Vibrio alginolyticus peritonitis associated with ambulatory peritoneal dialysis.

275 chorea occurs when the function of the corpus striatum is disrupted, the specific abnormality in Sydenham's chorea is unknown. The response to valproic acid suggests that the defect affects the GABA neurotransmitter system. Possibly the difference in effectiveness of valproic acid between Sydenham's chorea and Huntington's chorea reflects the degree of severity of the pathologic process or, alternatively, indicates a difference in the pathogenesis of the two diseases. Vibrio alginolyticus peritonitis associated with ambulatory peritoneal dialysis Vibrio alginolyticus is an unusual human pathogen. It is related to V parahaemolyticus and its natural habitat is the sea. Human infections reported to date have been mostly wound and ear infections in swimmers and others with marine contact. We believe that the following is the first reported case of V alginolyticus peritonitis. Case report A 20-year-old man with end-stage renal failurc, who had been receiving treatment for six months with continuous ambulatory peritoneal dialysis, presented with signs and symptoms of peritonitis. Several days previously he had been scuba-diving off the South Australian coast and had changed his peritoneal dialysis fluid on the beach without taking adequate precautions against infection. He presented with severe abdominal pain, appreciable fever, and signs of peritonism. Samples of macroscopically turbid peritoneal fluid were taken immediately from the Tenckhoff catheter for microscopy and culture. Gram staining showed pus cells but no organisms. Treatment was started with continuous peritoncal lavage with flucloxacillin (50 mg/l) added to the dialysis fluid. His symptoms improved but oxidase-positive, Gram-negative bacilli resistant to flucloxacillin (420 colonies/ml) were cultured from the first sample of dialysis fluid collected. The treatment was changed to gentamicin 4 mg/l as Pseudomonas was considered to be the likely infecting organism. Further identification was carried out using routine biochemical tests. Tl-e initial reactions suggested that the organism was possibly a member of the Bacillus genus. Since Gram staining showed large Gram-negative rods, however, the organism was resubmitted for appareil proc6d6s d'identification (API) and conventional tests. As the API system indicated that the organism was a vibrio (?V cholerae) his history was reviewed and marine vibrio suspected. Further identification procedures showed the organism to be V alginolyticus, sensitive to aminoglycosides, co-trimoxazole, cephalothin, and cephalexin but resistant to ampicillin. He made a satisfactory recovery over this period, and after four days cultures of the peritoneal fluid were negative and the gentamicin was stopped. He was discharged from hospital taking oral cephalexin and remained …