Streptococcal perianal infection in children

doi:10.1136/bmj.b1517

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ education articles:

From

Limit by

The BMJ iPad app brings you the best of print and online, including live links to the latest news, blogs, video, and podcasts. Get the BMJ iPad app.
You can use bmj.com to help you with your continuing medical education. Find out about CME/CPD credits for BMJ articles
Keep up to date with cardiology: Access the latest cardiovascular medicine resources from across BMJ Group.
Countdown to London 2012: BMJ Group's Olympics portal highlights latest Olympics and sports medicine-themed research, comment and learning

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Richard Lehman, general practitioner1,
Sarah Pinder, general practitioner 1

¹Hightown Surgery, Banbury OX16 9DB

Correspondence to: R Lehman richard.lehman{at}nhs.net

Case scenario

A 3 year old child is brought by her mother, who says that her daughter has had an itchy bottom and pain on opening her bowels most days for the past two weeks. On examination she has an erythematous and excoriated anus with multiple anal fissures. As these symptoms and findings in a preschool child are highly suggestive of streptococcal proctitis, you undertake a perianal swab, which shows a pure growth of group A streptococcus.

Streptococcal perianal infection in children is caused by group A Streptococcus pyogenes and is usually confined to the immediate perianal area, though it can spread to the perineum and occasionally the genitalia.1 2

How common is it?

The incidence of perianal infection caused by group A S pyogenes is not known, but since the first case descriptions in 19663 it has been reported in children from around the world. In a US general paediatric practice, perianal streptococcal disease was detected in one consultation per 300, and perineal disease (that is, perianal plus vulvovaginal disease) in one per 200.1 A 1996 audit of our own practice (an urban British practice with 7000 patients and four full …