Streptococcal Toxic Shock Syndrome: Life Saving Role of Peritoneal Lavage and Drainage

Abstract

PURPOSEWe encountered a case where an infection with group A streptococcus (GAS; ie, Streptococcus pyogenes) initially caused primary peritonitis and then subsequently caused streptococcal toxic shock syndrome. The patient’s life was likely saved by an emergency laparotomy followed by extensive peritoneal lavage and drainage.CASE PRESENTATIONA 40-year-old woman was admitted to the Emergency Department for lower abdominal pain and numbness in the extremities. She presented with systemic inflammatory response syndrome. An emergency laparotomy was performed, and ascites that resembled pus and general peritonitis were noted. Peritoneal lavage and drainage were performed, and GAS was isolated from peritoneal fluid. Gram staining of cervical polyp specimens revealed Gram-positive bacteria.CONCLUSIONSThe patient was diagnosed with streptococcal toxic shock syndrome due to an ascending GAS infection originating from vagina.

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.…”

Medically managed spontaneous bacterial peritonitis and bacteraemia associated with jugular catheter infection in a dog with tetanus

“…In people, peritoneal drainage and lavage is used postoperatively in cases of secondary peritonitis 4,51 and has also been used in cases of primary septic peritonitis. 52,53 In the case discussed, a percutaneous drainage device was placed once a surgical cause was excluded using CT. A sterile saline solution was used to lavage and the drain was removed after 24 hours. Although rapid and appropriate antimicrobial therapy is likely to be the main therapeutic intervention that contributed to the successful management in this case, peritoneal drainage and lavage likely provided mechanical reduction of intra-abdominal bacterial load.…”

“…In people, peritoneal drainage and lavage is used postoperatively in cases of secondary peritonitis 4,51 and has also been used in cases of primary septic peritonitis 52,53 . In the case discussed, a percutaneous drainage device was placed once a surgical cause was excluded using CT. A sterile saline solution was used to lavage and the drain was removed after 24 hours.…”

Necrotizing fasciitis following primary peritonitis caused by Streptococcus pyogenes with covS mutation in a healthy woman: a case report

“…There are some reports of peritonitis caused by S. pyogenes infection in healthy women [2][3][4][5][6][7]. The predominance of women among S. pyogenes peritonitis patients might implicate ascending infections of the genitourinary tract, since S. pyogenes are often part of the vaginal flora [8].…”