[Isolation of group A beta-hemolytic Streptococcus in children with perianal dermatitis].
BACKGROUND
Perianal dermatitis due to group A beta-hemolytic streptococcus is a rare diagnosis in pediatrics. Clinical manifestations include erythema, edema, and perianal pruritus associated with vulvovaginitis or balanitis, painful defecation, constipation, anal fissures, purulent discharge, and/or rectal bleeding.


METHODS
A descriptive, observational, prospective study was conducted between May, 2004 and April, 2005. In children presenting to the emergency room with erythema, edema, and perianal pruritus, a rapid streptococcal antigen test and bacterial cultures of their perianal secretions were obtained. Patients with a positive result in the rapid test were treated with oral phenoxymethylpenicillin (40-50 mg/kg/day) for 10 days, after which clinical and bacteriological evaluations were conducted.


RESULTS
Of the 24 patients presenting with erythema, edema, and perianal pruritus, 19 patients (12 boys and 7 girls), aged between 6 months and 4 years (median age: 30 months), tested positive for group A beta-hemolytic streptococcus. Nine patients also presented with constipation, 5 with anal fissures, 4 with rectal bleeding, 2 with vulvovaginitis, and 1 with streptococcal pharyngoamygdalitis. Outcome was favorable in 85 % of the patients, and perianal isolation of group A beta-hemolytic streptococcus was negative after treatment in 95 %.


CONCLUSIONS
In patients presenting with erythema, edema, and perianal pruritus, perianal streptococcal dermatitis should be ruled out. The rapid test for streptococcal antigen detection is a quick and reliable method for this diagnosis. The antibiotic of choice is oral penicillin.
Echeverría Fernández
M
M
Departamento de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
López-Menchero Oliva
J C
JC
Marañón Pardillo
R
R
Míguez Navarro
C
C
Sánchez Sánchez
C
C
Vázquez López
P
P
D001004:Anus Diseases / Q000382:microbiology; D002675:Child, Preschool; D003872:Dermatitis / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D011538:Pruritus Ani / Q000382:microbiology*; D013290:Streptococcal Infections / Q000175:diagnosis*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*