Prävalenz der streptogenen perianalen Dermatitis bei Kindern und Jugendlichen

Abstract

Perianal streptococcal dermatitis (PSD), caused by group A beta-haemolytic streptococci (GABHS), is a frequently overlooked medical entity. We investigated the prevalence of PSD at the University Children's Hospital Basel, Switzerland, from October 2000 to May 2001. Two hundred fifty randomly selected patients were studied for signs of PSD by history, examination, and culture. In addition, a pharyngeal swab was taken for culture of GABHS. Perianal swabs were positive for GABHS in 12 patients (7 girls, 5 boys) resulting in a prevalence of 5%. A diagnosis of PSD was made in one further culture-negative patient with compatible history and clinical signs. Signs and symptoms of 13 patients with PSD were as follows: perianal redness (67%), obstipation (58%), painful defecation (50%), perianal itching (25%), and melaena (25%). Ten of 13 patients had one or more symptoms and were treated with an antibiotic: 7 with penicillin (50 000IE/kg/d) per os for 10 days, 3 patients received amoxicillin and clavulanic acid per os or intravenously for concomitant pneumonia (n=1) and urinary tract infections (n=2). Six of 10 patients responded to treatment and were also negative for perianal GABHS on followup. Four patients, however, required a second treatment cycle for persistence of symptoms: with oral penicillin for 14 days and oral clarithromycin for 10 days in 3 and 1 patients, respectively. One month later all 4 patients were free of symptoms and 3 were also negative for perianal GABHS. In 1 patient GABHS could still be cultured from the pharynx and the perianal region but was not retreated due to lack of symptoms. Three untreated patients remained asymptomatic on follow-up and were considered to be perianal carriers of GABHS. In conclusion, PSD was frequent in our study cohort; signs and symptoms of PSD should be searched for systematically in order to treat affected patients appropriately.