Six cases of acute appendicitis with secondary peritonitis caused byStreptococcus pneumoniae

Abstract

In six previously healthy children and adults with typical acute appendicitis, Streptococcus pneumoniae was isolated from peritoneal swabs or periappendicular pus in pure culture (four patients) or together with intestinal flora. Pneumococci recovered by abdominal paracentesis are not pathognomonic of socalled primary or spontaneous peritonitis.

Streptococcus pneumoniae appendicitis in an adult patient

“…Information regarding previous respiratory infections was not available for all cases, but no patient questioned by this has reported previous infection [5][6][7][8][9], and only 1 presented pneumococcal nasopharynx colonization [7]. We have neither assessed the occurrence of previous infection nor previous administration of antipneumococcal vaccine.…”

“…It is intriguing, therefore, that only 1 case was associated with the expected enteric microorganisms [6,13]. In fact, in most cases (87.5%, 14/16), S pneumoniae was detected in pure cultures.…”

“…Bowel colonization may be the source of the pathologic process [6]. However, the intrinsic pneumococcal susceptibility to acid environment supports the protective role of gastric acid against significant bowel colonization.…”

Spectrum of Abdominal and Pelvic Infections Caused by Pneumococci in Previously Healthy Adult Women

“…There have been some reports of pneumococcal peritonitis in patients with cirrhosis or nephrotic syndrome, in those undergoing continuous peritoneal dialysis, in bone marrow transplant patients, and in patients with rheumatoid arthritis or systemic lupus erythematosus [5,6]. Abdominal pneumococcal infections have also been described in patients with acute appendicitis [7]. In a recent review, pneumococcal peritonitis in previously healthy adults was associated with genital infections [5].…”

Pneumococcal pneumonia preceding appendicitis in a child

“…Intra-abdominal infections due to S. pneumoniae are rare; Heltberg et al [3] reported only six cases of primary pneumococcal appendicitis during the years 1967 to 1981 and S. pneumoniae was isolated only from one patient's peritoneal fluid out of 296 perforated appendicitis cases [2]. The mechanism of the appendix colonisation by the bacteria is either by mucosal translocation leading to direct invasion of gut wall or via haematogenous seeding [5].…”