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September 20, 1976

Pneumococcal Appendicitis and Cecitis

JAMA. 1976;236(12):1388. doi:10.1001/jama.1976.03270130050033

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Although microbiologic examinations are rarely performed (or needed) in cases of acute appendicitis, companion articles in the current issue of Archives of Surgery emphatically demonstrate exceptions.

Dimond and Proctor (111:552-553, 1976) report the case of a 9-year-old boy who had classical symptoms and signs of acute appendicitis. At laparotomy, a cloudy, odorless exudate surrounded an acutely suppurative appendix, which was removed. Eighteen hours postoperatively, the patient's leukocyte count rose to 21,000/cu mm, and eight hours later, symptoms and signs of meningitis appeared. The spinal fluid contained numerous neutrophils and Gram-positive diplococci. At that time, cephalothin therapy, which had been started earlier, was withdrawn, and after intensive penicillin therapy was started, the infection was successfully quelled. Subsequent culture growths from peritoneal fluid, blood, and spinal fluid proved that the infection was caused by Diplococcus pneumoniae. Also, Gram-positive diplococci were found by microscopy in the wall and lumen of the appendix.