**Question:** Primary peritonitis with pneumococcus is associated with -

A. Liver abscess
B. Pancreatic abscess
C. Perforated appendicitis
D. Meningitis

**Core Concept:**

Primary peritonitis refers to the infection of the peritoneal cavity without prior abdominal surgery or injury. Pneumococcus is a gram-positive bacterium commonly causing pneumonia and meningitis. In certain cases, it can enter the peritoneal cavity and lead to primary peritonitis.

**Why the Correct Answer is Right:**

**D. Meningitis:** Pneumococcus is known to cause meningitis due to its invasive nature and ability to cross the blood-brain barrier. In rare cases, it can extend from adjacent structures (e.g., pneumonia) and cause meningitis.

**Why Each Wrong Option is Incorrect:**

**A. Liver abscess:** Pneumococcus is less likely to cause liver abscess directly. Liver abscesses are typically caused by Klebsiella, Salmonella, or other gram-negative bacteria.

**B. Pancreatic abscess:** Pneumococcus rarely causes pancreatic abscesses directly. Pancreatic abscesses are more commonly associated with gram-negative bacteria like Escherichia coli and Klebsiella species.

**C. Perforated appendicitis:** While appendicitis can lead to peritonitis, the correct answer should be perforated appendicitis, not appendicitis itself. Pneumococcus can cause peritonitis in cases of perforated appendicitis, but it is less common compared to other bacteria like Escherichia coli and Klebsiella species.

**Clinical Pearl / High-Yield Fact:**

Primary peritonitis with pneumococcus is less common but requires prompt diagnosis and treatment due to potential complications. Treatment typically involves antibiotics and surgery, depending on the severity of the infection.

In conclusion, while pneumococcus can cause primary peritonitis, the correct answer is meningitis due to its invasive nature and ability to cross the blood-brain barrier. Liver abscess, pancreatic abscess, and perforated appendicitis are less common causes of peritonitis in comparison to pneumococcus.