Primary pneumococcal peritonitis is an uncommon condition which in the preantibiotic era was associated with a high mortality rate. We present two cases and discuss the aetiology, clinical features and management of this condition.
PIP: Primary pneumococcal peritonitis is an uncommon condition 1st identified in 1885. It occurs when peritoneal inflammation is present in the absence of an intraabdominal source of infection. In the preantibiotic era, the condition accounted for 2% of childhood abdominal emergencies largely among girls aged 2-10 years. Mortality was 42-100%, with death sometimes occurring within 48 hours of the onset of symptoms. This condition now present in female adults, is associated with IUD use, and is comparatively common in India. Consideration should therefore be given to the existence of primary pneumococcal peritonitis when diagnosing and managing abdominal emergencies. The pneumococcus may enter the peritoneal cavity via the female genital tract, blood, or through transmural spread from the gastrointestinal tract. No evidence supports a relationship between type of IUD and/or length of time in place, and the onset of peritonitis. Given pneumococcus' commensal existence in the upper respiratory tract, urogenital sex may facilitate its entrance to the peritoneal cavity through the female genital tract. Abdominal pain, diarrhea, and vomiting generally present, while the patient may also be pyrexial and dehydrated. In diagnosing this condition, the practitioner may confuse it with acute appendicitis, pelvic inflammatory disease, or gastroenteritis if in the early stages of peritonitis. Diagnosis is often confirmed only thorough laparotomy, but abdominal paracentesis and/or abdominal ultrasound may also be employed as diagnostic aids. Laparotomy and a regime of antibiotics is the preferred treatment. 2 case studies are discussed.