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Streptococcal perianal disease in children
N P Kokx1, J A Comstock, R R Facklam
1Department of Pediatrics, Butterworth Hospital, Grand Rapids, Michigan 49503.
Insights
Group A beta-hemolytic streptococci caused perianal disease in children, presenting with dermatitis and itching. Researchers suggest renaming the condition from streptococcal perianal cellulitis to streptococcal perianal disease.
Area of Science:
- Pediatrics
- Infectious Diseases
- Dermatology
Background:
- Group A beta-hemolytic streptococci (GABHS) can cause various pediatric infections.
- Perianal symptoms in children are sometimes associated with GABHS, but the condition's nomenclature is debated.
Purpose of the Study:
- To characterize the clinical presentation, diagnosis, and treatment of GABHS-associated perianal disease in children.
- To evaluate the intrafamily spread and diagnostic accuracy of perianal antigen studies.
- To propose a revised nomenclature for the condition.
Main Methods:
- Retrospective chart review of 31 children treated for perianal symptoms.
- Perianal cultures for GABHS.
- Direct perianal antigen testing.
- Pharyngeal cultures.
- T-typing of GABHS isolates.
Main Results:
- Common symptoms included perianal dermatitis (90%), itching (78%), rectal pain (52%), and blood-streaked stools (35%).
- GABHS was identified in perianal cultures in all cases.
- Direct perianal antigen studies showed 89% sensitivity.
- Intrafamily spread occurred in 50% of cases, primarily to siblings.
- Relapse rate after oral penicillin treatment was 39%.
- Cellulitis signs were absent in all patients.
Conclusions:
- GABHS is a significant cause of perianal disease in children.
- The term 'streptococcal perianal disease' is more accurate than 'streptococcal perianal cellulitis' due to the absence of cellulitis signs.
- Effective diagnosis and management strategies are crucial, with consideration for high relapse rates.
Abstract:
From October 1985 through June 1986, 31 children in a single pediatric practice were treated for perianal signs and symptoms associated with growth of group A beta-hemolytic streptococci from perianal cultures. Signs and symptoms included perianal dermatitis (90%), perianal itching (78%), rectal pain (52%), and blood-streaked stools (35%). Ages ranged from 7 months to 8 years mean 4.25 +/- 1.8 years). There were 24 boys (77%) and seven girls (23%). The 31 cases occurred in 19 families. Intrafamily spread was only to siblings and occurred in 50% of the possible situations. Direct perianal antigen studies had a sensitivity of 89% for predicting positive cultures. Four different T types of group A streptococci were isolated from these cases, but the T type within each family outbreak was identical except in one case. When group A streptococci were found in the pharynx (64% of patients), the T type of the pharyngeal and perianal isolates were identical. Treatment was usually with oral penicillin. Relapses occurred in 39%. Signs of cellulitis were absent in all 31 cases and, therefore, we suggest that the nomenclature for this entity be changed from streptococcal perianal cellulitis to streptococcal perianal disease.