Fungal peritonitis

　　Candida is the main pathogen causing fungal peritonitis. Candida is the most common opportunistic pathogen among fungi, also known as pseudomycetes. It often resides in human skin, oral cavity, vagina, and intestinal mucosa, etc. Candida is a type of fungus, with an oval shape, pseudohyphae formed by spores and cell buds. Candida has weak resistance to heat, and it can be killed after heating to 60℃ for one hour. Candida albicans has been reported to be more common than non-albicans Candida. However, recent scientific research has shown different results. Some studies have shown that non-albicans Candida in the Candida genus causes 53.6% of fungal peritonitis, while Candida albicans accounts for 35.7%. In recent years, rare fungi and non-pathogenic fungi have been frequently reported as pathogens of fungal peritonitis.

　　If fungal peritonitis is not treated promptly and effectively, it will rapidly lead to multiple organ failure. The loss of fluid into the peritoneal cavity and intestines can lead to severe dehydration and electrolyte disorder, and the patient may appear with a mask-like expression (Hippocratic face), and may die within a few days. Adult respiratory distress syndrome may also appear rapidly, followed by renal failure, liver failure, and disseminated intravascular coagulation.

　　In general, the main clinical manifestations of peritonitis are abdominal pain, abdominal tenderness, abdominal muscle tension, as well as nausea, vomiting, fever, elevated white blood cells. In severe cases, it can lead to a decrease in blood pressure and systemic toxic reactions. If not treated in time, it can lead to death from toxic shock. Different patients may have different symptoms, such as some patients may have concurrent pelvic abscess, inter intestinal abscess, subdiaphragmatic abscess, iliac fossa abscess, and adhesive intestinal obstruction, etc.

　　In fact, there is no method to prevent fungal peritonitis at present. In summary, the fundamental measure to prevent peritonitis is to treat abdominal intra-peritoneal inflammatory diseases that may cause peritonitis early and appropriately. Any abdominal surgery, including peritoneal puncture, should be strictly carried out under sterile conditions. Oral antibiotics should be administered before intestinal surgery to reduce the occurrence of peritonitis.

　　1. Laboratory tests: increased white blood cell count and proportions of neutrophils, lymphocytes, and eosinophils, or toxic granules.

　　2. X-ray: general distension of the small intestine, with multiple small liquid flat intestinal paralysis signs; free gas under the diaphragm can be seen in cases of gastrointestinal or gallbladder perforation.

　　3. Ultrasound: can show fluid accumulation in the abdomen, which is helpful for the diagnosis of the primary disease.

　　4. Diagnostic abdominal puncture or lavage: abdominal puncture can determine the primary lesion, and fungi can be detected in the puncture fluid.

　　Fungal peritonitis is a consumptive disease, especially with a very high consumption of protein. Fungal peritonitis is mostly secondary, so the diet for fungal peritonitis should also take into account the characteristics of the primary disease. In general, the diet for fungal peritonitis should be rich in nutrition and light in taste. Fungal peritonitis diet注意事项:

　　1. Regular meals, eat less and more often

　　Patients with acute pancreatitis should eat in small portions and multiple times a day, with 5 to 6 meals a day, providing 1 to 2 types of food per meal, paying attention to selecting soft and easily digestible semi-liquid or soft foods, and avoiding overeating and overdrinking.

　　2. After the condition gradually stabilizes, gradually increase the amount of food intake and switch to low-fat semi-liquid diet. Protein should be moderate, not excessive, and sufficient carbohydrates should be provided.

　　3. Pay attention to supplementing vitamins and trace elements.

　　Currently, the only treatments for fungal peritonitis are the removal of catheters and antifungal treatment in Western medicine.

　　Early removal of catheters is necessary for the successful eradication of fungal peritonitis, and even some scholars believe that early removal of catheter therapy is the only successful therapy. Studies have shown that fungi can often be cultured on the removed catheters in patients with negative peritoneal dialysis fluid cultures, indicating that catheter removal and antifungal treatment are both necessary to cure fungal peritonitis. Conversely, routine early catheter removal without antifungal treatment may be insufficient treatment, as there is evidence that this simple catheter removal without antifungal treatment increases the risk of peritoneal adhesion, thus losing the opportunity for patients to restart peritoneal dialysis.