Outcomes in Children Treated for Perineal Group A Beta-hemolytic Streptococcal Dermatitis

Olson, Dan; Edmonson, M. Bruce

doi:10.1097/inf.0b013e318228492a

Cited by 31 publications

(20 citation statements)

References 19 publications

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“…GABHS isolates are rarely resistant to erythromycin or clindamycin, whereas higher resistant rates for both antibiotics were observed in GBBHS isolates. A 7-to 10-day course of oral penicillin V (50,000 to 100,000 IU/ kg) is considered to be the initial treatment of choice for pediatric GABHS-associated PSD (2,3,13,14,24,25). However, recurrence of the disease may occur in up to 39% of children treated and a repeated course of antibiotics is necessary, whereas some advocate prolonged treatment (e.g., 14-21 days) (26)(27)(28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

“…Alternatively, children can be treated with oral amoxicillin (50 mg/kg/day) and, if compliance is an issue, one dose of penicillin G 1.2 M IU im can be used in children weighing > 27 kg, and one dose of penicillin G 600,000 IU im in children weighing < 27 kg (24,25). In children with penicillin allergy, midecamycin (40 mg/kg/day), clarithromycin (15 mg/kg/day), or clindamycin (30 mg/kg/day) can be used (24,25), although data regarding their efficacy rely solely on a subset of treated children (2,4,14,20,31). To date, cefuroxime is the only alternative antibiotic in treatment of PSD that has been assessed in a randomized controlled trial (13).…”

Section: Discussionmentioning

confidence: 99%

“…However, treatment is often delayed because differential diagnosis of PSD includes a variety of clinical conditions (e.g., irritant diaper dermatitis, candidiasis, infection with Enterobius vermicularis, inverse psoriasis, seborrheic dermatitis, chronic inflammatory bowel disease, histiocytosis, zinc deficiency, and, rarely, sexual abuse) (2,8,12). In addition to oral penicillin and amoxicillin, PSD can also be treated with clindamycin, erythromycin, clarithromycin, or cefuroxime (1,6,13,14).…”

Section: Introductionmentioning

confidence: 99%

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Microbiological characteristics of perianal streptococcal dermatitis: a retrospective study of 105 patients in a 10-year period

Šterbenc

Seme

Lah

et al. 2016

Acta Dermatovenerologica Alpina Pannonica Et Adriatica

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Beta-hemolytic streptococci (BHS) are the most common causative agents of perianal streptococcal dermatitis (PSD). This study evaluates the distribution of BHS isolates in perianal bacterial cultures. We retrospectively reviewed microbiological results for perianal BHS that were isolated in our laboratory between 2006 and 2015. We identified a total of 105 BHS isolates from rectal swabs and swabs of clinically intact perianal skin. The majority of BHS were of group A (GABHS) (73/105; 69.5%), followed by group B BHS (GBBHS) (27/105; 25.7%), and non-group A or B BHS (5/105; 4.8%). The distribution of GABHS was age-specific, with the majority of GABHS obtained from young children. All BHS isolates were susceptible to penicillin. GABHS were universally susceptible to clindamycin, whereas 1.4% were resistant to erythromycin. GBBHS were resistant to erythromycin and clindamycin in 14.8% and 7.4% of cases. In addition, we wanted to emphasize the importance of correct diagnosis of PSD. Hence, we provide a review of protocols that can decrease the time to diagnosis and treatment of PSD, reduce patients' discomfort, and prevent unnecessary diagnostic procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Microbiological characteristics of perianal streptococcal dermatitis: a retrospective study of 105 patients in a 10-year period

Šterbenc

Seme

Lah

et al. 2016

Acta Dermatovenerologica Alpina Pannonica Et Adriatica

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“…El tratamiento varía según la bibliografía, aunque parece que la asociación de antibióticos por vía oral (penicilina o amoxicilina principalmente) y tópica (mupirocina o ácido fusídico), que cubran el EBHGA y el S. aureus, sea la mejor opción al evitar recidivas durante 7-10 días, aunque se necesitan más estudios 3 . La recurrencia de la enfermedad es de un 32-40% en pacientes tratados de manera única con amoxicilina o penicilina oral 7,9 . Si solo se usa tratamiento oral, las recurrencias parecen ser menores, con antibióticos resistentes a las β-lactamasas, pero todavía se necesita más investigación al respecto 3 .…”

Section: Discussionunclassified

Pensando en la dermatitis perianal

Osés

Fernández

Garcia³

et al. 2015

Rev Pediatr Aten Primaria

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Thinking of perianal dermatitis Introducción: la dermatitis perianal es una entidad infradiagnosticada, habitualmente producida por el estreptococo β-hemolítico del grupo A (EBHGA). La epidemiología, clínica y complicaciones están ampliamente descritas en la bibliografía. El diagnóstico es microbiológico y el tratamiento de elección asocia antibioterapia oral y tópica. Objetivo: describimos el cuadro clínico y manejo de seis pacientes para mejorar el índice de sospecha clínico. Serie de casos: seis pacientes (cinco varones). Edades: de nueve meses a cinco años (media de tres años). Clínica: seis con eritema perianal, tres con dolor defecatorio, dos con prurito, una con vaginitis. Se realizó una detección rápida de antígeno estreptocócico en cinco pacientes, de los que cuatro eran positivos inicialmente. En todos se recogió frotis rectal y en todos los cultivos creció EBHGA. Recibieron todos antibiótico oral (cinco penicilina y uno amoxicilina), asociando en cuatro mupirocina y en tres clotrimazol tópicos. Evolución satisfactoria. Discusión: los casos descritos concuerdan clínica y epidemiológicamente con la bibliografía. Es necesaria la sospecha clínica y el test rápido para el diagnóstico y tratamiento precoces. Introduction: perianal dermatitis is a misdiagnosed entity usually caused by group A beta-hemolytic streptococci (GABHS). Epidemiology, symptoms and complications are widely described in literature. The diagnosis is microbiological and the association of oral and topic antibiotic is the first choice of treatment. Objectives: we report the symptoms and management of six patients in order to improve the degree of clinical suspicion. Case-Series: patients: 6 (5 males). Ages: 9 months to 5 years (mode 3 years). Clinical presentation: 6 perianal rash, 3 rectal pain, 2 itching, 1 vaginitis. A rapid streptococcal test was done in 5 patients, 4 were initially positive. A rectum smear was taken in all patients, all of them showed GABHS growing. All patients were treated with oral antibiotic (5 penicillin, 1 amoxicillin), topic mupirocine was associated in 4 and clotrimazol in 3 patients. Satisfactory evolution. Discussion: the cases showed are clinical and epidemiologically concordant with the literature. Clinical suspicion and a rapid streptococcal test are necessary to get an early diagnosis and treatment.

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“…Group A beta‐hemolytic streptococcal infection can cause vulvar symptoms that typically occur in the female prepubertal age group . These infections may present in acute or subacute forms.…”

Section: Prepubertal Vulvar Pruritusmentioning

confidence: 99%

Female-specific pruritus from childhood to postmenopause: clinical features, hormonal factors, and treatment considerations

2013

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There have been considerable advances in our understanding of the pathophysiology of pruritus in recent years. The purpose of this review was to highlight itch entities in women, and in particular pruritic vulvar dermatoses that women experience among different age groups. Unique temporal shifts may contribute to the etiology of many of these conditions. These changes lead to cyclical changes in the skin's basic composition. Specifically, estrogen receptors have been detected on keratinocytes that respond to rising and falling levels of estrogen. These receptors lead to changes in skin hydration, collagen content, and in the concentration of glycosaminoglycans that form the skin barrier. In addition, hormonal pH changes associated with the menstrual cycle may be an important factor in the aggravation of itch as increasing pH is known to activate the proteinase-activated receptor-2, a well-known itch mediator. Common pruritic conditions in women that will be discussed include atopic and irritant dermatitis, psoriasis, lichen sclerosus, infectious vulvovaginitis, vulvovaginal candidiasis, atrophic vulvovaginitis, squamous cell carcinoma, lichen simplex chronicus, and neuropathic itch. We also examine pruritic conditions associated with pregnancy including pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy and atopic eruption of pregnancy. Finally, acceptable and contraindicated antipruritic agents in pregnancy are examined.

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Outcomes in Children Treated for Perineal Group A Beta-hemolytic Streptococcal Dermatitis

Abstract: Perineal streptococcal dermatitis initially treated with penicillin or amoxicillin is consistently associated with a high risk of clinical recurrence. Whether treatment with a beta-lactamase resistant agent reduces this risk is uncertain and should be subjected to a clinical trial.

Cited by 31 publications

References 19 publications

Microbiological characteristics of perianal streptococcal dermatitis: a retrospective study of 105 patients in a 10-year period

Microbiological characteristics of perianal streptococcal dermatitis: a retrospective study of 105 patients in a 10-year period

Pensando en la dermatitis perianal

Female-specific pruritus from childhood to postmenopause: clinical features, hormonal factors, and treatment considerations

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