PEDIATRICS Vol. 80 No. 5 November 1987, pp. 659-663
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Streptococcal Perianal Disease in Children

Nicholas P. Kokx MD1, Jody A. Comstock MD1, and Richard R. Facklam PhD1

1 From the Department of Pediatrics, Butterworth Hospital, Grand Rapids, Michigan, and the Reference Bacteriology Section of the Centers for Disease Control, Atlanta

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.

Key Words: streptococcal perianal disease • perianal streptococcal cellulitis • proctitis • perianal rash • perianal itching • rectal pain • blood streaked stools • direct streptococcal antigen

Submitted on November 21, 1986
Accepted on January 29, 1987




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