Tuboovarian Abscess and Peritonitis Caused by Streptococcus pneumoniae Serotype 1 in Young Girls

Streptococcus pneumoniae is a frequent bacterial cause of pneumonia, bacteremia, meningitis, and otitis media in infants and children. Primary pneumococcal peritonitis, however, is rare in children and is usually associated with an underlying medical condition (such as nephrotic syndrome) or with upper genital tract disease in females, Pneumococcal upper genital tract infections in the premenarchal child are extremely unusual. Epidemiologic reviews of pneumococcal serotypes causing infection in children have indicated that serotype 1 is an uncommon pathogen of pelvic disease in children. We describe three children who presented with abdominal pain and a toxic appearance; appendicitis was initially suspected in all three children, but peritonitis due to S pneumoniae serotype 1 was subsequently diagnosed in all three. Each child had a tuboovarian abscess that was demonstrated radiographically. Two children had complicated courses, but all ultimately recovered. The epidemiology and possible tropism of serotype 1 isolates for the female upper genital tract are discussed.