Group A streptococcal primary peritonitis in an otherwise healthy adolescent female

Group A Streptococcus Primary Peritonitis in Children, New Zealand

“…Although GAS is known to colonize the throat, skin, and female genital tract, it is not typically present in intestinal flora ( 30 ). Among previously reported pediatric cases, a possible skin or throat source was found in 50% of cases ( 14 ). In our cohort, a skin or throat source was identified in a similar proportion of cases (30%).…”

“…As in previous reports, symptoms of children in our cohort were abdominal pain, nausea, vomiting, and diarrhea. Several cases were initially diagnosed as viral gastroenteritis before deteriorating into peritonism and sepsis ( 3 , 14 ). Of the children in our cohort, 30% met STSS criteria, which is comparable with previous case reports that found an overall STSS incidence of 39% ( 5 , 14 , 15 ).…”

“…Although adult clinical practice guidelines advise nonoperative management, particularly in persons with underlying ascites, previous case reports found that most (83%) pediatric patients undergo surgery to rule out secondary peritonitis ( 14 , 30 ). This practice was also demonstrated in our series; 95% of patients underwent laparoscopy or laparotomy.…”

“…This practice was also demonstrated in our series; 95% of patients underwent laparoscopy or laparotomy. Surgical management might aid source control, particularly in patients with STSS where reduction of bacterial load plays a major role ( 4 , 14 , 31 ). Operative management has also been hypothesized to decrease the duration of illness: a 2020 case report describes a child who was managed nonoperatively and in whom a multi-loculated abscess developed that required multiple drains and 61 days of antibiotics ( 30 ).…”

“…We included children <15 years of age who had primary peritonitis, defined as bacterial infection within the peritoneal cavity in the absence of ascites or an intraabdominal source of infection either confirmed on abdominal imaging (typically free intraabdominal fluid and peritoneal enhancement with small bowel dilation and bowel wall thickening) ( 14 ) or operative findings (free fluid in the abdomen without intraabdominal or gynecological pathology) ( 3 ); and from whom GAS had been isolated from culture or molecular methods from blood culture, peritoneal fluid, peritoneal tissue, or intraoperative peritoneal swab samples ( 3 , 4 ). We excluded children with peritonitis secondary to preexisting ascites or an indwelling peritoneal dialysis catheter or device; children in whom an intraabdominal source of infection, such as a perforated viscus, acute appendicitis, or gynecological pathology, had been identified; or in whom another bacterial cause of primary peritonitis had been identified, by culture or molecular method, from any of blood culture, peritoneal fluid, peritoneal tissue, or intraoperative peritoneal swab sample.…”