Perianal streptococcal disease in childhood: systematic literature review

Renato Gualtieri,Gabriel Bronz,Mario G Bianchetti,Gregorio P Milani,Sebastiano A G Lava,Elena Giuliano,Luca M M Jermini

doi:10.1007/s00431-021-03965-9

Abstract

Group A Streptococcus has been associated with a perianal infection. We conducted a systematic review of the literature on childhood streptococcal perianitis in three databases: Excerpta Medica, National Library of Medicine, and Web of Science. The main purposes were to document the clinical features, the tendency to recur, the association with an asymptomatic streptococcal throat carriage, the accuracy of rapid streptococcal tests, and the mechanism possibly underlying the acquisition of this infection. More than 80% of cases are boys ≤7.0 years of age with defecation disorders, perianal pain, local itch, rectal bleeding, or fissure and a sharply demarcated perianal redness. Perianitis is associated with a streptococcal tonsillopharyngitis in about every fifth case. The time to diagnosis is ≥3 weeks in 65% of cases. Recurrences occur within 3½ months in about 20% of cases. An asymptomatic group A streptococcal throat carriage occurs in 63% of cases. As compared with perianal Streptococcus A culture, the rapid streptococcal tests have a positive predictive value of 80% and a negative predictive value of 96%. It is hypothesized that digital inoculation from nasopharynx to anus underlies perianitis. Many cases are likely caused directly by children, who are throat and nasal carriers of Streptococcus A. Some cases might occur in children, who have their bottoms wiped by caregivers with streptococcal tonsillopharyngitis or carriage of Streptococcus.Conclusion: Perianitis is an infection with a distinctive presentation and a rather long time to diagnosis. There is a need for a wider awareness of this condition among healthcare professionals.What is Known:• Group A Streptococcus may cause perianitis in childhood.• Systemic antimicrobials (penicillin V, amoxycillin, or cefuroxime) are superior to topical treatment.What is New:• The clinical presentation is distinctive (defecation disorders, perianal pain, local itch, rectal bleeding, or fissure and a sharply demarcated perianal redness).• The time to diagnosis is usually ≥3 weeks.Recurrences occur in about 20% of cases.

Highlights

First reported in 1966, perianal infection associated with group A Streptococcus [1], for simplicity subsequently referred to as perianitis, is a pediatric disease that presents with sharply demarcated redness, mostly associated with local signs of inflammation [2].A few months ago, we treated a child affected by perianitis [3] and were impressed by the paucity of recent literature on this condition
Perianitis is an infection with a distinctive presentation and a rather long time to diagnosis
The reports detailing the 147 children do not unambiguously address the possible concurrent occurrence of perianitis and tonsillopharyngitis. The latter issue was investigated in two case series [33, 56] including 62 children affected by perianitis

Summary

Introduction

First reported in 1966, perianal infection associated with group A Streptococcus [1], for simplicity subsequently referred to as perianitis, is a pediatric disease that presents with sharply demarcated redness, mostly associated with local signs of inflammation [2]. A few months ago, we treated a child affected by perianitis [3] and were impressed by the paucity of recent literature on this condition. To efficiently integrate the existing information on perianitis, we conducted a systematic review of the original literature. The main purposes were to document the clinical features (including the occurrence of immunologically mediated sequelae and the association with tonsillopharyngitis), the prevalence, the seasonality, the tendency to recur, the association with an asymptomatic streptococcal throat carriage, the accuracy of rapid streptococcal tests, and, the acquisition and the transmission of the disease

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