasn’t tolerated that well.” Posaconazole can be given orally and it is tolerated well, he said. As for the cockatoo, the patient donated it to a friend.