Pneumococcal Peritonitis: Still with Us and Likely to Increase in Importance

Abstract

BACKGROUND: Pneumococcal peritonitis is uncommon and poorly understood.METHODS: As part of a five-year study (2000 to 2004) of invasive pneumococcal disease (IPD) in Alberta, all cases of peritonitis due toStreptococcus pneumoniaewere reviewed and compared with all other cases of IPD.RESULTS: Twenty-three of 1768 (1.3%) IPD patients were found to have peritonitis. Patients with peritonitis were more likely to have cirrhosis, hepatitis C, alcoholism and HIV/AIDS, than the remainder of the patients with IPD. The all-cause mortality did not differ between the two groups. Peritonitis was classified as primary in nine (39%) patients, secondary in 12 (52%) patients, and genitourinary in females, specifically, in two (9%) patients. Pneumococcal serotypes causing peritonitis were under-represented in current vaccines – 17% among peritonitis patients versus 53% for the remainder of IPD patients for the 7-valent pneumococcal conjugate vaccine, and 56% versus 86% for the 23-valent pneumococcal polysaccharide vaccine.CONCLUSIONS: Peritonitis represents a small subset of patients with IPD, but one that is likely to grow in importance given the increase in the number of patients with hepatitis C and HIV, and the reduced coverage of peritonitis serotypes in currently available vaccines.

Clinical Features and Outcomes of Spontaneous Bacterial Peritonitis Caused by Streptococcus pneumoniae

“…Previous reports suggest that some serotypes, such as 1, 3, and 5, are more commonly associated with pneumococcal peritonitis than with other invasive pneumococcal diseases. 14 , 24 – 26 None of these serotypes was included in the 7-valent pneumococcal conjugated vaccine (PCV-7), which was first introduced in 2000. Widespread usage of PCV-7 has led to a significant decrease in invasive pneumococcal diseases by the pneumococcal serotypes covered by PCV-7.…”

What is Different About Serotype 1 Pneumococci?

“…Since this infection is uncommon, evidence is largely limited to case reports. Some have supported an association with serotype 1 [66], while others have identified other pneumococcal serotypes [67]. However, routine surveillance of IPD in Chile identified a large number of cases of pneumococcal peritonitis among children [38].…”

Primary pneumococcal peritonitis can be the first presentation of a familial complement factor I deficiency1

“…Primary pneumococcal peritonitis is an unusual clinical entity. It is currently thought to represent three distinct clinical groups: (a) pneumococcal peritonitis associated with liver disease, infectious hepatitis, cirrhosis, ascites, nephrotic syndrome, chronic renal failure and continuous ambulatory peritoneal dialysis, autoimmune disease or known immunocompromise including HIV [11], (b) pneumococcal peritonitis associated with gastrointestinal disease including appendicitis or after intra‐abdominal surgery [12] and (c) pneumococcal peritonitis sometimes, but not always, presenting with an apparent genitourinary focus in otherwise healthy young women. We identified 40 published descriptions of the latter [13–17].…”