Practice

Easily Missed?

Streptococcal perianal infection in children

BMJ 2009; 338 doi: 10.1136/bmj.b1517 (Published 5 May 2009)
Cite this as: BMJ 2009;338:b1517

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  1. Richard Lehman, general practitioner1,
  2. Sarah Pinder, general practitioner 1
  1. 1Hightown Surgery, Banbury OX16 9DB
  1. 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 …

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