traditionally , the neisseria species has two potential pathogenic strains ; neisseria meningitidis and neisseria gonorrhoeae . the remainder of neisseria species , including neisseria mucosa , are considered normal flora colonizing the respiratory tract , living in symbiosis .
one analysis showed that the majority of people are colonized by one to two of these neisseria species .
specifically , neisseria mucosa is increasingly found to cause a multitude of diseases , in particular peritonitis .
part of the difficulty in associating disease with other species of neisseria , such as neisseria mucosa , is the fact that they do not contain the typical virulence factors .
the established pathogens neisseria meningitidis and neisseria gonorrhoeae derive much of their virulence from attaching to mucosal surfaces .
however , the lack of these virulence factors does not necessarily make the other neisseria species benign .
the advent of chronic ambulatory peritoneal dialysis ( capd ) has permitted significant patient autonomy with the concomitant risk of bacterial peritonitis .
the typical culprits are gram - positive species , such as staphylococcus species and streptococcus species .
we performed a pubmed literature search using the terms neisseria mucosa , peritonitis , and chronic ambulatory peritoneal dialysis .
this yielded very few published cases of capd patients afflicted by neisseria mucosa peritonitis . in this clinical vignette , we add another case of capd associated with neisseria mucosa peritonitis .
the patient was a 28 year - old hispanic man with a history of end stage renal disease due to hypertensive disease since the age of 10 years , complicated by malignant hypertension .
his surgical history was remarkable for a remotely failed renal transplant requiring an allograft nephrectomy .
he had been on hemodialysis for about a decade since , and transitioned to peritoneal dialysis just six months prior to presenting to our facility with sepsis due to new - onset peritonitis . in the outpatient clinic ,
the patient had been diagnosed with external cheek cellulitis that responded to a short course of empiric cephalexin .
he overcame this only to experience three days of abdominal pain near his dialysis catheter .
the pain was constant and severe pain , worsened by draining and filling during dialysis sessions .
he denied any fevers , chills , nausea , vomiting , diarrhea , oropharyngeal and genitourinary complaints or decrease in recent ultrafiltration .
exam was remarkable for a blood pressure of 167/99 mmhg , heart rate of 107 beats per minute and abdominal tenderness to palpation diffusely with the catheter exit site clear dry and intact without exudate or erythema .
he quickly underwent peritoneal fluid examination , revealing an absolute neutrophil count of 14,458 cells / mm , confirming the diagnosis of bacterial peritonitis .
his gram stain revealed gram - negative diplococci and subsequent chocolate agar plated cultures grew neisseria species , not gonorrhoeae or meningitidis .
further biochemical speciation ( via rapid nh system by remel , thermo fisher scientific inc .
, waltham , usa ) showed neisseria mucosa to be the etiology of the patient s bacterial peritonitis . given this is typically nonpathogenic , further susceptibility was not performed .
the patient was placed on empiric intraperitoneal vancomycin 1 gram and cefepime 1 gram therapy and later transitioned to oral ciprofloxacin 500 mg daily for two weeks . during the hospitalization ,
the likely source of neisseria mucosa contamination of the dialysis port was the oral cellulitis .
the transmission from the oral site to catheter site is supported by the well - known colonization of the oropharyngeal tract .
capd seems to be associated with an increased risk for neisseria mucosa , particularly in cases of peritonitis . in general
, this case adds to the current literature highlighting the importance of considering all types of disease caused by traditionally - benign neisseria mucosa species .
although , nongonococcal and nonmeningococcal neisseria strains are usually benign and infections are rare , they may cause a variety of disease .
this case highlights the danger of neisseria mucosa peritonitis in patients undergoing capd , and is the fourth reported case .
the rarity of case reports and lack of the established pathogenic factors of nongonococcal and nonmeningococcal neisseria may limit recognition of these infections .
this makes the association with clinical disease complex , and further investigation regarding their pathogenicity is warranted . in previously described case reports of nongonococcal and nonmeningococcal neisseria ,
our patient was also successfully treated with ciprofloxacin . given the increasing frequency of infections by nongonococcal and nonmeningococcal neisseria , guidelines regarding appropriate antimicrobial therapy should be established .
further case reports should also establish the safety of preserving the peritoneal dialysis catheters , as in our patient s case .
 peritonitis is a leading complication of chronic ambulatory peritoneal dialysis . however , very rarely does neisseria mucosa cause peritonitis . 
 we describe an unusual case of n. mucosa peritonitis in a chronic ambulatory peritoneal dialysis patient . a 28-year - old hispanic male presents with diffuse abdominal pain exacerbated during draining of the peritoneal fluid . 
 peritoneal fluid examination was remarkable for leukocytosis and gramnegative diplococci . 
 bacterial cultures were positive for n. mucosa growth . 
 the patient was treated with ciprofloxacin with preservation of the dialysis catheter . 
 this case highlights the rarity and importance of neisseria mucosa causing peritonitis in chronic ambulatory peritoneal dialysis patients. there seems to be a unique association between n. mucosa peritonitis and chronic ambulatory peritoneal dialysis patients. the patient was successfully managed with ciprofloxacin along with salvaging of the dialysis catheter . 
Introduction
Case Report
Discussion and Conclusions