Primary pneumococcal peritonitis with a fulminant course
Authors:
Benjamín Tolmáči; Jiří Klein; Peter Žuffa; Alona Řehulková
Authors place of work:
Chirurgické oddělení Krajské nemocnice T. Bati, Zlín
Published in the journal:
Vnitř Lék 2021; 67(E-2): 34-37
Category:
Case Reports
Summary
Introduction: Primary peritonitis is an inflammation of the peritoneal cavity in the absence of a localized intra-abdominal source. It is included in the differential diagnosis of acute abdomen and can be potentially life-threatening. Pneumococci were a frequent pathogen causing primary peritonitis especially in the preantibiotic era. Nowadays, they act as an uncommon primary pathogen. Pneumococcal peritonitis in adults is more frequently seen in cases of liver cirrhosis with ascites and other pre-existing conditions. Primary pneumococcal peritonitis is uncommon in healthy individuals and therefore its diagnosis is difficult. Secondary peritonitis has to be excluded.
Case report: A 36-year-old woman was admitted to our surgery department with symptoms of severe sepsis. She reported a sudden onset of diffuse abdominal pain and was eight weeks after delivery per vias naturales. A computed tomography scan of the abdomen with intravenous contrast has not demonstrated any pathology explaining the condition of our patient. Empiric anti-microbial therapy with broad-spectrum antibiotics was commenced and a laparotomy was performed, which also did not reveal any source of infection. Purulent odorless fluid was found in the peritoneal cavity. Peritoneal lavage with an antiseptic was performed. Cultures from peritoneal fluid demonstrated a monobacterial growth of Streptococcus pneumoniae. The condition of our patient improved after continued adequate antibiotic therapy and lavage.
Conclusion: Primary pneumococcal peritonitis is difficult to diagnose in healthy individuals, since it is mimicking secondary peritonitis that has to be excluded. A clinical diagnose without surgical intervention is impossible in most cases. Surgical treatment has an important role in both the diagnosis and management of primary pneumococcal peritonitis, same as adequate antibiotic therapy. Primary peritonitis should be a part of the differential diagnosis of patients presenting with acute abdominal pain.
Keywords:
acute abdomen – primary peritonitis – Streptococcus pneumoniae – invasive pneumococcal disease – surgical treatment
Zdroje
1. Gürlich R, Adámková V, Ulrych J, et al. Základní principy diagnostiky a léčby sekundární peritonitidy – doporučení odborníků s podporou SIS. Rozhl. Chir., 2014; 93(6): 334–352.
2. Hemsley C, Eykyn SJ. Pneumococcal peritonitis in previously healthy adults: case report nad review. Clin Infect Dis. 1998; 27(2): 376–379. doi: 10.1086/514670.
3. Šenkeříková R, Fraňková S, Šperl J, et al. Spontánní bakteriální peritonitida. Vnitř Lék 2015; 61(2): 134–140.
4. Cortese F, Fransvea P, Saputelli A, et al. Streptococcus pneumoniae primary peritonitis mimicking acute appendicitis in an immunocompetent patient: a case report and review of the literature. J Med Case Rep. 2019; 13(1): 126. doi: 10.1186/s13256-019-2038-3.
5. Ortqvist A, Hedlund J, Kalin M. Streptococcus pneumoniae: epidemiology, risk factors, and clinical features. Semin Respir Crit Care Med. 2005; 26(6): 563–574. DOI: 10.1055/s- 2005-925523.
6. Capdevilla O, Pallares R, Grau I et al. Pneumococcal peritonitis in adult patients: report of 64 cases with special reference to emergence of antibiotic resistance. Arch Intern Med. 2001; 161(14): 1742–1748. DOI: 10.1001/archinte.161.14.1742.
7. Dugi DD 3rd, Musher DM, Clarridge JE 3rd et al. Intraabdominal infection due to Streptococcus pneumoniae. Medicine (Baltimore). 2001; 80(4): 236–244. doi: 10.1097/00005792- 200107000-00002.
8. Fowler R. – Primary peritonitis: changing aspects 1956-1970. Aust Paediatr J. 1971; 7(2): 73–83.
9. Ricketson LJ, Conradi NG, Vanderkooi OG et al. Changes in the nature and severity of invasive pneumococcal disease in children before and after the seven-valent and thirteen- valent pneumococcal conjugate vaccine programs in Calgary, Canada. Pediatr Infect Dis J. 2018; 37(1): 22–27. doi: 10.1097/INF.0000000000001709.
10. Klugman KP, Black S. Impact of existing vaccines in reducing antibiotic resistance: Primary and secondary effects. Proc Natl Acad Sci USA. 2018; 115(51): 12896–12901. doi: 10.1073/pnas.1721095115.
11. Løvlie A, Vestrheim DF, Aaberge IS, Steens A. Changes in pneumococcal carriage prevalence and factors associated with carriage in Norwegian children, four years after introduction of PCV 13. BMC Infect Dis. 2020; 20(1): 29. doi: 10.1186/s12879-019-4754-0.
12. Geno KA, Gilbert GL, Song JY, et al. Pneumococcal capsules and their types: past, present, and future. Clin Microbiol Rev. 2015; 28(3): 871–899. doi: 10.1128/ CMR.00024-15.
13. Kozáková J, Okonji Z, Klímová M, Křížová P. Invazivní pneumokokové onemocnění v České republice v roce 2019. Zprávy CEM (SZU, Praha) 2019; 28(7): 277–282.
14. Sendi P, Moser Schaub EM, Nirgianakis K, et al. An uncommon site of Streptococcus pneumoniae colonization leading to recurrent pneumococcal disease. Open Forum Infect Dis. 2016; 4(1): ofw257. doi: 10.1093/ofid/ofw257 eCollection Winter 2017.
15. Westh H, Skibsted L, Korner B. Streptococcus pneumoniae infections of the female genital tract and in the newborn child. Rev Infect Dis. 1990; 12(3): 416–422. doi: 10.1093/ clinids/12.3.416.
16. Farooq A, Ammori BJ. Laparoscopic diagnosis and management of primary bacterial peritonitis. Surg Laparosc Endosc Percutan Tech. 2005; 15(1): 36–37. doi: 10.1097/01. sle.000148464.31652.5d.
17. Jarovsky D, Grodzicki Ambrus T, Galvão Gurgel M, Jenné Mimica M, Volpe Arnoni M, Almeida FJ, Palazzi Sáfadi MA, Naaman Berezin E. Jarovsky D, et al. Spontaneous pneumococcal peritonitis diagnosed by qPCR IDCases. 2019; 15: e00489. doi: 10.1016/j.idcr.2019. e00489.
18. Mališová L, Urbášková P, Jakubů V, et al. Surveillance antibiotické rezistence u Streptococcus pneumoniae v České republice, výsledky respirační studie za roky 2010–2017. Epidemiol. Mikrobiol. Imunol. 2019; 68(2): 75–81.
19. Van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016; 22(Suppl 3): S37–62. doi: 10.1016/j.cmi.2016.01.007.
Štítky
Diabetology Endocrinology Internal medicineČlánok vyšiel v časopise
Internal Medicine
2021 Číslo E-2
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