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Non-Group A or B Streptococcal and...

PEDIATRICS Vol. 106 No. 2 August 2000, pp. 276-281

Perineal Group A Streptococcal Disease in a Pediatric Practice

Received Aug 10, 1999; accepted Dec 8, 1999.

Nancy P. Mogielnicki*, Joseph D. SchwartzmanDagger , and John A. Elliott§

From the Departments of * Pediatrics and Community and Family Medicine and Dagger  Pathology, Dartmouth Medical School, Lebanon, New Hampshire; and § Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.

Objective.   This study was designed to document the frequency and define the clinical, epidemiologic, and microbiologic characteristics of perineal disease caused by group A beta -hemolytic streptococci (GAS) in a pediatric practice in which increased numbers of cases had been observed.

Methods.  Clinical, epidemiologic, and microbiologic data were collected on all culture-confirmed cases of perineal GAS disease during the calendar year 1997. GAS isolates from clinical cases and a comparison group of children with GAS pharyngitis were analyzed by T typing, emm gene analysis, and pulsed-field gel electrophoresis (PFGE).

Results.  Twenty-three cases of GAS perineal disease were diagnosed during 4530 office visits in 1997. Thirteen cases had perianal disease, 8 had vulvovaginal infection, and 2 were infected at both sites. No cases of penile disease were identified. Infections peaked in late winter and early spring and affected children with an average age of 5 years with a range of perineal, gastrointestinal, and genitourinary symptoms. Analysis of T and emm types showed the majority (82%) of perineal isolates to be T 28 emm 28, showing 2 closely related PFGE patterns. In contrast, the pharyngeal isolates were distributed among 6 different T and emm types.

Conclusion.  Perineal infection caused by GAS may be a relatively common diagnosis in a pediatric or family practice setting. There may be specific GAS types that have a tropism for perineal tissues but the mechanism of infection is yet to be established.  Key words:  streptococcal infections, vulvovaginitis, perineum, skin diseases, infectious.




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