Pneumococcal peritonitis—A forgotten disease?

Abstract

In 1923 McCartney separated ‘primary’ pneumococcal peritonitis from peritonitis secondary to a pneumococcal lesion elsewhere, usually in the lungs. McCartney believed that primary pneumococcal peritonitis was an ascending infection from the vagina and occurred exclusively in females. It seems to be unrecognized that pneumococcal peritonitis still occurs. However, during the past 11½ years (1965 to June 1976, inclusive) we have encountered 17 cases of pneumococcal peritonitis. Patients with an underlying disease, such as nephritis, have been excluded. In 14 cases a pneumococcus was isolated from peritoneal exudate and in 3 cases on blood culture. There were 6 primary cases, 4 of which occurred in girls, aged 4–9 yr. Six cases were secondary to appendicitis, which also occurred mainly in children (4 boys and 1 girl). The remaining 5 cases had peritonitis secondary to a perforated duodenal ulcer or a twisted ovarian cyst (1 case each), or clinical details were insufficient for classification. No instance of peritonitis complicating pneumonia was recognized. All 6 cases of primary peritonitis were caused by serotype 1. This high incidence of type 1 is striking because type 1 pneumococci were isolated from only 16 of 294 cases (5%) of acute pneumococcal infections studied in Sydney in 1965–9. In peritonitis secondary to appendicitis, 4 pneumococcal types were met (1, 14, 15 and 19). During the 1920s pneumococcal peritonitis had a high mortality rate; thus only 2 of McCartney's 10 cases survived. Because this infection responds readily to penicillin G, it should now be rarely fatal.