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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.
Pediatrics
|November 1, 1987
Summary
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.