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Perianal Streptococcal Dermatitis

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1. Perianal Streptococcal Dermatitis

Perianal Streptococcal Dermatitis Perianal Streptococcal Dermatitis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Perianal (...) Streptococcal Dermatitis Perianal Streptococcal Dermatitis Aka: Perianal Streptococcal Dermatitis , Perianal Streptococcal Cellulitis , Chronic Perianal Cellulitis II. Epidemiology Affects children ages 6 months to 10 years III. Cause IV. Risk Factors: Exposure to infection V. Symptoms Painful Blood streaked stools associated with s Perianal VI. Signs Bright red, sharply demarcated perianal rash Local spread to genitalia may occur No associated fever or systemic signs Yellow crust or mucoid discharge may

2018 FP Notebook

2. Guttate psoriasis triggered by perianal streptococcal infection. (PubMed)

Guttate psoriasis triggered by perianal streptococcal infection. The association of guttate psoriasis (GP) with streptococcal pharyngitis is well accepted. However, less is known about the association with perianal streptococcal infection. We report a case of a 19-month-old boy with GP after a preceding perianal streptococcal dermatitis, with no clinical signs of a streptococcal pharyngitis. Treatment with phenethicillin was given together with mometasone ointment. After 4 weeks, the perianal (...) redness was reduced and the psoriasis had improved significantly. A review of the literature revealed nine previous case reports, comprising a total of 15 patients. In all cases, the perianal dermatitis and the GP improved after treatment with oral antibiotics, sometimes in combination with topical corticosteroids. We conclude that in cases of GP in children, the perianal area must be examined for streptococcal infection.© 2017 British Association of Dermatologists.

2017 Clinical & Experimental Dermatology

3. Perianal streptococcal infection precipitating pustular psoriasis in an adult (PubMed)

Perianal streptococcal infection precipitating pustular psoriasis in an adult 27504479 2016 08 09 2019 02 26 2352-5126 2 4 2016 Jul JAAD case reports JAAD Case Rep Perianal streptococcal infection precipitating pustular psoriasis in an adult. 281-3 10.1016/j.jdcr.2016.05.010 Maiolo Corinne C Department of Dermatology, Royal Adelaide Hospital, Adelaide, Australia. Kwok Samuel M SM Department of Dermatology, Royal Adelaide Hospital, Adelaide, Australia. Ross Christopher C Department (...) of Dermatology, Royal Adelaide Hospital, Adelaide, Australia. Ibbetson Jan J Department of Anatomical Pathology, SA Pathology, Adelaide, Australia. eng Case Reports 2016 07 25 United States JAAD Case Rep 101665210 2352-5126 Streptococcus adult infection perianal psoriasis pustular 2016 8 10 6 0 2016 8 10 6 0 2016 8 10 6 1 epublish 27504479 10.1016/j.jdcr.2016.05.010 S2352-5126(16)30038-8 PMC4968311 Pediatr Dermatol. 2000 Jan-Feb;17(1):1-6 10720979 Contact Dermatitis. 2005 Mar;52(3):142-4 15811028 J Cutan

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2016 JAAD Case Reports

4. Perianal Streptococcal Dermatitis

Perianal Streptococcal Dermatitis Perianal Streptococcal Dermatitis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Perianal (...) Streptococcal Dermatitis Perianal Streptococcal Dermatitis Aka: Perianal Streptococcal Dermatitis , Perianal Streptococcal Cellulitis , Chronic Perianal Cellulitis II. Epidemiology Affects children ages 6 months to 10 years III. Cause IV. Risk Factors: Exposure to infection V. Symptoms Painful Blood streaked stools associated with s Perianal VI. Signs Bright red, sharply demarcated perianal rash Local spread to genitalia may occur No associated fever or systemic signs Yellow crust or mucoid discharge may

2015 FP Notebook

5. Randomized, comparative efficacy trial of oral penicillin versus cefuroxime for perianal streptococcal dermatitis in children (PubMed)

Randomized, comparative efficacy trial of oral penicillin versus cefuroxime for perianal streptococcal dermatitis in children To investigate the efficacy of penicillin compared with cefuroxime for group A beta-hemolytic Streptococcus pyogenes (GABHS) perianal dermatitis.Children 1 to 16 years of age with signs and symptoms of perianal dermatitis and a positive anal swab were randomized to penicillin or cefuroxime treatment and were clinically re-evaluated on day 3 and at the end of treatment (...) with the ethics committee. Clinical improvement was more rapid in the cefuroxime group (P = .028) and GAHBS was not isolated from the anus the last day of therapy in 13 of 14 patients treated with cefuroxime compared with 7 of 15 patients treated with penicillin (P < .01).Cefuroxime was more effective than penicillin and therefore should be considered as the treatment of choice for perianal dermatitis due to GABHS.

2009 EvidenceUpdates

6. Outcomes in children treated for perineal group A beta-hemolytic streptococcal dermatitis. (PubMed)

Outcomes in children treated for perineal group A beta-hemolytic streptococcal dermatitis. To evaluate reports that describe relapse or recurrence following treatment of perineal streptococcal dermatitis (PSD), we studied a large cohort of children with these perianal or perivaginal infections to determine whether outcomes are related to the antimicrobial agent selected for initial treatment.We audited laboratory logs and medical records to retrospectively identify incident cases of culture (...) [95% CI: 1.18-4.81]).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.

2011 The Pediatric infectious disease journal

7. CRACKCast E137 – Skin Infections

cellulitis. Skin infection mimics include venous stasis dermatitis and other forms of dermatitis. Rosen’s in Perspective The skin is the largest organ in the body and accounts for about 15% of total body weight. It has three layers, the hypodermis, dermis, and epidermis. Let’s talk about some quick pathophysiology: The epidermal appendages are important as sites of infection because they provide a break in the otherwise continuous protective layer of keratinocytes and create a potential space (...) diagnosis for cellulitis Cellulitis is an inflammatory condition of skin and subcutaneous tissue thought to be the result of bacterial infection. It may be purulent or non-purulent and may occur in the setting of wounds, foreign bodies, or impaired perfusion. Differential Diagnoses Contact dermatitis Fungal infection Burns (superficial burns) Viral infections Insect bites (e.g. large localized reaction to hymenoptera sting) Allergies: including fixed drug eruptions localized inflammation. Necrotizing

2017 CandiEM

8. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections

or abscesses who have failed initial antibiotic treatment or have markedly impaired host defenses or in patients with SIRS and hypotension (severe; Figure and Table (strong, low). Table 2. Antimicrobial Therapy for Staphylococcal and Streptococcal Skin and Soft Tissue Infections Disease Entity Antibiotic Dosage, Adults Dosage, Children a Comment Impetigo b ( Staphylococcus and Streptococcus ) Dicloxacillin 250 mg qid po N/A N/A Cephalexin 250 mg qid po 25–50 mg/kg/d in 3–4 divided doses po N/A Erythromycin (...) antimicrobial agents for patients with severe penicillin hypersensitivity N/A Streptococcal skin infections Penicillin 2–4 million units every 4–6 h IV Clindamycin 600–900 mg every 8 h IV Nafcillin 1–2 g every 4–6 h IV Cefazolin 1 g every 8 h IV Penicillin VK 250–500 mg every 6 h po Cephalexin 500 mg every 6 h po Penicillin 60–100 000 units/kg/dose every 6 h 10–13 mg/kg dose every 8 h IV 50 mg/kg/dose every 6 h 33 mg/kg/dose every 8 h IV Clindamycin, vancomycin, linezolid, daptomycin, or telavancin

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2014 Infectious Diseases Society of America

11. Pruritus ani

and perianal erythema. Psychological pruritus ani — itching is associated with psychosomatic or psychiatric disorders (such as depression). Secondary pruritus ani has many possible causes, including: Skin conditions, such as dermatitis and psoriasis. Infections and infestations, such as a staphylococcal infections (which may also present with anal discharge) and scabies. Colorectal and anal pathology, such as anal fissure and haemorrhoids (which may also present with perianal pain and bleeding (...) of faecal loss (anorectal dysfunction) causes itching and transient perianal erythema. Psychological pruritus ani — itching is associated with psychosomatic or psychiatric disorders (such as depression). Secondary pruritus ani can be caused by a number of underlying disorders, including [ ; ; ; ; ; ]: Skin conditions (50% of cases), including: Primary conditions, such as atopic eczema, Bowen's disease, lichen planus, lichen sclerosus, psoriasis, seborrhoeic dermatitis, and Paget's disease (very rare

2016 NICE Clinical Knowledge Summaries

12. Balanitis

Balanitis Balanitis - NICE CKS Clinical Knowledge Summaries Share Balanitis: Summary Balanitis describes inflammation of the glans penis, and posthitis describes inflammation of the prepuce (foreskin). In practice, both areas are often affected, and the term 'balanoposthitis' is then used. Balanitis may be caused by a range of different conditions affecting the penile skin (which may present similarly and may co-exist) including: Non-specific dermatitis with possible candidal or bacterial (...) secondary infection, or trauma. Other infections including anaerobes and sexually transmitted infections (STIs). Skin conditions such as contact dermatitis, seborrhoeic dermatitis, psoriasis, lichen planus, or lichen sclerosus. Pre-malignant penile conditions. Balanitis affects about 4% of uncircumcised boys between the ages of 2–5 years. Complications may include phimosis, meatal stenosis, urethral stricture, sexual dysfunction, and penile squamous cell carcinoma, depending on the underlying cause

2014 NICE Clinical Knowledge Summaries

13. Nappy rash

. Lesions may be haemorrhagic, and the child may have a fever and be systemically unwell. See the CKS topic on for more information. Perianal streptococcal dermatitis Presents as a bright red, sharply demarcated perianal rash with possible maceration that may involve the penis and vulvovaginal area. Satellite lesions are uncommon. Perianal pain and itching are common and defecation may be painful. It is usually caused by group A beta-haemolytic streptoccocus (GABHS). Infantile seborrhoeic dermatitis (...) volume and pH, such as gastroenteritis, malabsorption, and liver conditions such as hepatitis (rare). [ ; ; ; ; ; ] Complications What are the complications? Complications of nappy rash include: Candida secondary infection — see the CKS topic on for more information. Bacterial secondary infection — may be caused by staphylococcal or streptococcal infection. See the CKS topics on , , and for more information. Jacquet's erosive diaper dermatitis — presents with punched out ulcers or erosions

2013 NICE Clinical Knowledge Summaries

14. Child Abuse Mimic: Avulsion Injury in a Child With Penoscrotal Webbing. (PubMed)

, perianal streptococcal dermatitis, and straddle injury (J Pediatr Health Care. 2009;23:283-288 and Acta Paediatr. 2011;100:590-593). The following case involves a 5-week-old male infant who presented to the pediatric emergency department with an avulsion injury to his penis concerning for sexual abuse. He was ultimately diagnosed with a relatively rare anatomic variant of the genitalia and determined to have sustained an accidental injury whose appearance mimicked abuse.

2015 Pediatric Emergency Care

16. Bacterial Infections and Pregnancy (Follow-up)

the initial insult face possible hearing or vision loss, learning disabilities, and other neurologic sequelae CDC recommendations are as follows: At 35-37 weeks’ gestation, all pregnant women should undergo screening with a vaginal and rectal swab for culture [ ] The most specific site for culture is at the introitus, just inside the hymeneal ring and rectally beyond the sphincter; cervical, perianal, perirectal, or perineal specimens are not acceptable, and speculum should not be used for culture (...) of bacterial STDs Gonococcal infections cause no symptoms in approximately 50% of patients Pregnancy is a predisposing factor to the development of disseminated gonococcal infection, which classically presents as an arthritis-dermatitis syndrome Newborns exposed to gonorrhea during vaginal delivery can develop an acute conjunctivitis (ophthalmia neonatorum), sepsis, arthritis, and/or meningitis The American College of Obstetricians and Gynecologists recommends screening (via endocervical culture) in high

2014 eMedicine.com

17. Ecthyma (Diagnosis)

by crowding and poor hygiene. Previous Next: Etiology Ecthyma can be seen in areas of previously sustained tissue injury (eg, excoriations, insect bites, dermatitis). Insect bites in the setting of recent travel have been associated with ecthyma. [ ] Ecthyma can be seen in patients who are immunocompromised (eg, diabetes, neutropenia, HIV infection). [ ] Important factors that contribute to the development of streptococcal pyodermas or ecthyma include the following: High temperature and humidity (...) [ , ] Crowded living conditions Poor hygiene Untreated impetigo that progresses to ecthyma most frequently occurs in patients with poor hygiene. Some strains of Streptococcus pyogenes have a high affinity for both pharyngeal mucosa and skin. Pharyngeal colonization of S pyogenes has been documented in patients with ecthyma. [ ] Ecthyma has also been reported in the setting of perianal streptococcal disease. [ ] Previous Next: Epidemiology Frequency The exact incidence of ecthyma worldwide remains unknown

2014 eMedicine.com

18. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Diagnosis)

and diagnostic tests, including KOH and Tzanck preparations, can help determine the correct diagnosis. Biopsy is generally not necessary, although a lack of response to treatment warrants a biopsy to exclude premalignant or malignant lesions. Differential diagnoses The differential diagnoses include intertrigo (see ); irritant dermatitis; and candidal (see ), viral, or fungal infections. [ , ] As emphasized above, the clinical history, in association with KOH and Tzanck preparations, often helps to determine (...) is necessary to differentiate these diseases. Erosive lichen planus, contact dermatitis, psoriasis, and immunobullous diseases can cause similar clinical lesions in the glans region. Balanitis xerotica obliterans (BXO; see ) can show similar microscopic features of a dense inflammatory infiltrate and a thinned epidermis; however, the infiltrate usually lacks a rich plasma cell component. Candidal balanitis should also be considered in the differential diagnoses. Although previously described as a separate

2014 eMedicine.com

19. Bacterial Infections and Pregnancy (Diagnosis)

the initial insult face possible hearing or vision loss, learning disabilities, and other neurologic sequelae CDC recommendations are as follows: At 35-37 weeks’ gestation, all pregnant women should undergo screening with a vaginal and rectal swab for culture [ ] The most specific site for culture is at the introitus, just inside the hymeneal ring and rectally beyond the sphincter; cervical, perianal, perirectal, or perineal specimens are not acceptable, and speculum should not be used for culture (...) of bacterial STDs Gonococcal infections cause no symptoms in approximately 50% of patients Pregnancy is a predisposing factor to the development of disseminated gonococcal infection, which classically presents as an arthritis-dermatitis syndrome Newborns exposed to gonorrhea during vaginal delivery can develop an acute conjunctivitis (ophthalmia neonatorum), sepsis, arthritis, and/or meningitis The American College of Obstetricians and Gynecologists recommends screening (via endocervical culture) in high

2014 eMedicine.com

20. Fournier Gangrene (Diagnosis)

, is defined as a polymicrobial of the perineal, perianal, or genital areas (see the image below.) In contrast to Fournier's initial description, the disease is not limited to young people or to males, and a cause is now usually identified. [ ] Photomicrograph of Fournier gangrene (necrotizing fasciitis), oil immersion at 1000X magnification. Note the acute inflammatory cells in the necrotic tissue. Bacteria are located in the haziness of their cytoplasm. Courtesy of Billie Fife, MD, and Thomas A. Santora (...) multiplication. [ ] Although Meleney in 1924 attributed the necrotizing infections to streptococcal species only, [ ] subsequent clinical series have emphasized the multiorganism nature of most cases of necrotizing infection, including Fournier gangrene. [ , , , , ] Presently, recovering only streptococcal species is unusual. [ ] Rather, streptococcal organisms are cultured along with as many as 5 other organisms. The following are common causative microorganisms: Streptococcal species Staphylococcal species

2014 eMedicine.com

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