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Streptococcus pyogenes peritonitis: a rare, lethal imitator of appendicitis

Matthew Johnson1, Ashley Bartscherer1, Ellis Tobin2

  • 1Department of Surgery, Albany Medical College, Albany, New York, USA.

BMJ Case Reports
|October 2, 2019
PubMed

Insights

Invasive Streptococcus pyogenes infections mimic appendicitis, leading to unnecessary surgeries. Early suspicion and prompt antibiotic treatment are crucial for better outcomes in these serious infections.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Surgical Pathology

Background:

  • Streptococcus pyogenes is a significant pathogen causing infections.
  • Invasive S. pyogenes infections have increased by 24% since 2010.
  • These infections carry a substantial mortality rate of 10%.

Observation:

  • A case series and literature review identified 32 patients with invasive S. pyogenes.
  • Two presented with appendicitis-like symptoms, undergoing appendectomies with S. pyogenes confirmed post-operatively.
  • Literature review revealed common characteristics: average age 27, 75% female, 9% immunocompromised, 15% with rashes, and 88% surgical intervention.

Findings:

  • Invasive S. pyogenes can present with symptoms mimicking acute appendicitis.
  • Diffuse peritoneal inflammation without appendicitis was noted in surgical cases.
  • Risk factors include female gender, immunosuppression, and prior varicella infection.

Implications:

  • Early suspicion of S. pyogenes is vital when symptoms resemble appendicitis.
  • Prompt antibiotic therapy can improve patient outcomes.
  • Distinguishing S. pyogenes from appendicitis can prevent unnecessary surgical procedures.
Keywords:
general surgeryinfectious diseases

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