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Matsumoto Y, Shimizu A, Ogawa K, Kuroki S, Ikuta K, Senda E, Kagawa H, Shio S. Primary Peritonitis Due to Group A Streptococcus Successfully Treated with Intraperitoneal Drainage. Intern Med 2024; 63:1229-1235. [PMID: 37722896 DOI: 10.2169/internalmedicine.1933-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
A 42-year-old woman was admitted to our hospital because of lower abdominal pain and diarrhea. Although the initial symptoms and imaging findings were similar to those of acute enteritis, blood and ascites cultures led to the diagnosis of primary peritonitis caused by group A Streptococcus. In many cases, the disease rapidly deteriorates, and laparotomy is performed for the early diagnosis and to reduce the number of bacteria in the abdominal cavity. In the present case, intraperitoneal drainage was effective for avoiding surgery. We suggest that intraperitoneal drainage is effective for the treatment of this disease.
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Affiliation(s)
| | - Akiko Shimizu
- Division of Gastroenterology, Shinko Hospital, Japan
| | - Kento Ogawa
- Division of Gastroenterology, Shinko Hospital, Japan
| | | | - Kozo Ikuta
- Division of Gastroenterology, Shinko Hospital, Japan
| | - Eri Senda
- Division of Gastroenterology, Shinko Hospital, Japan
| | - Hiroki Kagawa
- Division of Infectious Diseases, Shinko Hospital, Japan
| | - Seiji Shio
- Division of Gastroenterology, Shinko Hospital, Japan
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Soga K, Mazaki M, Takakura S, Kitae H, Akamatsu N. Streptococcus pyogenes Infection-Induced Primary Peritonitis in a Healthy Adult Female: A Very Rare Causative Agent. Cureus 2023; 15:e43330. [PMID: 37700962 PMCID: PMC10493072 DOI: 10.7759/cureus.43330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
A 44-year-old woman with an unremarkable medical history presented to another hospital complaining of lower abdominal pain and nausea. The clinical presentation was consistent with an acute abdomen, raising suspicion of gastrointestinal tract perforation. However, imaging studies failed to provide evidence of perforation. Subsequently, the patient was diagnosed with peritonitis of unknown origin and promptly administered broad-spectrum antibiotics in a fasting state. Although the patient initially exhibited unstable symptoms, hemodynamics, and serology, she gradually improved over three days, with values approaching normal levels. On the sixth day of hospitalization, a follow-up abdominal computed tomography scan revealed pleural effusions, extensive ascites, and intra-abdominal stranding. The thickened wall of the small intestine and intra-abdominal stranding that were suggestive of peritonitis were further exacerbated. On the seventh day of hospitalization, aerobic and anaerobic blood cultures revealed the presence of Gram-positive cocci, later confirmed to be Streptococcus pyogenes, leading to the diagnosis of S. pyogenes infection-induced primary peritonitis. The source of infection was identified as a 10 mm hydrosalpinx in the left fallopian tube, suggesting the possibility of retrograde infection. The patient ultimately made a complete recovery without relapse and has been doing well since. This case report highlights a unique and rare occurrence of primary peritonitis caused by group A Streptococcus associated with infection from a hydrosalpinx in an otherwise healthy and young female patient. The diagnosis of primary spontaneous bacterial peritonitis in such an individual presents an uncommon clinical manifestation, emphasizing the importance of considering atypical sources of peritoneal infection in clinical practice.
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Affiliation(s)
- Koichi Soga
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Saitama, JPN
- Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, JPN
| | - Mika Mazaki
- Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, JPN
| | - Shun Takakura
- Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, JPN
| | - Hiroaki Kitae
- Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, JPN
| | - Naoaki Akamatsu
- Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, JPN
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Kumar S, Kumar R, Saha K, Chauhan S, Diwakar K. A Case Report of Rare and Lethal Methicillin-Resistant Staphylococcus aureus (MRSA) Peritonitis in Infancy. Cureus 2023; 15:e41303. [PMID: 37539401 PMCID: PMC10394718 DOI: 10.7759/cureus.41303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Peritoneal inflammation without a discernible intraperitoneal source is referred to as primary peritonitis. Only 2% of pediatric acute abdominal crises are diagnosed preoperatively. Association with other infections is uncommon and is often limited to hepatic and urinary pathogens. Here, we describe a case of primary peritonitis in a one-month-old child who had laparotomy and appendicectomy as per the recommended treatment plan. There were no accompanying hepatic and urinary diseases. In this instance, methicillin-resistant Staphylococcus aureus (MRSA) was the responsible bacteria. The use of linezolid, as per the culture sensitivity report of intraperitoneal pus, ensured a smooth recovery in this case.
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Affiliation(s)
- Shishir Kumar
- Department of General Surgery, Tata Main Hospital, Jamshedpur, IND
| | - Ratan Kumar
- Pediatric Intensive Care Unit, Tata Main Hospital, Jamshedpur, IND
| | - Kaushik Saha
- Department of Pathology, Tata Main Hospital, Jamshedpur, IND
| | - Shivraj Chauhan
- Department of General Surgery, Tata Main Hospital, Jamshedpur, IND
| | - Kumar Diwakar
- Department of Pediatrics, Manipal Tata Medical College (MTMC) Tata Main Hospital, Jamshedpur, IND
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Maraki S, Moraitis P, Barbagadakis S, Vlachakis I. Primary Bacterial Peritonitis Caused by Streptococcus pneumoniae. J Glob Infect Dis 2021; 13:103-104. [PMID: 34194180 PMCID: PMC8213084 DOI: 10.4103/jgid.jgid_197_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/26/2020] [Accepted: 01/04/2021] [Indexed: 11/24/2022] Open
Abstract
Primary peritonitis is a rare infection in healthy children, mainly affecting patients with underlying medical disorders. We report a case of primary pneumococcal peritonitis in an immunocompetent 3-year-old boy. Diagnosis was made at laparotomy and cultures of the intra-abdominal pus yielded Streptococcus pneumoniae. Timely antibiotic treatment administered resulted in complete resolution of the infection.
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Affiliation(s)
- Sofia Maraki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
| | - Panagiotis Moraitis
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
| | - Sophia Barbagadakis
- Department of Pediatric Surgery, University Hospital of Heraklion, Crete, Greece
| | - Ioannis Vlachakis
- Department of Pediatric Surgery, University Hospital of Heraklion, Crete, Greece
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Aw AEY, Lee JWK, Tay KV. Primary Peritonitis Secondary to Streptococcus pyogenes in a Young Female Adult-A Case Report and Literature Review. Infect Dis Rep 2021; 13:26-32. [PMID: 33401399 DOI: 10.3390/idr13010005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/29/2022] Open
Abstract
Primary spontaneous bacterial peritonitis (SBP) is a rare cause of acute abdomen in previously healthy patients, even more unusually caused by a group A Streptococcus (GAS) (also known as Streptococcus pyogenes) infection. We report a young, otherwise healthy female who presented with generalized abdominal pain that was initially managed conservatively as gastroenteritis, with a computed tomography (CT) scan showing a ruptured corpus luteal cyst. Upon subsequent readmission with worsened pain and symptoms, a repeat CT scan showed worsened free fluid with signs of peritonitis. A diagnostic laparoscopy confirmed primary peritonitis with an unknown infection source and causative pathology, as the appendix, ovaries and bowels were healthy-looking. Fluid cultures returned positive for GAS Pyogenes, while blood and urine cultures were negative. The discussion reviews the challenges in diagnosis and treatment of GAS primary peritonitis, highlighting the need for clinical suspicion, early diagnosis via laparoscopy or laparotomy and prompt antibiotic therapy as the current standard for treatment.
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Tolmáči B, Klein J, Žuffa P, Řehulková A. Primary pneumococcal peritonitis with a fulminant course. Vnitr Lek 2021; 67:34-37. [PMID: 34074103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Primary peritonitis is an inflammation of the peritoneal cavity in the absence of a localized intra-abdominal source. It is included in the differential diagnosis of acute abdomen and can be potentially life-threatening. Pneumococci were a frequent pathogen causing primary peritonitis especially in the preantibiotic era. Nowadays, they act as an uncommon primary pathogen. Pneumococcal peritonitis in adults is more frequently seen in cases of liver cirrhosis with ascites and other pre-existing conditions. Primary pneumococcal peritonitis is uncommon in healthy individuals and therefore its diagnosis is difficult. Secondary peritonitis has to be excluded. CASE REPORT A 36-year-old woman was admitted to our surgery department with symptoms of severe sepsis. She reported a sudden onset of diffuse abdominal pain and was eight weeks after delivery per vias naturales. A computed tomography scan of the abdomen with intravenous contrast has not demonstrated any pathology explaining the condition of our patient. Empiric anti-microbial therapy with broad-spectrum antibiotics was commenced and a laparotomy was performed, which also did not reveal any source of infection. Purulent odorless fluid was found in the peritoneal cavity. Peritoneal lavage with an antiseptic was performed. Cultures from peritoneal fluid demonstrated a monobacterial growth of Streptococcus pneumoniae. The condition of our patient improved after continued adequate antibiotic therapy and lavage. CONCLUSION Primary pneumococcal peritonitis is difficult to diagnose in healthy individuals, since it is mimicking secondary peritonitis that has to be excluded. A clinical diagnose without surgical intervention is impossible in most cases. Surgical treatment has an important role in both the diagnosis and management of primary pneumococcal peritonitis, same as adequate antibiotic therapy. Primary peritonitis should be a part of the differential diagnosis of patients presenting with acute abdominal pain.
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Farkas L, Lazáry G, Köves I, Csákváry V, Rónaky R, Nagy T. Primary peritonitis in an adolescent boy. Orv Hetil 2020; 161:977-979. [PMID: 32453696 DOI: 10.1556/650.2020.31757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/17/2020] [Indexed: 11/19/2022]
Abstract
Primary peritonitis is very rare in healthy children without predisposing factors. In the absence of unique factors and signs, the clinical picture does not differ from secondary peritonitis. Therefore, the diagnosis is almost always an intraoperative diagnosis. Case report: We admitted a previously healthy 15-year-old boy with symptoms of acute enteritis. Within 24 hours, he developed acute abdomen and signs of septic shock. Computer tomography of the abdomen revealed air bubbles in the middle of the abdomen and near the terminal ileum. Suspecting perforation, we performed an emergency laparotomy. However, there was no perforation to be found in the background of the purulent peritonitis. We initiated empirical broad-spectrum antimicrobial therapy which we later adjusted. Septic shock and complications were treated successfully. We could not find the source of the primary peritonitis. Since hospital discharge, the child has been asymptomatic. In primary peritonitis, due to the nonspecific, rapidly progressing symptoms, an emergency surgery can not be avoided. With proper antibiotics and supportive therapy, the prognosis is favourable. Orv Hetil. 2020; 161(23): 977-979.
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Affiliation(s)
- László Farkas
- Csecsemő- és Gyermekgyógyászati Osztály, Gyermeksebészeti Szakambulancia,Markusovszky Egyetemi Oktatókórház Szombathely, Markusovszky út 5., 9700
| | - György Lazáry
- Csecsemő- és Gyermekgyógyászati Osztály, Gyermeksebészeti Szakambulancia,Markusovszky Egyetemi Oktatókórház Szombathely, Markusovszky út 5., 9700
| | - Ilona Köves
- Csecsemő- és Gyermekgyógyászati Osztály,Markusovszky Egyetemi Oktatókórház Szombathely
| | - Violetta Csákváry
- Csecsemő- és Gyermekgyógyászati Osztály,Markusovszky Egyetemi Oktatókórház Szombathely
| | - Rebeka Rónaky
- Csecsemő- és Gyermekgyógyászati Osztály, Gyermeksebészeti Szakambulancia,Markusovszky Egyetemi Oktatókórház Szombathely, Markusovszky út 5., 9700
| | - Tamás Nagy
- Központi Radiológiai Osztály,Markusovszky Egyetemi Oktatókórház Szombathely
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Barrés-Fernández A, Piolatti-Luna A, Bretón-Martínez JR, Crehuá-Gaudiza E, Quiñones-Torrelo C, Moscardó-Navarro A, Fuertes-Latasa C, Martínez-Costa C. Case Report: Primary Peritonitis as the Onset of Pediatric Ménétrier's Disease. Front Pediatr 2020; 8:589853. [PMID: 33520889 PMCID: PMC7838494 DOI: 10.3389/fped.2020.589853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/07/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction: Primary peritonitis (PP) and Ménétrier's Disease (MD) are both rare conditions among pediatric population. Although about 150 MD cases have been described in the scientific literature to date, its onset with a PP is an unusual condition. Case Presentation: We present a case of an 11-year-old boy who was admitted to our unit because of abdominal pain and distension. Complementary tests showed ascites, bilateral pleural effusion, leukocytosis, increased acute phase reactants and hypoproteinemia with hypoalbuminemia. Laparoscopy ruled out appendicitis or visceral perforations and exposed purulent peritoneal fluid, compatible with PP. Biochemical stool analysis showed increased clearance of alpha-1-antitrypsin, which was consistent with a protein-losing enteropathy. Gastroscopy findings were compatible with MD. The clinical course was favorable and he had no recurrence after 12 months of follow-up. Conclusion: PP can be the first clinical manifestation of pediatric MD. Knowledge of MD and its generally benign nature in children is important in order to avoid excessive testing and unnecessary treatment.
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Affiliation(s)
| | | | - José Rafael Bretón-Martínez
- Pediatric Department, Hospital Clínico Universitario, Valencia, Spain.,Department of Pediatrics, University of Valencia, Valencia, Spain
| | - Elena Crehuá-Gaudiza
- Pediatric Department, Hospital Clínico Universitario, Valencia, Spain.,Department of Pediatrics, University of Valencia, Valencia, Spain
| | - Carmen Quiñones-Torrelo
- Clinic Biochemistry and Molecular Pathology Department, Hospital Clínico Universitario, Valencia, Spain
| | | | | | - Cecilia Martínez-Costa
- Pediatric Department, Hospital Clínico Universitario, Valencia, Spain.,Department of Pediatrics, University of Valencia, Valencia, Spain
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Scotti KM, Koenigshof A, Sri-Jayantha LSH, Kato M, Bishop M, Barr JW, Pashmakova MB. Prognostic indicators in cats with septic peritonitis (2002-2015): 83 cases. J Vet Emerg Crit Care (San Antonio) 2019; 29:647-652. [PMID: 31654546 DOI: 10.1111/vec.12896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 12/25/2017] [Accepted: 01/11/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To identify physical exam findings, clinicopathological parameters, time to surgery, empirical antimicrobial use, and culture results that could be associated with outcome in cats with septic peritonitis (SP). DESIGN Retrospective cohort study of cats from 2002 to 2015. SETTING Four university teaching hospitals. ANIMALS Eighty-three cats diagnosed with SP by cytology or culture. INTERVENTIONS None MEASUREMENTS AND MAIN RESULTS: Fifty-eight cats survived to discharge (69.9%); 1 cat was euthanized in surgery; 20 were euthanized postoperatively; 4 cats suffered cardiac arrest after surgery. The most common etiology of SP was secondary SP due to gastrointestinal perforation (49.4%), followed by primary SP (22.3%). Mean blood glucose concentration was significantly different between survivors and nonsurvivors (P = 0.006). Cats that received appropriate empirical antibiotic therapy were 4.4 times more likely to survive than cats that did not receive appropriate antibiotics (P = 0.018). CONCLUSIONS As previously documented, SP secondary to gastrointestinal leakage was the most common etiology. In this population, cats with a higher blood glucose concentration on presentation had a worse prognosis. Cats that received appropriate empirical antimicrobial therapy were more likely to survive.
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Affiliation(s)
| | - Amy Koenigshof
- Michigan State University Veterinary Medical Center, East Lansing, Missouri
| | - Loren S H Sri-Jayantha
- Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Michael Kato
- William R. Pritchard Veterinary Medical Teaching Hospital, Davis, California
| | - Micah Bishop
- WAVE Veterinary Internal Medicine, Naples, Florida
| | - James W Barr
- BluePearl Veterinary Partners, Grand Rapids, Michigan
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Iitaka D, Ochi F, Nakashima S, Fujiyama J, Masuyama M. Treatment with antibodies against primary group A streptococcal peritonitis: A case report and a review of the literature. Medicine (Baltimore) 2017; 96:e9498. [PMID: 29384948 PMCID: PMC6392647 DOI: 10.1097/md.0000000000009498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Several reports describe severe group A streptococcal (GAS) infections causing septic shock, soft-tissue necrosis, and multiple organ failure known as streptococcal toxic shock syndrome (STSS). However, primary peritonitis with GAS is rare and most of them were undertaken surgical procedure. PATIENT CONCERNS We herein reported the case of 26-year-old healthy woman with sudden severe abdominal pain and hypotension. Computed tomography (CT) showed that large amount of free fluid in the peritoneal cavity consist with peritonitis, and no free air. DIAGNOSES Primary peritonitis with GAS. INTERVENTIONS Proper antibiotic therapy according to blood culture results. OUTCOMES After antibiotic therapy, the patient recovered well without complications. LESSONS An appropriate diagnostic approach and prompt antibiotic therapy is essential in GAS primary peritonitis.
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Abstract
We herein report the case of a 66-year-old woman presenting with symptoms of gastroenteritis. Computed tomography showed small-bowel dilation without ischemic signs. After admission, she went into shock and was treated for sepsis of unknown origin. She was later diagnosed with group A streptococcal peritonitis due to an ascending vaginal infection. This case highlights the importance of considering Group A Streptococcus (GAS) infection as a cause of peritonitis in postmenopausal women.
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Affiliation(s)
- Yuri Iwata
- Department of Gastroenterology, Fujisawa City Hospital, Japan
| | - Shigeru Iwase
- Department of Gastroenterology, Fujisawa City Hospital, Japan
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12
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Abstract
Primary peritonitis is a rare phenomenon in modern antibiotic era. A case of pediatric primary peritonitis is presented here, in which a child presented with complaints of abdominal pain, vomiting for one day. Abdominal examination showed marked tenderness and guarding, diagnosis of appendicitis was made and laparoscopic appendectomy done. Later, ascitic fluid analysis and appendix histopathology proved it to be a case of primary peritonitis.
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