Perianal streptococcal cellulitis

• Alternative Names

  Streptococcal proctitis; Proctitis - streptococcal

• Causes, incidence, and risk factors

  Perianal streptococcal cellulitis usually occurs in children, often with or after "strep throat" (streptococcal pharyngitis), nasopharyngitis, or streptococcal skin infection (impetigo).

  Children can infect the skin around the anus while cleaning the area after using the toilet or by scratching with hands contaminated by secretions from their mouth or nose.

• Symptoms
  • Fever
  • Itching, pain, or bleeding with bowel movements
  • Redness around the anus
• Signs and tests
  • Rectal swab culture
  • Skin culture from rectal area
  • Throat culture
• Treatment

  The infection is treated with antibiotics for about 10 days, depending on how well and quickly it appears to be working. Penicillin is the most often used antibiotic in children who are not allergic to it.

  Mupirocin can be applied directly to the skin (topical). It can be used along with other antibiotics, but should not be the only treatment.

• Expectations (prognosis)

  Children usually recover quickly with antibiotic treatment. It is important to contact your health care provider if your child does not get better soon on antibiotics.

• Complications
  • Anal scarring, fistula, or abscess
  • Bleeding, discharge
  • Bloodstream or other streptococcal infections (including heart, joint, and bone)
  • Kidney disease (acute glomerulonephritis)
  • Severe skin and soft tissue infection (necrotizing fasciitis)
• Calling your health care provider

  Call your health care provider if your child complains of pain in the rectal area, painful bowel movements, or other symptoms of perianal streptococcal cellulitis.

  If your child is taking antibiotics for this condition and the area of redness gets worse, or the discomfort or fever are increasing, call your health care provider immediately.

• Prevention

  Take a full course of antibiotics to eliminate the bacteria from the affected site. Careful handwashing can help prevent this and other infections caused by bacteria carried in the nose and throat.

• References

  Gerber MA. Group A streptococcus. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 182.

Review Date: 12/1/2009

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.