Group A streptococcal pharyngitis associated with primary peritonitis

Abstract

Primary peritonitis, a bacterial infection within the peritoneal cavity that arises in the absence of an intraperitoneal source, is a rare entity in paediatrics. We describe the case of a previously healthy 11-year-old girl who presented with an acute abdomen and was found to have primary peritonitis due to Streptococcus pyogenes. She had an episode of pharyngitis with pharyngeal cultures positive for S. pyogenes in the month prior to presentation. We performed a review of the literature to better elucidate the risk factors, pathophysiology and presentation of peritonitis due to S. pyogenes and to draw attention to the potential association between group A streptococcal pharyngitis and peritonitis.

Primary Group A Streptococcal Peritonitis in a Previously Healthy Female Teenage Patient

“… 7 , 8 Review of the pediatric literature reveals treatment consists of laparotomy to establish the diagnosis and treatment, with surgical exploration of the abdominal cavity and extensive washout. 2 - 8 , 10 - 13 In contrast, our patient did not undergo exploratory laparotomy. However, she developed large loculated abscesses, requiring placement of multiple drains during her treatment course.…”

“… 3 , 6 In the literature, the duration of antibiotics ranges from 10 to 21 days ( Table 1 ). 2 , 3 , 10 - 14 Our patient required 61 days of antibiotic therapy, suggesting that laparotomy may decrease length of illness. Although penicillin G remains first-line for treatment and prevention of GAS infection, various antibiotics have been employed ( Table 1 ).…”

“…1 However, recent reports indicate a trend toward an increased incidence of primary GAS peritonitis. 2 The pathogenesis of primary GAS peritonitis remains unclear, although various theories have been proposed. Principal theories include hematogenous spread from the respiratory tract or skin, ascending infection in the female genital tract, and translocation from gastrointestinal tract and intact bowel.…”

“…Although penicillin G remains first-line for treatment and prevention of GAS infection, various antibiotics have been employed ( Table 1 ). 2 - 8 , 10 - 14 In this case, penicillin G was selected for inpatient treatment of peritonitis, while cephalexin was utilized as an oral alternative for outpatient antibiotic therapy due to ease of dosing.…”

Case Report: Primary Peritonitis as the Onset of Pediatric Ménétrier's Disease

“…The most frequent clinical manifestation of PP is an acute onset of abdominal pain with or without peritonism; while fever, vomiting, and diarrhea are less frequent ( 1 , 3 , 9 , 12 ). Periumbilical erythema is a rare sign of peritonitis ( 12 ), however, our patient initially presented erythematous plaques on the abdomen, pubis, and proximal segments of both limbs.…”