Skip to content

Advertisement

  • Case Report
  • Open Access

A case of damage to a peritoneal dialysis tubing by a pet cockatoo and review of the literature

  • 1Email author,
  • 1,
  • 1 and
  • 1
Renal Replacement Therapy20184:47

https://doi.org/10.1186/s41100-018-0190-7

  • Received: 2 May 2018
  • Accepted: 8 November 2018
  • Published:

Abstract

Background

Peritoneal dialysis (PD) access is important for patients undergoing PD. However, one of the potential complications of peritoneal dialysis access is damage to the dialysis tubing. Although most dialysis tubing damage is due to human error, there have been reports of damages attributed to pets owned by the patients. Much of the damage caused by pets has been attributable to cat biting or scratching, whereas the present case is an extremely rare case of dialysis tubing damage caused by a pet cockatoo.

Case presentation

A 65-year-old male with end-stage renal disease due to diabetic nephropathy who had been undergoing continuous ambulatory peritoneal dialysis (CAPD) for 6 years was admitted to our hospital with the chief complaint of dialysis tubing damage. While the patient was playing with his pet cockatoo on his belly after taking it out of its cage, the bird bit into his dialysis tubing of his transfer set without him realizing it, thus damaging the tube. The patient noticed that his dialysis tubing was leaking and realized that it had been damaged. He folded the end of the damaged tube, secured it with a rubber band to prevent further leakage, and made an emergency visit to our hospital. Upon inspection, we found that the dialysis tubing was completely disconnected, 28 cm from the metal connector of the connection tube. After consultation, the damaged tube was replaced. As a preventive measure for peritonitis, antibiotics were administered orally for 1 week (oral levofloxacin, 250 mg every 48 h). The patient was instructed to be careful when handling his cockatoo, and his CAPD treatment has been continued without incident to date.

Conclusion

This is a rare case report of PD tubing damage caused by a cockatoo kept at home. It may be necessary to pay sufficient attention to PD equipment damage by birds in PD patients keeping large birds, such as cockatoos.

Keywords

  • Peritoneal dialysis
  • Dialysis tubing
  • Damage
  • Pet
  • Bird
  • Cockatoo

Background

Peritoneal dialysis (PD) access is important for patients undergoing PD, just as vascular access is important for hemodialysis patients. However, one of the potential complications of peritoneal dialysis access is damage to the PD equipment including dialysis tubing. Although most dialysis tubing damage is due to human error, there have been reports of damages attributed to pets owned by the patients [118]. Damage to the dialysis tubing is usually discovered by dialysate leakage, but dialysis tubing damage has also been revealed after examining the cause of peritonitis. As such, while many of the damages brought about by pets have been attributable to cat biting [110, 13, 14, 1618], our present case was an extremely rare case of dialysis tubing damage caused by a pet cockatoo.

Case presentation

A 65-year-old male with end-stage renal disease due to diabetic nephropathy who had been undergoing continuous ambulatory peritoneal dialysis (CAPD) for 6 years was admitted to our hospital with the chief complaint of dialysis tubing damage. One Sunday night, while exchanging the dialysate, the patient took his pet cockatoo out of the cage and let it play on his belly, but the bird bit and cut the dialysis tubing without this being noticed by the patient. He became aware of an abnormality when he noticed leakage of dialysate and then found that the tube was cut. He folded the end of the damaged tube, secured it with a rubber band to prevent further leakage, and visited the emergency room of our hospital about 30 min after the damage occurred.

Upon inspection, we found that the tube was completely disconnected, 28 cm from the metal connector of the connection tube (Figs. 1 and 2). At that time, his blood pressure was 130/80 mmHg, heart rate 72/min with regular rhythm, and temperature 36.8 °C. He was lucid, and his abdomen was soft and flat and had no tenderness. Laboratory findings revealed a white blood cell count of 4700/μL, hemoglobin of 8.9 g/dl, a platelet count of 168 × 103/μl, and a C-reactive protein level of 0.21 mg/dL.
Fig. 1
Fig. 1

Cut peritoneal dialysis tubing (entire view)

Fig. 2
Fig. 2

Cut surface of the tubing

After consultation, the damaged tube was replaced. Since the patient was treated at the nighttime emergency room, a blood cell count in the dialysate and a culture of the dialysate and damaged catheter were not performed. As a preventive measure for peritonitis, antibiotics were administered orally for 1 week (oral levofloxacin, 250 mg every 48 h). The patient was advised to revisit the hospital if he had fever or abdominal pain before his regular visit 1 month later, but he did not suffer from peritonitis during that time. The patient was instructed to be careful when handling his cockatoo, and his CAPD treatment has been continued without incident to date.

Discussion

Damage to PD equipment can often occur due to human error. However, PD equipment damage caused by pets in PD patients has recently been occasionally reported, with an increase in the number of families keeping pets [118]. As described above, the causative pet was a cat in almost all cases, other than two cases caused by a hamster [11, 12], and one case caused by a cockatoo [15] (Table 1). To our knowledge, this is the second case report of PD tubing damage by a bird.
Table 1

Reports of damage to PD equipment caused by animals

Case

References

Year reported

Age (y)/sex

PD type

Animal exposure

State of damage of PD equipment

Peritonitis

Culture results

1

Paul et al. [1]

1987

55/F

CCPD

Cat

Dialysis tubing punctured

+

Pasteurella multocida

2

London et al. [2]

1991

54/M

CCPD

Cat

Dialysis tubing punctured

+

Pasteurella multocida

3

Makin et al. [3]

1991

39/M

CAPD

Cat

Dialysis tubing punctured

+

Neisseria pharyngis

4

Makin et al. [3]

1991

58/F

CAPD

Cat

Dialysis tubing punctured

Staphylococcus hominis

5

Makin et al. [3]

1991

73/M

CAPD

Cat

Dialysis tubing punctured

Sterile

6

Makin et al. [3]

1991

24/F

CAPD

Cat

Dialysis tubing punctured

Sterile

7

Kitching et al. [4]

1996

75/M

CAPD

Cat

Dialysis tubing punctured

+

Pasteurella multocida

8

Uribarri et al. [5]

1996

42/F

CCPD

Cat

Dialysis tubing punctured

+

Pasteurella multocida

9

Loghman et al. [6]

1997

12/F

CCPD

Cat

Dialysis tubing punctured

+

Pasteurella multocida

10

Joh et al. [7]

1998

55/M

CCPD

Cat

Dialysis tubing punctured

+

Pasteurella multocida

11

Chadha et al. [8]

1999

18/M

CCPD

Cat

Dialysis tubing punctured

+

Capnocytophaga canimorsus

12

Hamai et al. [9]

1999

49/M

CCPD

Cat

Dialysis tubing punctured

+

Enterobacter agglomerans, Pasteurella multocida, alpha-Streptcoccus

13

Van Langenhove et al. [10]

2000

22/F

CCPD

Cat

Dialysis tubing punctured

+

Pasteurella multocida

14

Campos et al. [11]

2000

8/M

CCPD

Hamster

Dialysis tubing punctured

+

Pasteurella pneumotropica

15

Freeman et al. [12]

2004

14/F

Unknown

Hamster

Peritoneal catheter punctured

+

Pasteurella aerogenes

16

Mat et al. [13]

2005

52/M

CCPD

Cat

Dialysis tubing punctured

+

Pasteurella multocida

17

Malik et al.

2005

21/F

CCPD

Cat

Dialysis tubing punctured

+

Pasteurella multocida

18

Malik et al.

2005

58/M

CCPD

Cat

Dialysis tubing punctured

+

Pasteurella multocida

19

Sedlacek et al. [15]

2008

57/F

CCPD

Cockatoo

Dialysis tubing punctured

+

Mucor species

20

Rondon-Berrios et al. [16]

2010

38/M

CCPD

Cat

Dialysis tubing punctured

+

Pasteurella multocida

21

Nishina et al. [17]

2012

45/M

CCPD

Cat

PD solution bag punctured

+

Pasteurella multocida

22

Giron et al. [18]

2017

72/M

CCPD

Cat

Dialysis tubing punctured

+

Pasteurella multocida and Streptcoccus canis

23

Present case

2018

65/M

CAPD

Cockatoo

Dialysis tubing cut

NA

PD peritoneal dialysis, F female, M male, CCPD continuous cycler peritoneal dialysis, CAPD continuous ambulatory peritoneal dialysis, NA not available

The PD equipment damaged by pets was dialysis tubing in most reported cases. One case each of PD catheter damage and PD solution bag damage has also been reported (Table 1). The type of PD in patients whose equipment was damaged was continuous cycler peritoneal dialysis in many cases (Table 1), suggesting that animals frequently bit or scratched the equipment which remained unnoticed by the patient, i.e., during sleep. Damage to PD tubing by pets does not completely tear the tube (Table 1), but results in a pinhole-shaped damage that may go unnoticed until leakage of PD solution is confirmed, and discovery may be delayed when the leakage is minor. In our case, the cockatoo completely cut the dialysis tubing with its beak in front of the patient during CAPD operation. Thus, the patient noticed the damage immediately and visited our hospital. Early treatment including antibiotic administration may have prevented peritonitis.

Very little epidemiological data are available on pet-related peritonitis in peritoneal dialysis. Incidences of 0.54% in all PD peritonitis cases in a report on a French-speaking registry for peritoneal dialysis (RDPLF) and of 0.03% in all cases of PD peritonitis in a single-center study have been reported [19]. In general, PD equipment damage can be a cause of PD peritonitis, but bacteria not observed in normal peritonitis are often detected in PD peritonitis caused by pets (Table 1), due to differences in bacterial flora between pets and humans [1921]. In cats and dogs, Pasteurella species, which are indigenous bacteria in the oral cavity, are problematic as causative bacteria of peritonitis [19, 21]. As shown in Table 1, the culture results were Pasteurella species in most previous reports with a cat. Chlamydia psittaci infection is a well-known Cockatoo-associated infection [22], and generally, birds may cause fungal infection because many fungi are found on the feathers and skin of healthy birds [20]. Among these, Cryptococcus neoformans is well-known and causes pulmonary and skin cryptococcosis [20, 23]. Fungal infection of PD patients caused by birds has rarely been reported, but an outbreak of Candida parasilosis-induced fungal peritonitis that was considered to have been caused by pigeon guano has been described [24]. Mucormycosis peritonitis that was likely to have been caused by a cockatoo has also been reported in a case involving biting of PD tubing by a cockatoo [15], similarly to our case. Our patient received preventive drug administration of levofloxacin because the presence or absence of infection was unclear at the time of arrival and this drug is effective for both Chlamydia psittaci and contaminating bacteria.

In conclusion, this is the first case report of PD tubing damage without peritonitis caused by a cockatoo kept at home. However, only cases in which peritonitis develops tend to be reported. Thus, there actually may be more cases of PD equipment damage by pets. Therefore, it may be necessary to pay attention to PD equipment damage by birds in PD patients keeping large birds, such as cockatoos, that have powerful beaks and are playful because of their high intelligence.

Abbreviations

CAPD: 

Continuous ambulatory peritoneal dialysis

CCPD: 

Continuous cycler peritoneal dialysis

F: 

Female

M: 

Male

NA: 

Not available

PD: 

Peritoneal dialysis

Declarations

Acknowledgements

Not applicable.

Funding

The authors declare that there is no funding related to this manuscript.

Availability of data and materials

The data and materials were all included in the manuscript.

Authors’ contributions

All the authors have approved the manuscript and agree with the submission to the esteemed journal. YT provided the discussion and treatment of the patient. JU collected the data and wrote the manuscript. TN reviewed and revised the manuscript. All authors read and approved the final manuscript.

Ethics approval and consent to participate

Written informed consent was obtained from the patient for the publication of this case report.

Consent for publication

For the publication of this case report, written agreement was obtained from the patient.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Department of Urology, Osaka City University Medical School, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan

References

  1. Paul RV, Rostand SG. Cat-bite peritonitis: Pasteurella multocida peritonitis following feline contamination of peritoneal dialysis tubing. Am J Kidney Dis. 1987;10(4):318–9.View ArticleGoogle Scholar
  2. London RD, Bottone EJ. Pasteurella multocida: zoonotic cause of peritonitis in a patient undergoing peritoneal dialysis. Am J Med. 1991;91(2):202–4.View ArticleGoogle Scholar
  3. Makin AJ, Cartwright KA, Banks RA. Keeping the cat out of the bag: a hazard in continuous ambulatory peritoneal dialysis. BMJ. 1991;303(6817):1610–1.View ArticleGoogle Scholar
  4. Kitching AR, Macdonald A, Hatfield PJ. Pasteurella multocida infection in continuous ambulatory peritoneal dialysis. N Z Med J. 1996;109(1016):59.PubMedGoogle Scholar
  5. Uribarri J, Bottone EJ, London RD. Pasteurella multocida peritonitis: are peritoneal dialysis patients on cyclers at increased risk? Perit Dial Int. 1996;16(6):648–9.PubMedGoogle Scholar
  6. Loghman-Adham M. Pasteurella multocida peritonitis in patients undergoing peritoneal dialysis. Pediatr Nephrol. 1997;11(3):353–4.View ArticleGoogle Scholar
  7. Joh J, Padmanabhan R, Bastani B. Pasteurella multocida peritonitis following cat bite of peritoneal dialysis tubing. With a brief review of the literature. Am J Nephrol. 1998;18(3):258–9.View ArticleGoogle Scholar
  8. Chadha V, Warady BA. Capnocytophaga canimorsus peritonitis in a pediatric peritoneal dialysis patient. Pediatr Nephrol. 1999;13(8):646–8.View ArticleGoogle Scholar
  9. Hamai K, Imai H, Ohtani H. Repeated cat-associated peritonitis in a patient on automated nocturnal intermittent peritoneal dialysis. Clin Exp Nephrol. 1999;1:59–61.View ArticleGoogle Scholar
  10. Van Langenhove G, Daelemans R, Zachee P, Lins RL. Pasteurella multocida as a rare cause of peritonitis in peritoneal dialysis. Nephron. 2000;85(3):283–4.View ArticleGoogle Scholar
  11. Campos A, Taylor JH, Campbell M. Hamster bite peritonitis: Pasteurella pneumotropica peritonitis in a dialysis patient. Pediatr Nephrol. 2000;15(1–2):31–2.View ArticleGoogle Scholar
  12. Freeman AF, Zheng XT, Lane JC, Shulman ST. Pasteurella aerogenes hamster bite peritonitis. Pediatr Infect Dis J. 2004;23(4):368–70.View ArticleGoogle Scholar
  13. Mat O, Moenens F, Beauwens R, Rossi C, Muniz-Martinez MC, Mestrez F, et al. Indolent Pasteurella multocida peritonitis in a CCPD patient. 25 years of “cat-bite peritonitis”: a review. Perit Dial Int. 2005;25(1):88–90.PubMedGoogle Scholar
  14. Malik A, Al Aly Z, Mailey KS, Bastani B. Pasteurella multocida peritoneal dialysis-associated peritonitis: a report of two cases and review of the literature. J Nephrol. 2005;18(6):791–3.PubMedGoogle Scholar
  15. Sedlacek M, Cotter JG, Suriawinata AA, Kaneko TM, Zuckerman RA, Parsonnet J, et al. Mucormycosis peritonitis: more than 2 years of disease-free follow-up after posaconazole salvage therapy after failure of liposomal amphotericin B. Am J Kidney Dis. 2008;51(2):302–6.View ArticleGoogle Scholar
  16. Rondon-Berrios H, Trevejo-Nunez GJ. Pets or pest: peritoneal dialysis-related peritonitis due to Pasteurella multocida. J Microbiol Immunol Infect. 2010;43(2):155–8.View ArticleGoogle Scholar
  17. Nishina M, Yanagi H, Koizumi M, Kimura M, Kakuta T, Endoh M, et al. Pasteurella multocida peritonitis associated with a cat in a peritoneal dialysis patient using an automated cycler device. CEN Case Rep. 2012;1(2):73–6.View ArticleGoogle Scholar
  18. Giron FF, Martin JMS, Gomez ER, Munoz SC, Carmelo FG, Gomez IG, et al. Simultaneous Streptococcus canis and Pasteurella multocida peritonitis in a peritoneal dialysis patient. Perit Dial Int. 2017;37(4):483–4.View ArticleGoogle Scholar
  19. Broughton A, Verger C, Goffin E. Pets-related peritonitis in peritoneal dialysis: companion animals or trojan horses? Semin Dial. 2010;23(3):306–16.View ArticleGoogle Scholar
  20. Boseret G, Losson B, Mainil JG, Thiry E, Saegerman C. Zoonoses in pet birds: review and perspectives. Vet Res. 2013;44:36.View ArticleGoogle Scholar
  21. Poliquin PG, Lagace-Wiens P, Verrelli M, Allen DW, Embil JM. Pasteurella species peritoneal dialysis-associated peritonitis: household pets as a risk factor. Can J Infect Dis Med Microbiol. 2015;26(1):52–5.View ArticleGoogle Scholar
  22. Hogerwerf L, DEG B, Baan B, VDH W. Chlamydia psittaci (psittacosis) as a cause of community-acquired pneumonia: a systematic review and meta-analysis. Epidemiol Infect. 2017;145(15):3096–105.View ArticleGoogle Scholar
  23. Nosanchuk JD, Shoham S, Fries BC, Shapiro DS, Levitz SM, Casadevall A. Evidence of zoonotic transmission of Cryptococcus neoformans from a pet cockatoo to an immunocompromised patient. Ann Intern Med. 2000;132(3):205–8.View ArticleGoogle Scholar
  24. Greaves I, Kane K, Richards NT, Elliott TS, Adu D, Michael J. Pigeons and peritonitis? Nephrol Dial Transplant. 1992;7(9):967–9.View ArticleGoogle Scholar

Copyright

© The Author(s) 2018

Advertisement