Peritoneal dialysis-associated peritonitis caused by Brucella

Jianyun Zhu^1*Shufang Pan¹Munire Abulizi²Adili Sawuti²Su-ying Han²Maimaitiaili Tuerxun²Cai-lian Cheng^1,2

• ¹Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
• ²The First People’s Hospital of Kashi Prefecture, kashi, China

Background: Brucella can affect multiple organs in the body, with peritonitis being a rare complication primarily observed in patients with cirrhosis or undergoing peritoneal dialysis. Our aim is to analyse the clinical features of patients with peritoneal dialysis-associated peritonitis in order to provide a reference for clinical diagnosis and treatment. Methods: A retrospective analysis was performed on three cases of Brucella-associated peritonitis in patients undergoing peritoneal dialysis, who were admitted to the First People's Hospital of Kashi Prefecture between January 2022 and June 2025. The analysis covered general data, epidemiological history, clinical features, laboratory tests and treatment efficacy. Results: All three patients had been in contact with animals or had drunk raw milk. Two were male and one was female. The patients were aged 36, 40 and 50 years old. They were all on peritoneal dialysis and the main symptoms were abdominal pain, abdominal distension and malaise, with no fever. All three patients had low leukocyte counts in their bloods, a normal or mildly elevated neutrophil ratio, significantly elevated C-reactive protein levels and mildly elevated procalcitonin levels. Peritoneal effluent showed >500 leukocytes/mm³ and an differential leukocyte count with a high proportion of mononuclear cells. Brucella was cultured from all peritoneal effluent samples, confirming the diagnosis of Brucella peritonitis. Symptoms decreased or disappeared following effective anti-infective treatment in all patients. Conclusion: Brucella peritonitis occurs in patients undergoing peritoneal dialysis and is characterised by abdominal pain and pressure. The basis for confirming the diagnosis is the presence of elevated leukocytes, predominantly monocytes, in the peritoneal effluent, and the culture of Brucella in the peritoneal effluent. Effective treatment involves a combination of doxycycline and rifampicin for at least six weeks, which controls the peritonitis without requiring the removal of the peritoneal dialysis catheter.