Immune plasma complicates determination of sensitivity of malaria to chloroquine.

Primary bacterial peritonitis is a rare condition and one which carries a mortality rate in excess on 50%. Recently a patient with clinical features of primary bacterial peritonitis who had had an IUD in situ while receiving immunosuppressive drugs was treated. The 13-year-old white girl underwent successful renal transplantation in 1979 for renal failure due to chronic glomerulonephritis. After an uneventful pregnancy in 1984 she was provided with a copper-containing IUD for contraception. In April 1985 she presented with abdominal pain fever and signs of peritopnitis which was confirmed at laparotomy. The cause of the peritonitis could not be established at laparotomy and in particular the fallopian tubes were macroscopically normal. Bacteriological cultures of the peritoneal pus grew Strepococcus pyogenes Staphylococcus epidermidis and eptostreptococcus spp. but preparation of endocervical cultures of a profuse yellow-green vaginal discharge was delayed until removal of the IUD after commencement of antibiotic therapy and yielded no growth. Response to antibiotic therapy was complete. Primary bacterial peritonitis is a bacterial infection of the peritoneum which develops in the absence of evidence of direct extension from abdominal organs. It appears that depressed defense mechanisms are a prerequisite for its development. The patient was maintained on an immunosuppresive regimen of prednisone and azathioprine and is therefore likely to have been predisposed to develop infection. The IUD also may have played a role by providing a source of infection. The organisms isolated from the peritoneal fluid cultures are consistent with a vaginal source and although the patient denied gynecological symptoms a profuse yellow-green vaginal discharge was noted on removal of the IUD. Therapeutic serum antibiotic levels precluded laboratory confirmation of the vaginal presence of these same organisms. It is now the policy of these physicians to avoid the IUD as a means of contraception in female transplant recipients and to advise instead the use of barrier methods and oral contraceptives when temporary contraception is desired.