Published online May 16, 2023. doi: 10.12998/wjcc.v11.i14.3311
Peer-review started: February 2, 2023
First decision: February 17, 2023
Revised: February 23, 2023
Accepted: March 30, 2023
Article in press: March 30, 2023
Published online: May 16, 2023
Neisseria mucosa is a gram negative diplococcus belonging to the genus Neisseria found commonly in the upper respiratory tract. It is typically a commensal organism when it is parasitic on oral and nasal mucosa. To our knowledge, it does not cause disease in healthy individuals with normal immunity, but can be pathogenic in those with impaired immune function or change in bacterial colonization site. Neisseria mucosa has been reported to cause bacterial meningitis, conjunctivitis, pneumonia, endocarditis, peritonitis and urethritis. However, peritoneal dialysis-related peritonitis caused by Neisseria mucosa is extremely rare in clinical practice, which has not previously been reported in China.
A 55-year-old female presented to the nephrology clinic with upper abdominal pain without apparent cause, accompanied by nausea, vomiting and diarrhea for two days. The patient had a history of Stage 5 chronic kidney disease for five years, combined with renal hypertension and renal anemia, and was treated with peritoneal dialysis for renal replacement therapy. The patient was subsequently diagnosed with peritoneal dialysis-related peritonitis. Routine examination of peritoneal dialysis fluid showed abdominal infection, and the results of microbial culture of the peritoneal dialysis fluid confirmed Neisseria mucosa. Imi-penem/ cilastatin 1.0 g q12h was added to peritoneal dialysis fluid for anti-infection treatment. After 24 d, the patient underwent upper extremity arteriovenous fistulation. One month later, the patient was discharged home in a clinically stable state.
Peritonitis caused by Neisseria mucosa is rare. Patients with home-based self-dialysis cannot guarantee good medical and health conditions, and require education on self-protection.
Core Tip:Neisseria mucosa is part of the normal human flora when it is parasitic in the oral and nasal mucosa, and rarely causes infection. However, it may be associated with severe disease when patients undergo invasive, instrumented procedures or have underlying conditions, as shown in the present patient who was undergoing continuous ambulatory peritoneal dialysis. In addition, the infection was also closely related to the patient’s health behavior and habits during peritoneal dialysis. Treatment should be based on antimicrobial susceptibility testing and a sufficient and full course of antimicrobial therapy should be given.