Group A streptococcal primary peritonitis in a healthy girl

Abstract

We read with great interest the article by Huynh et al.1 titled 'Vitamin D in newborns. A randomised controlled trial comparing daily and single oral bolus vitamin D in infants' published in your journal which concluded that a single bolus dose of cholecalciferol is a safe and effective alternative to daily vitamin D dosing for healthy breastfed newborn infants of vitamin D deficient mothers. We appreciate that it was the first randomised control trial which compared the efficacy and safety of single oral bolus vitamin D with the standard of care, daily vitamin D 400 IU in newborn infants. Also, the biochemical analysis of vitamin D level was carried out using tandem mass spectrometry which is considered to be superior to chemiluminescent immunoassay and is now considered to be the 'gold standard' for measuring serum 25 OHD levels. This trial was need based and addressed a very important and clinically relevant issue. However, we would like to address a few important concerns which came to our notice while reading through the article.While reading through the flow diagram for patient allocation and follow-up (Fig. 1); 1 we realised that the number of patient in daily dose group who were followed up and underwent analysis according to CONSORT guidelines 2 at 1-2 weeks were 32 (36 − 4 = 32) rather than 31 as represented in Figure 1. The sample size estimated by us using a power of 90%, twosided alpha level of 0.05 and detection of 40% difference in the proportions of vitamin D repletion between the two groups is 46 in contrast to 56 estimated by the author.The author has specified in the statistical analysis section that all predetermined analyses were performed according to intention to treat principle. However, the analysis of the primary outcome was carried out using per protocol principle (Table 1) 1 which is also not in accordance to CONSORT guidelines. 2The proportion of infants who were Vitamin D replete at 3-4 months of age was similar in both group with a significantly lower mean 25-OHD in the bolus (65 nmol/L, 95% confidence interval (CI) 59-71) compared with the daily group (81 nmol/L, 95% CI 77-85) (P = 0.008) despite only eight (31%) babies reporting daily adherence (i.e. cumulative dose of 50 000 IU of vitamin D) versus 100% in single bolus group. This finding was not explained systematically by the author. Dear Editor, GROUP A STREPTOCOCCAL PRIMARY PERITONITIS IN A HEALTHY GIRLWe report the case of a previously healthy 10-year-old girl admitted to hospital in a state of septic shock. Three days prior to admission she developed abdominal pain and diarrhoea, along with fever, sore throat and vomiting. There were no sick contacts in her immediate entourage (including family members). At initial presentation she was tachycardic, with a blood pressure of 80/40 mmHg. Physical exam revealed an erythematous rash on the face and trunk, non-necrotic small petechiae on her legs and an abdomen that was tense and guarded. Neutrophil count was 8.6 Á 10 9 /L, C reactive protein (CRP) 327 mg/L and lactate 2.6 mmol/...

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 ).…”

“…Pharyngeal and vaginal cultures are often negative, thus a source of infection is not always identified. 3 , 10 …”

“…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.…”

Peritonitis caused by group A streptococcus: A case report and literature review

“…According to the PRISMA 2020 statement [3] , 56 reports including 65 cases were found to be eligible ( Fig. 3 ) [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] . As shown in Fig.…”