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Šterbenc A, Točkova O, Lah LL, Kamhi Trop T, Seme K, Švent-Kučina N, Peteln I, Pirs M. A retrospective analysis of clinical characteristics and management of perianal streptococcal dermatitis in children and adults. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2021. [DOI: 10.15570/actaapa.2021.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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2
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Raef HS, Elmariah SB. Vulvar Pruritus: A Review of Clinical Associations, Pathophysiology and Therapeutic Management. Front Med (Lausanne) 2021; 8:649402. [PMID: 33898486 PMCID: PMC8058221 DOI: 10.3389/fmed.2021.649402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/12/2021] [Indexed: 01/08/2023] Open
Abstract
Vulvar pruritus is an unpleasant sensation and frequent symptom associated with many dermatologic conditions, including infectious, inflammatory and neoplastic dermatoses affecting the female genitalia. It can lead to serious impairment of quality of life, impacting sexual function, relationships, sleep and self-esteem. In this review, common conditions associated with vulvar itch are discussed including atopic and contact dermatitis, lichen sclerosus, psoriasis and infectious vulvovaginitis. We review the potential physiologic, environmental and infectious factors that contribute to the development of vulvar itch and emphasize the importance of addressing their complex interplay when managing this disruptive and challenging symptom.
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Affiliation(s)
- Haya S Raef
- Tufts University School of Medicine, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
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3
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Gualtieri R, Bronz G, Bianchetti MG, Lava SAG, Giuliano E, Milani GP, Jermini LMM. Perianal streptococcal disease in childhood: systematic literature review. Eur J Pediatr 2021; 180:1867-1874. [PMID: 33532889 PMCID: PMC8105195 DOI: 10.1007/s00431-021-03965-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 11/24/2022]
Abstract
Group A Streptococcus has been associated with a perianal infection. We conducted a systematic review of the literature on childhood streptococcal perianitis in three databases: Excerpta Medica, National Library of Medicine, and Web of Science. The main purposes were to document the clinical features, the tendency to recur, the association with an asymptomatic streptococcal throat carriage, the accuracy of rapid streptococcal tests, and the mechanism possibly underlying the acquisition of this infection. More than 80% of cases are boys ≤7.0 years of age with defecation disorders, perianal pain, local itch, rectal bleeding, or fissure and a sharply demarcated perianal redness. Perianitis is associated with a streptococcal tonsillopharyngitis in about every fifth case. The time to diagnosis is ≥3 weeks in 65% of cases. Recurrences occur within 3½ months in about 20% of cases. An asymptomatic group A streptococcal throat carriage occurs in 63% of cases. As compared with perianal Streptococcus A culture, the rapid streptococcal tests have a positive predictive value of 80% and a negative predictive value of 96%. It is hypothesized that digital inoculation from nasopharynx to anus underlies perianitis. Many cases are likely caused directly by children, who are throat and nasal carriers of Streptococcus A. Some cases might occur in children, who have their bottoms wiped by caregivers with streptococcal tonsillopharyngitis or carriage of Streptococcus.Conclusion: Perianitis is an infection with a distinctive presentation and a rather long time to diagnosis. There is a need for a wider awareness of this condition among healthcare professionals. What is Known: • Group A Streptococcus may cause perianitis in childhood. • Systemic antimicrobials (penicillin V, amoxycillin, or cefuroxime) are superior to topical treatment. What is New: • The clinical presentation is distinctive (defecation disorders, perianal pain, local itch, rectal bleeding, or fissure and a sharply demarcated perianal redness). • The time to diagnosis is usually ≥3 weeks. Recurrences occur in about 20% of cases.
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Affiliation(s)
- Renato Gualtieri
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gabriel Bronz
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Mario G. Bianchetti
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Sebastiano A. G. Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Elena Giuliano
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gregorio P. Milani
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via della Commenda 9, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Luca M. M. Jermini
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Rafei R, Hawli M, Osman M, Khelissa S, Salloum T, Dabboussi F, Tokajian S, Hamze M. Molecular epidemiology of nonpharyngeal group A streptococci isolates in northern Lebanon. Future Microbiol 2020; 15:1555-1569. [PMID: 33236928 DOI: 10.2217/fmb-2020-0072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aim: To characterize the epidemiology of group A Streptococcus (GAS) involved in nonpharyngeal infections sparingly addressed in Lebanon. Materials & methods: A collection of 63 nonpharyngeal GAS isolates recovered between 2010 and 2019 from northern Lebanon were analyzed through emm typing, virulence gene profiling, FCT typing and antibiotic susceptibility analysis. Results & conclusion: A total of 29 emm subtypes was detected, with emm1 being the most dominant. A great intraclonal divergence driven by the loss and gain of superantigens or by the structural variability within the FCT regions was unraveled. The resistance rates for erythromycin and tetracycline were 8 and 20.6%, respectively. The 30-valent vaccine coverage was 76%. This study evidences the complexity of the neglected GAS pathogen in Lebanon.
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Affiliation(s)
- Rayane Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School for Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, 1300, Lebanon
| | - Malaik Hawli
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School for Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, 1300, Lebanon
| | - Marwan Osman
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School for Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, 1300, Lebanon
| | - Simon Khelissa
- Université de Lille, Centre National de la Recherche Scientifique, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Centrale Lille, Unité Mixte de Recherche 8207 - Unité Matériaux et Transformations, Lille, 59000, France
| | - Tamara Salloum
- Department of Natural Sciences, School of Arts & Sciences, Lebanese American University, Byblos campus, Postal Box 36, Byblos, 1401, Lebanon
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School for Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, 1300, Lebanon
| | - Sima Tokajian
- Department of Natural Sciences, School of Arts & Sciences, Lebanese American University, Byblos campus, Postal Box 36, Byblos, 1401, Lebanon
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School for Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, 1300, Lebanon
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5
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Rafei R, Hawli M, Osman M, Dabboussi F, Hamze M. Distribution of emm types and macrolide resistance determinants among group A streptococci in the Middle East and North Africa region. J Glob Antimicrob Resist 2020; 22:334-348. [PMID: 32084609 DOI: 10.1016/j.jgar.2020.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/03/2020] [Accepted: 02/09/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The aim of this review was to provide an updated scenario on the epidemiology of group A streptococci (GAS) in the Middle East and North Africa (MENA) region with a special spotlight on the most prevalent emmtypes and macrolide resistance profiles. METHODS This review briefly summarises the disease burden for GAS in the MENA region. RESULTS Whilst the burden of invasive GAS infections is difficult to assess in the MENA region, the GAS prevalence ranged from 2.5% up to 42.4% in pharyngitis patients and from 2.4% up to 35.4% in healthy carriers.emm1, emm12, emm89, emm4, emm28 and emm3were responsible for the major GAS burden in the MENA region. The coverage rate of the new M protein-based vaccine candidate (30-valent) varied from 42% to 100% according to the country. The rate of erythromycin resistance differed substantially between countries from low to moderate or high. CONCLUSION These data add more shreds of evidence on the neglected GAS burden in the MENA region. Systematic surveillance of invasive GAS infections along with molecular characterisation of GAS isolates are strongly recommended to track the trends of circulating clones and to evaluate the potential coverage of vaccine candidates.
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Affiliation(s)
- Rayane Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Malaik Hawli
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Marwan Osman
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
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Konrad P, Hufnagel M, Berner R, Toepfner N. Long-term, single-center surveillance of non-invasive group A streptococcal (GAS) infections, emm types and emm clusters. Eur J Clin Microbiol Infect Dis 2019; 39:273-280. [PMID: 31758439 DOI: 10.1007/s10096-019-03719-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
Group A streptococci (GAS) are among the most frequent pathogens in children. Many epidemiological studies focus on specific GAS infections (such as tonsillopharyngitis or invasive disease), on GAS carriers or on post-streptococcal sequelae. By comparison, reports on regional GAS characteristics, particularly circulating non-invasive GAS in Europe, are rare. In a monocentric study, all GAS isolated from pediatric patients at a tertiary care hospital over a 6-year period (2006-2012) were characterized. GAS emm types and clusters were determined. Associated patient data were analyzed. Five hundred sixty-six GAS strains were collected. GAS tonsillopharyngitis was most common (71.6%), followed by pyoderma (6.0%), otitis media (3.7%), perineal dermatitis (3.4%), and invasive infections (1.4%). Colonizing strains represented 13.6% of GAS. GAS emm12 was most prevalent among invasive and non-invasive isolates. Emm1, emm4, emm28, and emm89 were the most frequent non-invasive GAS strains. The emm E4 cluster was most common, followed by the A-C4, A-C3, and E1. Among the GAS infections, different emm types and clusters were identified, e.g., emm4 was more common among patients with scarlet fever. Three new emm subtypes were characterized: emm29.13, emm36.7, and emm75.5. This comprehensive review of a large, local GAS cohort points to the differences between and similarities among GAS genotypes and disease manifestations, while minimizing regional variations. Considerable deviation from previous epidemiological findings is described, especially regarding the frequent detection of emm1 and emm89 in non-invasive GAS infections. Periodic updates on molecular and epidemiological GAS characteristics are needed to track the multifaceted pathogenic potential of GAS.
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Affiliation(s)
- Peter Konrad
- Department of Pediatrics, Carl Gustav Carus University Hospital, Technical University Dresden, Dresden, Germany
| | - Markus Hufnagel
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Reinhard Berner
- Department of Pediatrics, Carl Gustav Carus University Hospital, Technical University Dresden, Dresden, Germany
| | - Nicole Toepfner
- Department of Pediatrics, Carl Gustav Carus University Hospital, Technical University Dresden, Dresden, Germany.
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Serban ED. Perianal infectious dermatitis: An underdiagnosed, unremitting and stubborn condition. World J Clin Pediatr 2018; 7:89-104. [PMID: 30627524 PMCID: PMC6321840 DOI: 10.5409/wjcp.v7.i4.89] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/23/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023] Open
Abstract
Perianal infectious dermatitis (PID) represents a superficial inflammation of the perianal skin, which is of bacterial origin (classically, group A beta-hemolytic streptococci). This narrative review aims to critically review and summarize the available scientific literature regarding pediatric PID, being the first of its kind, to the best of the author’s knowledge. It also reports the first cases of Romanian children with PID. Multiple databases were subjected to systematic literature search (from 1966 to April 30, 2018) to identify studies and case reports of children with PID. As such, this review provides updated information about essential aspects of PID (epidemiology, etiology, pathogenesis, as well as clinical features, required investigations and therapeutic options) and of diagnostic pitfalls. Although a well-defined entity, PID remains largely underdiagnosed. PID may mimic other common conditions with skin manifestations (like candidiasis, pinworms, eczema, irritant dermatitis, anal fissure, hemorrhoids, Crohn’s disease, psoriasis, seborrheic dermatitis, zinc deficiency dermatosis and even sexual abuse), with consequent unnecessary, sometimes expensive and invasive investigations and futile therapies, which cause patients and families discomfort and distress. Since PID has an unremitting course, early recognition is imperative, as it allows for prompt and efficacious antibiotic therapy. However, PID represents a stubborn condition and, even if properly treated, its recurrence rate remains high. Further well-designed prospective randomized controlled trials, with adequate follow-up, are required in order to formulate the optimum personalized antibiotic therapy (oral alone or in association with topical medication), able to prevent recurrences. Awareness of this condition by healthcare professionals should improve patient outcomes.
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Affiliation(s)
- Elena Daniela Serban
- 2nd Department of Pediatrics, “Iuliu Hatieganu” University of Medicine and Pharmacy, Emergency Hospital for Children, Cluj-Napoca 400177, Romania
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Chen X, Chen L, Zeng W, Zhao X. Haemophilus influenzae vulvovaginitis associated with rhinitis caused by the same clone in a prepubertal girl. J Obstet Gynaecol Res 2018. [PMID: 28621044 DOI: 10.1111/jog.13311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vulvovaginitis caused by upper respiratory flora is generally considered to be the most common gynecological problem in prepubertal girls. To date, however, no direct evidence has been obtained for the underlying mechanism of transmission. This report describes a case of non-capsulate Haemophilus influenzae vulvovaginitis in a 6-year-old girl with a history of foreign bodies (cotton wool) in her vagina. Moreover, this girl had recurrent rhinitis for approximately 3 years. On Pulsed Field Gel Electrophoresis (PFGE) analysis the H. influenzae strain isolated from vaginal secretions and the H. influenzae strain isolated from nasal secretions were derived from the same clone. The patient was successfully treated with appropriate antibiotics. The present case might provide the first direct evidence of the nose-hand-vagina method of transmission.
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Affiliation(s)
- Xiao Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lifeng Chen
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Wenjie Zeng
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Xiaofeng Zhao
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
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9
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Randjelovic G, Otasevic S, Mladenovic-Antic S, Mladenovic V, Radovanovic-Velickovic R, Randjelovic M, Bogdanovic D. Streptococcus pyogenes as the cause of vulvovaginitis and balanitis in children. Pediatr Int 2017; 59:432-437. [PMID: 27638252 DOI: 10.1111/ped.13169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Streptococcus pyogenes (group A Streptococcus) is the etiological agent of perineal infection in children, consisting of perianal infection, vulvovaginitis and balanitis. If it is not properly diagnosed and treated, it can persist for many months and can cause severe complications. Furthermore, treatment with penicillin can be followed by failures and recurrences. METHODS We report here the prevalence of S. pyogenes isolates in genital tract specimens from girls (n = 1692) with symptoms of vulvovaginitis and from boys (n = 52) with balanitis in the municipality of Nis, Southeast-Serbia (the Western Balkans) in a 10 year period, and the seasonal distribution, patient age and sensitivity to bacitracin and antimicrobial drugs used in the treatment of streptococcal infection. RESULTS Streptococcal vulvovaginitis was diagnosed in 2.30% of examinees. Of those cases, 64.10% were detected from April to September, and it was most common (71.79%) in girls aged 3-7 years. Streptococcal balanitis was diagnosed in two instances: in a 4-year-old boy and in a 7-year-old boy. S. pyogenes strains resistant to bacitracin were identified in five girls. Two isolates with M phenotype and five isolates with cMLSB phenotype were identified. CONCLUSIONS Streptococcal vulvovaginitis was diagnosed less often in the present study, but it was still far more common than streptococcal balanitis in childhood. Bacitracin resistance of S. pyogenes strains should be taken into account in routine microbiological identification, and the detection of S. pyogenes isolates resistant to erythromycin requires surveillance in the present geographical territory.
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Affiliation(s)
- Gordana Randjelovic
- Faculty of Medicine, University of Nis, Niš, Serbia.,Center of Microbiology, Public Health Institute Nis, Niš, Serbia
| | - Suzana Otasevic
- Faculty of Medicine, University of Nis, Niš, Serbia.,Center of Microbiology, Public Health Institute Nis, Niš, Serbia
| | | | - Vesna Mladenovic
- Center of Microbiology, Public Health Institute Nis, Niš, Serbia
| | | | | | - Dragan Bogdanovic
- Center of Microbiology, Public Health Institute Nis, Niš, Serbia.,Department of Biomedical Sciences, State University of Novi Pazar, Novi Pazar, Serbia
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Ranđelović G, Mladenović V, Mladenović- Antić S, Stojanović P, Ranđelović M, Stolić J. STREPTOCOCCUS PYOGENES AS THE CAUSE OF VULVOVAGINITIS IN ADULT WOMEN. ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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11
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Abstract
Perineal streptococcal dermatitis (PSD) is largely known to be caused by group A β-hemolytic Streptococcus (GAS). We would like to bring cases of non-GAS PSD to the attention of dermatologists, as there are implications for workup and therapy. We report 3 pediatric cases of PSD: 1 caused by GAS, 1 caused by group B β-hemolytic Streptococcus (GBS), and 1 associated with group C β-hemolytic Streptococcus (GCS). GBS and GCS are very rarely reported in pediatric cases of PSD. The literature on non-GAS PSD is reviewed, which additionally revealed several instances of PSD caused by group G β-hemolytic Streptococcus (GGS) and Staphylococcus aureus. GBS, GCS, GGS, and S aureus are significant causes of PSD to consider, particularly among adult patients, based on our encountered cases and the literature. If using rapid antigen tests to expedite the diagnosis of GAS, we recommend supplementing with a lesional swab for bacterial culture and sensitivity as the rapid antigen test does not detect non-GAS organisms. Therapy should be tailored to the microbiologic cause.
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Affiliation(s)
- Connie Zhang
- 1 Division of Dermatology, University of Calgary, AB, Canada
| | - Richard M Haber
- 1 Division of Dermatology, University of Calgary, AB, Canada
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Clinical and microbiologic characteristics of vulvovaginitis in Korean prepubertal girls, 2009-2014: a single center experience. Obstet Gynecol Sci 2016; 59:130-6. [PMID: 27004204 PMCID: PMC4796083 DOI: 10.5468/ogs.2016.59.2.130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/25/2015] [Accepted: 10/20/2015] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To update information on the clinical and microbiologic characteristics of pediatric vulvovaginitis in Korean prepubertal girls. METHODS A total of 120 girls (aged 0 to 9 years) with culture-confirmed pediatric vulvovaginitis, diagnosed between 2009 and 2014, were enrolled in the study. The epidemiologic and microbiologic characteristics, and clinical outcomes were assessed. Patients with sexual precocity, as well as those who were referred for suspected sexual abuse, were excluded. RESULTS Girls aged 4 to 6 years were at the highest risk of pediatric vulvovaginitis. Seasonal distribution indicated obvious peaks in summer and winter. Of the 120 subjects, specific pathogens were identified in the genital specimens in only 20 cases (16.7%). Streptococcus pyogenes (n=12, 60%) was the leading cause of specific vulvovaginitis. Haemophilus influenzae was isolated in one patient. No cases presented with enteric pathogens, such as Shigella or Yersinia. A history of recent upper respiratory tract infection, swimming, and bubble bath use was reported in 37.5%, 15.8%, and 10.0% of patients, respectively. Recent upper respiratory tract infection was not significantly correlated with the detection of respiratory pathogens in genital specimens (P>0.05). Of 104 patients who underwent perineal hygienic care, 80 (76.9%) showed improvement of symptoms without antibiotic treatment. Furthermore, the efficacy of hygienic care was not significantly different between patients with or without specific pathogens (P>0.05). CONCLUSION Specific pathogens were only found in 16.7% of pediatric vulvovaginitis cases. Our results indicate an excellent outcome with hygienic care, irrespective of the presence of specific pathogens.
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13
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Gelfand MS, Cleveland KO. Streptococcus pyogenes: Acute Proctosigmoiditis, Bacteremia and Death in a Healthy Adult. Am J Med Sci 2016; 351:120-1. [DOI: 10.1016/j.amjms.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 09/01/2015] [Indexed: 10/22/2022]
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14
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Clegg HW, Giftos PM, Anderson WE, Kaplan EL, Johnson DR. Clinical Perineal Streptococcal Infection in Children: Epidemiologic Features, Low Symptomatic Recurrence Rate after Treatment, and Risk Factors for Recurrence. J Pediatr 2015; 167:687-93.e1-2. [PMID: 26095284 DOI: 10.1016/j.jpeds.2015.05.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/16/2015] [Accepted: 05/19/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate the epidemiology of perineal streptococcal infection and recurrence rates following amoxicillin treatment. STUDY DESIGN We used laboratory logs in a single pediatric practice to identify patients 0-18 years of age with perineal cultures positive for group A Streptococcus (GAS) and reviewed their medical charts. We described epidemiologic features, determined recurrence rates following antibiotic treatment, and performed a case-control study to identify possible risk factors for recurrence in patients treated with amoxicillin. RESULTS We found a perineal streptococcal infection rate of 4.6 per 10,000 patient encounters and a recurrence rate in 157 patients with perineal streptococcal infection of 12.4% after amoxicillin. In male patients, the predominant site of involvement was the perianal region (86%), and for female patients, the perivaginal area (62%). Nearly 80% of patients were 2-7 years of age (range 18 days-12.5 years). Perineal streptococcal infection and GAS pharyngitis followed a similar seasonal pattern of occurrence with 65% of perineal streptococcal infection occurring October through March. In patients with perineal streptococcal infection, 95% had a concomitant pharyngeal culture positive for GAS. Best predictive factors for recurrence after amoxicillin were longer duration of symptoms prior to diagnosis and having a sibling with perineal streptococcal infection at some time before or after the initial episode. CONCLUSIONS Following treatment with amoxicillin, we found a low recurrence rate of 12.4%. Amoxicillin can be expected to be reliable first-line therapy for perineal streptococcal infection.
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15
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Chang JC, Jimenez JC, Federle MJ. Induction of a quorum sensing pathway by environmental signals enhances group A streptococcal resistance to lysozyme. Mol Microbiol 2015; 97:1097-113. [PMID: 26062094 DOI: 10.1111/mmi.13088] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2015] [Indexed: 01/29/2023]
Abstract
The human-restricted pathogen Streptococcus pyogenes (Group A Streptococcus, GAS) is responsible for wide-ranging pathologies at numerous sites in the body but has the proclivity to proliferate in individuals asymptomatically. The ability to survive in diverse tissues is undoubtedly benefited by sensory pathways that recognize environmental cues corresponding to stress and nutrient availability and thereby trigger adaptive responses. We investigated the impact that environmental signals contribute to cell-to-cell chemical communication [quorum sensing (QS)] by monitoring activity of the Rgg2/Rgg3 and SHP-pheromone system in GAS. We identified metal limitation and the alternate carbon source mannose as two environmental indicators likely to be encountered by GAS in the host that significantly induced the Rgg-SHP system. Disruption of the metal regulator MtsR partially accounted for the response to metal depletion, whereas ptsABCD was primarily responsible for QS induction due to mannose, but each sensory system induced Rgg-SHP signaling apparently by different mechanisms. Significantly, we found that induction of QS, regardless of the GAS serotype tested, led to enhanced resistance to the antimicrobial agent lysozyme. These results indicate the benefits for GAS to integrate environmental signals with intercellular communication pathways in protection from host defenses.
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Affiliation(s)
- Jennifer C Chang
- Department of Medicinal Chemistry and Pharmacognosy, Center for Pharmaceutical Biotechnology, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, 60607, USA
| | - Juan Cristobal Jimenez
- Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago, Chicago, IL, 60607, USA
| | - Michael J Federle
- Department of Medicinal Chemistry and Pharmacognosy, Center for Pharmaceutical Biotechnology, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, 60607, USA
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Wollner A, Levy C, Benani M, Thollot F, Béchet S, Cohen J, Bonacorsi S, Bidet P, Cohen R. [Use of group A streptococcal rapid diagnostic test in extra-pharyngeal infections]. Arch Pediatr 2014; 21 Suppl 2:S84-6. [PMID: 25456686 DOI: 10.1016/s0929-693x(14)72266-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to assess the performances of the group A streptococcus (GAS) rapid antigen diagnostic tests (RADTs) in extra-pharyngeal infections. Between October 2009 and June 2014, 368 patients (median age: 48 months) were enrolled. The pathologies involved were : 160 perineal infections (44 %), 69 blistering distal dactylitis (19 %), 55 cervical lymphadenitis (15 %), 31 crusty or bleeding rhinitis (8 %), and 53 other diseases (14 %). The sensitivity of GAS-RADT used was 96 % (95 % CI: 92-99 %), the specificity 81 % (95 % CI: 75- 86 %), the negative predictive value 97 % (CI 95 %: 93-99 %), and the positive predictive value 79 % (95 % CI: 73-85 %). Finally, positive and negative likelihood ratio were 5 (95 % CI: 4-7) and 0.05 (95 % CI: 0.02-0.11) respectively. The GAS-RADTs developed for pharyngitis have comparable performances in these settings and therefore can be used.
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Affiliation(s)
- A Wollner
- ACTIV (Association clinique et thérapeutique infantile du Val-de-Marne), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France
| | - C Levy
- ACTIV (Association clinique et thérapeutique infantile du Val-de-Marne), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France; Centre de recherche clinique (CRC) et Centre hospitalier intercommunal (CHI), 40, avenue de Verdun, 94010 Créteil, France; AFPA (Association française de pédiatrie ambulatoire), 4, rue Parmentier, 54270 Essey-les-Nancy, France.
| | - M Benani
- ACTIV (Association clinique et thérapeutique infantile du Val-de-Marne), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France
| | - F Thollot
- AFPA (Association française de pédiatrie ambulatoire), 4, rue Parmentier, 54270 Essey-les-Nancy, France
| | - S Béchet
- ACTIV (Association clinique et thérapeutique infantile du Val-de-Marne), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France
| | - J Cohen
- INSERM, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health (UMR S953), hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - S Bonacorsi
- Université Paris-Diderot, PRES Sorbonne-Paris-Cité, 46, rue Henri-Huchard, 75018 Paris, France; Service de microbiologie, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - Ph Bidet
- Université Paris-Diderot, PRES Sorbonne-Paris-Cité, 46, rue Henri-Huchard, 75018 Paris, France; Service de microbiologie, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - R Cohen
- ACTIV (Association clinique et thérapeutique infantile du Val-de-Marne), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France; Centre de recherche clinique (CRC) et Centre hospitalier intercommunal (CHI), 40, avenue de Verdun, 94010 Créteil, France; AFPA (Association française de pédiatrie ambulatoire), 4, rue Parmentier, 54270 Essey-les-Nancy, France; Unité court séjour, petits nourrissons, service de néonatologie, CHI de Créteil, 40, avenue de Verdun, 94010 Créteil, France
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17
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Koskas M, Levy C, Romain O, Schlemmer C, Béchet S, Bonacorsi S, Bidet P, Cohen R. [Group A streptococcal perineal infection in children]. Arch Pediatr 2014; 21 Suppl 2:S97-S100. [PMID: 25456689 DOI: 10.1016/s0929-693x(14)72269-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Perineal diseases in children are usually caused by group A streptococcus (GAS). If the natural course of untreated cases is not known, it is well known that symptoms do not resolve spontaneously and can persist often for many months, until appropriate diagnosis and effective treatment are instituted. Furthermore, failures and recurrences after penicillin treatment are frequent. From 2009 to 2014, 165 perineal infections (median age: 48 months, extremes: 0.4-139) were enrolled by 15 pediatricians: 4 balanitis, 29 vulvo-vaginal diseases and 132 perianal infections. Painful defecation, anal fissures and macroscopic blood in stools were significantly more frequent in GAS perianal infections than negative GAS infections (p<0.01). The performance of GAS-rapid antigen test compared to the GAS culture was : sensitivity 97 % [CI 95 %: 89-100 %], specificity 76 % [CI 95 %: 66-84 %], negative predictive value 97 % [CI 95 %: 91-100 %], positive predictive value 71 % [CI 95 %: 60-80 %].
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Affiliation(s)
- M Koskas
- ACTIV (Association clinique et thérapeutique infantile du Val-de-Marne), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France
| | - C Levy
- ACTIV (Association clinique et thérapeutique infantile du Val-de-Marne), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France; Centre de recherche clinique (CRC) et Centre hospitalier intercommunal (CHI), 40, avenue de Verdun, 94010 Créteil, France; AFPA (Association française de pédiatrie ambulatoire), 4, rue Parmentier, 54270 Essey-les-Nancy, France.
| | - O Romain
- ACTIV (Association clinique et thérapeutique infantile du Val-de-Marne), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France
| | - C Schlemmer
- ACTIV (Association clinique et thérapeutique infantile du Val-de-Marne), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France
| | - S Béchet
- ACTIV (Association clinique et thérapeutique infantile du Val-de-Marne), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France
| | - S Bonacorsi
- Université Paris-Diderot, PRES Sorbonne-Paris-Cité, 46, rue Henri-Huchard, 75018 Paris, France; Service de microbiologie, hôpital Robert-Debré (AP-HP), 48, boulevard Sérurier, 75019 Paris, France
| | - Ph Bidet
- Université Paris-Diderot, PRES Sorbonne-Paris-Cité, 46, rue Henri-Huchard, 75018 Paris, France; Service de microbiologie, hôpital Robert-Debré (AP-HP), 48, boulevard Sérurier, 75019 Paris, France
| | - R Cohen
- ACTIV (Association clinique et thérapeutique infantile du Val-de-Marne), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France; Centre de recherche clinique (CRC) et Centre hospitalier intercommunal (CHI), 40, avenue de Verdun, 94010 Créteil, France; AFPA (Association française de pédiatrie ambulatoire), 4, rue Parmentier, 54270 Essey-les-Nancy, France; Unité court séjour, petits nourrissons, service de néonatologie, CHI de Créteil, 40, avenue de Verdun, 94010 Créteil, France
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18
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Cohen R, Levy C, Bonacorsi S, Wollner A, Koskas M, Jung C, Béchet S, Chalumeau M, Cohen J, Bidet P. Diagnostic accuracy of clinical symptoms and rapid diagnostic test in group A streptococcal perianal infections in children. Clin Infect Dis 2014; 60:267-70. [PMID: 25313248 DOI: 10.1093/cid/ciu794] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
From 2009 to 2014, we prospectively enrolled 132 children with perianal infections. The presentation of painful defecation, anal fissures, and macroscopic blood in stools was highly suggestive of group A streptococcal perianal infection (probability 83.3%). We found a high sensitivity of a group A streptococcal rapid diagnostic testing (98%) but relatively low specificity (72.8%).
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Affiliation(s)
- Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés Clinical Research Center, Centre Hospitalier Intercommunal de Créteil Association Française de Pédiatrie Ambulatoire Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés Clinical Research Center, Centre Hospitalier Intercommunal de Créteil Association Française de Pédiatrie Ambulatoire
| | - Stéphane Bonacorsi
- Université Paris Diderot, Sorbonne Paris Cité Service de Microbiologie, Hôpital Robert-Debré
| | - Alain Wollner
- Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés
| | - Marc Koskas
- Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés
| | - Camille Jung
- Clinical Research Center, Centre Hospitalier Intercommunal de Créteil
| | - Stéphane Béchet
- Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés
| | - Martin Chalumeau
- Department of Pediatrics, Necker-Enfants-Malades Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, France
| | - Jérémie Cohen
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, France
| | - Philippe Bidet
- Université Paris Diderot, Sorbonne Paris Cité Service de Microbiologie, Hôpital Robert-Debré
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Simpson RC, Murphy R. Paediatric vulvar disease. Best Pract Res Clin Obstet Gynaecol 2014; 28:1028-41. [PMID: 25134451 DOI: 10.1016/j.bpobgyn.2014.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 07/10/2014] [Indexed: 11/30/2022]
Abstract
Paediatric vulvar skin conditions are relatively common but often cause diagnostic difficulties for clinicians, which can lead to anxiety within the children's families. Vulvar skin conditions can be caused by various underlying aetiologies. Most are general dermatologic conditions that occur in the vulvar area, such as eczema, psoriasis, skin lesions or infections. However, other conditions such as lichen sclerosus and napkin dermatitis ('nappy rash') only affect the genital region. Every affected child needs a sensitive evaluation of the complaint including an assessment of the impact of the condition on the patient and her family. Paediatric vulvar disease often influences bowel and bladder habits and may lead to behavioural problems. General measures such as avoidance of irritants or soap substitution and regular use of emollients are helpful for all patients. Specific therapy depends upon the underlying diagnosis. Time spent reassuring the families, reinforcing regimens and providing written documentation can all be very helpful in successful management of paediatric vulvar skin conditions.
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Affiliation(s)
- Rosalind C Simpson
- Centre of Evidence Based Dermatology, King's Meadow Campus, University of Nottingham, Lenton Lane, NG7 2NR, United Kingdom.
| | - Ruth Murphy
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, United Kingdom.
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20
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Abdolrasouli A, Hemmati Y, Amin A, Roushan A, Butler I. Lancefield group G Streptococcus dysgalactiae subsp. equisimilis: an unusual aetiology of perianal streptococcal dermatitis acquired from heterosexual oral-anal intercourse. Int J STD AIDS 2013; 23:911-2. [PMID: 23258838 DOI: 10.1258/ijsa.2012.012112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Perianal streptococcal dermatitis (PSD) is an uncommon superficial cutaneous infection of the perianal area, almost exclusively described in children and mainly caused by group A streptococci. We report here a case of PSD caused by Streptococcus dysgalactiae subsp. equisimilis, Lancefield group G, in an adult man due to heterosexual oral-anal sexual contact.
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Affiliation(s)
- A Abdolrasouli
- Department of Medical Microbiology, 4th Floor, East Wing, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RP, UK.
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21
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Kahlke V, Jongen J, Peleikis HG, Herbst RA. Perianal streptococcal dermatitis in adults: its association with pruritic anorectal diseases is mainly caused by group B Streptococci. Colorectal Dis 2013; 15:602-7. [PMID: 23216793 DOI: 10.1111/codi.12089] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 09/14/2012] [Indexed: 12/06/2022]
Abstract
AIM Although perianal streptococcal dermatitis (PSD) is well known in children, it has only rarely been documented in adults. The incidence and necessity for treatment may be underestimated. We have retrospectively identified adult patients with perianal streptococcal dermatitis. METHOD Patients with streptococcal anal dermatitis were identified from a prospective office database. Treatment was with oral antibiotics according to the organism sensitivity. Additional concomitant anorectal disease was treated according to standard guidelines. Patients were compared with a control group, without eczema or erythema, for the presence of β-haemolysing Streptococci on perianal swab. Demographic and microbiological data were assessed and compared between and within treatment and control groups. RESULTS Fifty-three (22 female) patients older than 20 (mean = 49) years of age were diagnosed with perianal streptococcal dermatitis between 2005 and 2009. In most cases group B β-haemolytic Streptococci were found. Fifty patients received antibiotics for 14 days. In 28 of 33 patients who had a post-treatment swab, the result was negative. Five patients showed Streptococci of different groups in the post-treatment swab. Of the 50 patients, 21 (42%) had no further anorectal complaint and 29 (58%) required continuing treatment for another anorectal condition. In the control group β-haemolysing Streptococcus was found in 34%. Men over 60 years of age more often required no further anorectal treatment compared with women (P < 0.05). CONCLUSION Perianal streptococcal dermatitis occurs in adult patients more often than reported. It is mainly caused by group B β-haemolysing Streptococcus. Its diagnosis is important because it can cause serious systemic infections, especially in the elderly and in newborns. Antibiotics resolve the condition in a high proportion of patients.
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Affiliation(s)
- V Kahlke
- Department of Proctological Surgery, Park Klinik Kiel, Kiel, Germany.
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22
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Microbiological aspects of vulvovaginitis in prepubertal girls. Eur J Pediatr 2012; 171:1203-8. [PMID: 22383074 DOI: 10.1007/s00431-012-1705-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED This study aimed to establish the vaginal introitus microbial flora in girls with and without symptoms of vulvovaginitis, and to present the distribution of isolated microorganisms by age groups in girls with vulvovaginitis. We enrolled 500 girls with vulvovaginitis symptoms, aged 2-12 years, referred by their pediatricians for microbiological examination of the vaginal introitus swabs, and 30 age-matched asymptomatic girls. Similar microbial flora was isolated in both groups, but the symptomatic girls had significantly more common positive microbiological findings compared to controls (p < 0.001). In symptomatic girls, the following pathogenic bacteria were isolated: Streptococcus pyogenes (4.2%), Haemophilus influenzae (0.4%), and Staphylococcus aureus (5.8%). Bacteria of fecal origin were found in vaginal introitus swabs in 33.8% of cases, most commonly Proteus mirabilis (14.4%), Enterococcus faecalis (12.2%), and Escherichia coli (7.0%). The finding of fecal flora was more common compared to controls, reaching a statistical significance (p < 0.05), as well as in girls aged up to 6 years (p < 0.001). Candida species were found in 2.4% of girls with vulvovaginitis symptoms. CONCLUSION The microbial ecosystem in girls with clinical signs of vulvovaginitis is complex and variable, and the presence of a microorganism does not necessarily imply that it is the cause of infection. The diagnosis of vulvovaginitis in prepubertal girls requires a complex and comprehensive approach, and microbiological findings should be interpreted in the context of clinical findings.
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Delago C, Finkel MA, Deblinger E. Urogenital symptoms in premenarchal girls: parents' and girls' perceptions and associations with irritants. J Pediatr Adolesc Gynecol 2012; 25:67-73. [PMID: 22051787 DOI: 10.1016/j.jpag.2011.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 08/09/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Premenarchal girls commonly seek care for urogenital symptoms, yet little is published about parents' and girls' perceived causes of symptoms or associations with irritant exposures. We sought to describe urogenital symptoms, perceived causes, and associations between symptoms and genital irritant exposures. DESIGN Descriptive study. Parents/girls interviewed; medical records reviewed. PARTICIPANTS Five- to 12-year-old well, premenarchal girls and their parents. SETTING One urban and 1 suburban pediatric practice. OUTCOME MEASURES Prevalence of histories of urogenital symptoms and perceived causes; association between symptoms and exposure to genital irritants in a well population. RESULTS Of 191 parent/girl dyads, 33% of parents and 48% of girls reported girls' histories of urogenital symptoms not attributed to urinary tract infections or trauma. Perceived causes: poor hygiene (29% of parents vs 14% of girls); soap products (20% of parents and girls); none identified (24% of parents vs 53% of girls). Analysis of symptoms versus irritant exposures demonstrated these associations: dysuria and genital soreness with poor genital hygiene, tight garments, or exposure to soap products; genital pruritus with poor hygiene (all P < .05). No symptoms were associated with nylon underwear, tights, or bike or horseback riding. Vaginal discharge was not associated with any irritants. CONCLUSION Almost half the girls had histories of urogenital symptoms. Poor hygiene and soap exposure were perceived causes of most symptoms. When no cause for urogenital symptoms is identified, treatment should be focused on hygiene, soap exposure, and tight-fitting clothes, not on bike or horseback riding or wearing nylon underwear or tights. Vaginal discharge warrants further evaluation.
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Affiliation(s)
- Cynthia Delago
- Albert Einstein Medical Center, Department of Pediatrics, Philadelphia, PA 19141, USA.
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24
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Abstract
OBJECTIVES 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. METHODS We audited laboratory logs and medical records to retrospectively identify incident cases of culture-confirmed PSD in children at a large university-affiliated health system during 2006-2008. We estimated rates of recurrence (defined as any return visit with a clinical diagnosis of perineal dermatitis within 6 months) and, then, incorporated these rates into a meta-analysis that included 8 previous studies. RESULTS A total of 81 children had incident PSD during the study period, and 26 (32.1%) had a recurrence. Most (18/26 [69.2%]) had their first recurrence within 6 weeks. Among children treated with an oral agent, the recurrence rate was 16/42 (38.1%) following penicillin or amoxicillin and 10/36 (27.8%) following a beta-lactamase resistant agent (adjusted odds ratio: 2.02 [95% confidence interval {CI}: 0.69-5.92]). In the meta-analysis, recurrence rates following penicillin or amoxicillin were consistent across studies (fixed-effect test for heterogeneity, P = 0.35), and the pooled rate (37.4% [95% CI: 28.8%-46.5%]) was higher than observed following a beta-lactamase resistant agent (odds ratio: 2.39 [95% CI: 1.18-4.81]). CONCLUSIONS 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.
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Eyk NV, Allen L, Giesbrecht E, Jamieson MA, Kives S, Morris M, Ornstein M, Fleming N. Pediatric vulvovaginal disorders: a diagnostic approach and review of the literature. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 31:850-862. [PMID: 19941710 DOI: 10.1016/s1701-2163(16)34304-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Vulvovaginal complaints in the prepubertal child are a common reason for referral to the health care provider. The Cochrane Library and Medline databases were searched for articles published in English from 1980 to December 2004 relating to vulvovaginal conditions in girls. The following search terms were used: vulvovaginitis, prepubertal, pediatric, lichen sclerosis, labial fusion, labial adhesion, genital ulcers, urethral prolapse, psoriasis, and straddle injuries. The objectives of this article are to review the normal vulvovaginal anatomy, describe how to perform an age-appropriate examination, and discuss common vulvovaginal disorders and their management in young girls.
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Affiliation(s)
- Nancy Van Eyk
- Department of Obstetrics and Gynaecology, IWK Health Centre, Dalhousie University, Halifax NS
| | - Lisa Allen
- Division of Paediatric Gynaecology, Hospital for Sick Children, University of Toronto, Toronto ON
| | - Ellen Giesbrecht
- Department of Obstetrics and Gynaecology, BC Women's Hospital, University of BC, Vancouver BC
| | - Mary Anne Jamieson
- Department of Obstetrics and Gynaecology, Kingston General Hospital, Queen's University, Kingston ON
| | - Sari Kives
- Division of Paediatric Gynaecology, Hospital for Sick Children, University of Toronto, Toronto ON
| | - Margaret Morris
- Department of Obstetrics and Gynecology, Health Sciences Centre, University of Manitoba, Winnipeg MB
| | - Melanie Ornstein
- Division of Paediatric Gynaecology, Hospital for Sick Children, University of Toronto, Toronto ON
| | - Nathalie Fleming
- Division of Pediatric and Adolescent Gynecology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa ON
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26
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Affiliation(s)
- Vanessa LaQuinte
- Inova Fairfax Hospital for Children, Falls Church, Virginia, USA
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27
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Meury SN, Erb T, Schaad UB, Heininger U. Randomized, comparative efficacy trial of oral penicillin versus cefuroxime for perianal streptococcal dermatitis in children. J Pediatr 2008; 153:799-802. [PMID: 18692203 DOI: 10.1016/j.jpeds.2008.06.035] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 05/20/2008] [Accepted: 06/18/2008] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the efficacy of penicillin compared with cefuroxime for group A beta-hemolytic Streptococcus pyogenes (GABHS) perianal dermatitis. STUDY DESIGN 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 (cefuroxime, day 7; penicillin, day 10). An anal swab was obtained to document eradication of GABHS at the end of treatment. Severity of disease was assessed with a clinical score (perianal erythema, 5 points; perianal itch, 3 points; painful defecation, 3 points; constipation, 2 points). RESULTS Patients were enrolled and randomly assigned to penicillin (n = 18) or cefuroxime (n = 17) treatment. Treatment with penicillin was inferior to cefuroxime, which led to premature study termination after consultation 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). CONCLUSIONS Cefuroxime was more effective than penicillin and therefore should be considered as the treatment of choice for perianal dermatitis due to GABHS.
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Affiliation(s)
- Susanne Navarini Meury
- Division of Pediatric Infectious Diseases, University Children's Hospital Basel, Basel, Switzerland
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28
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Shouval DS, Schurr D, Nussinovitch M. Presentation of perianal group a streptococcal infection as irritability among children. Pediatr Dermatol 2008; 25:568-70. [PMID: 18950404 DOI: 10.1111/j.1525-1470.2008.00737.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We report on a series of 11 children with perianal Streptococcus group A infection who presented with intermittent episodes of irritability. Awareness and recognition of this disease by pediatricians and its early diagnosis by a rapid-strep test will lead to appropriate treatment and prompt recovery.
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Affiliation(s)
- Dror S Shouval
- Department of Pediatrics C, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Petach Tivka, Israel
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29
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Jongen J, Eberstein A, Peleikis HG, Kahlke V, Herbst RA. Perianal streptococcal dermatitis: an important differential diagnosis in pediatric patients. Dis Colon Rectum 2008; 51:584-7. [PMID: 18324440 DOI: 10.1007/s10350-008-9237-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 09/19/2007] [Accepted: 11/11/2007] [Indexed: 02/08/2023]
Abstract
Perianal streptococcal dermatitis is an infectious disease that predominantly affects younger children and is mostly caused by Group A beta-hemolytic streptococci. Although patients are mostly seen primarily by their pediatrician or family physician, the diagnosis is not infrequently established just after referral to a dermatologist or colorectal surgeon. We report a case series of 124 children, aged 14 years or younger, who were seen at our office for anorectal complaints between February 2003 and September 2006. Twenty-one of 124 patients (16 percent) were diagnosed with perianal streptococcal dermatitis on the basis of a positive perianal swab by microbiologic analysis. Perianal streptococcal dermatitis was the most frequent infectious disease in that age group in our practice. Sixteen (of 21, 76 percent) patients were male, and the mean age was 6.3 years. One course of systemic antibiotic treatment augmented by additional local antiseptic ointment in selected cases cured all patients within 10 to 14 days. One patient presented with a new perianal streptococcal dermatitis episode five months after treatment and was successfully retreated with an oral antibiotic. With this report, we wish to alert the colorectal community of the diagnosis because it may be underdiagnosed in our practices and thereby lead to prolonged discomfort, protracted disease, and potentially harmful sequelae for these typically very young patients.
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Affiliation(s)
- Johannes Jongen
- Proctological Office and Department of Surgical Proctology, Park-Klinik, Beselerallee 67, 24105, Kiel, Germany.
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30
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Non-traumatic causes of perianal hemorrhage and excoriation in the young. Forensic Sci Med Pathol 2008; 4:159-63. [PMID: 19291454 DOI: 10.1007/s12024-007-9023-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2007] [Accepted: 12/11/2007] [Indexed: 12/14/2022]
Abstract
The discovery at autopsy or at a death scene of fresh perianal hemorrhage and/or cutaneous excoriation in a young child is always of concern as this raises the possibility of inflicted injury. Three cases are reported where perianal bleeding and excoriation that were initially considered due to possible sexual assault were subsequently found to be of a non-suspicious nature. Case 1: A previously well 18-month-old boy was accidentally hanged. Fresh perianal hemorrhage that had raised the possibility of sexual assault was subsequently shown to be due to perineal streptococcal dermatitis. Case 2: A 2-year-old girl vomited and then stopped breathing. Fresh blood at the anus, that was also thought to be patulous, raised suspicions of sexual assault. At autopsy, however, bleeding around the normally configured anus was due to a midgut volvulus associated with intestinal malrotation. Case 3: A 21-month-old girl was found dead in her cot. Sexual abuse was suspected when lacerations were allegedly found around her anus. These were, however, due to skin lesions from her previously diagnosed ectodermal dysplasia clefting syndrome. Death was due to upper airway obstruction from acute and chronic inflammation. There was no evidence of anogenital trauma or sexual assault in any of the cases. Although inflicted traumatic causes of perianal hemorrhage and excoriation must be judiciously sought in the young, the current cases demonstrate that organic etiologies must also be considered. Perianal infections, congenital malformations of the mesentery and intestines, and inherited disorders of the skin may all produce findings that may initially suggest that sexual assault has occurred. Careful examination with appropriate photography and/or microbiological testing are required.
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Cohen R, Wollner A. [Use of rapid antigen detection tests in unusual infections by Group A beta-hemolytic streptococcus]. Arch Pediatr 2007; 14:527-8. [PMID: 17416497 DOI: 10.1016/j.arcped.2007.02.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 02/27/2007] [Indexed: 11/23/2022]
Affiliation(s)
- R Cohen
- ACTIV (Association clinique et thérapeutique infantile du Val-de-Marne), 27, rue d'Inkerman, 94100 Saint-Maur, France
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32
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Group A β-hemolytic streptococcal hemorrhagic colitis complicated with pharyngitis and impetigo. J Infect Chemother 2007; 13:411-3. [DOI: 10.1007/s10156-007-0550-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Accepted: 07/10/2007] [Indexed: 10/22/2022]
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Echeverría Fernández M, López-Menchero Oliva JC, Marañón Pardillo R, Míguez Navarro C, Sánchez Sánchez C, Vázquez López P. [Isolation of group A beta-hemolytic Streptococcus in children with perianal dermatitis]. An Pediatr (Barc) 2006; 64:153-7. [PMID: 16527068 DOI: 10.1157/13084175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Perianal dermatitis due to group A beta-hemolytic streptococcus is a rare diagnosis in pediatrics. Clinical manifestations include erythema, edema, and perianal pruritus associated with vulvovaginitis or balanitis, painful defecation, constipation, anal fissures, purulent discharge, and/or rectal bleeding. MATERIAL AND METHODS A descriptive, observational, prospective study was conducted between May, 2004 and April, 2005. In children presenting to the emergency room with erythema, edema, and perianal pruritus, a rapid streptococcal antigen test and bacterial cultures of their perianal secretions were obtained. Patients with a positive result in the rapid test were treated with oral phenoxymethylpenicillin (40-50 mg/kg/day) for 10 days, after which clinical and bacteriological evaluations were conducted. RESULTS Of the 24 patients presenting with erythema, edema, and perianal pruritus, 19 patients (12 boys and 7 girls), aged between 6 months and 4 years (median age: 30 months), tested positive for group A beta-hemolytic streptococcus. Nine patients also presented with constipation, 5 with anal fissures, 4 with rectal bleeding, 2 with vulvovaginitis, and 1 with streptococcal pharyngoamygdalitis. Outcome was favorable in 85 % of the patients, and perianal isolation of group A beta-hemolytic streptococcus was negative after treatment in 95 %. CONCLUSIONS In patients presenting with erythema, edema, and perianal pruritus, perianal streptococcal dermatitis should be ruled out. The rapid test for streptococcal antigen detection is a quick and reliable method for this diagnosis. The antibiotic of choice is oral penicillin.
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Affiliation(s)
- M Echeverría Fernández
- Departamento de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Affiliation(s)
- Tanja Gizela Bohl
- Vulva Disorders Clinic, Royal Women's Hospital, Melbourne, Victoria, Australia.
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Nicolas X, Granier H, Le Guen P, Chapalain JC, Rouby Y, Talarmin F. Streptococcus pyogenes : une cause exceptionnelle d'urétrite et de balanite non gonococcique de l'adulte. Med Mal Infect 2006; 36:170-1. [PMID: 16309875 DOI: 10.1016/j.medmal.2005.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Accepted: 10/05/2005] [Indexed: 11/22/2022]
Abstract
Urethritis and balanitis due to S. pyogenes are very uncommon. The authors report the case of a 22 year-old male patient, presenting with this association, the first case reported in France. There was no associated STD.
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Affiliation(s)
- X Nicolas
- Service de médecine interne et maladies infectieuses, hôpital Clermont-tonnerre, F 29240 Brest, France.
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36
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Bray S, Morgan J. Two cases of group A streptococcal vulvovaginitis in premenopausal adults in a sexual health setting. Sex Health 2006; 3:187-8. [PMID: 17044225 DOI: 10.1071/sh05062] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Two cases of group A streptococcus (GAS) causing vulvovaginitis in premenopausal adults are described. A review of the literature of genital GAS is made, as this is an uncommon cause of vulvovaginitis in premenopausal adults. Contrasts are made between anogenital carriage of GAS and group B streptococcus (GBS) to highlight the differences in anogenital carriage between these two organisms.
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Affiliation(s)
- Susan Bray
- Waikato Sexual Health Service, 3 Ohaupo Road, Hamilton, New Zealand.
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Green NM, Beres SB, Graviss EA, Allison JE, McGeer AJ, Vuopio-Varkila J, LeFebvre RB, Musser JM. Genetic diversity among type emm28 group A Streptococcus strains causing invasive infections and pharyngitis. J Clin Microbiol 2005; 43:4083-91. [PMID: 16081955 PMCID: PMC1233891 DOI: 10.1128/jcm.43.8.4083-4091.2005] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Genome sequencing of group A Streptococcus (GAS) has revealed that prophages account for the vast majority of gene content differences between strains. Serotype M28 strains are a leading cause of pharyngitis and invasive infections, but little is known about genetic diversity present in natural populations of these organisms. To study this issue, population-based samples of 568 strains from Ontario, Canada; Finland; and Houston, Texas, were analyzed. Special attention was given to analysis of variation in prophage-encoded virulence gene content by a PCR-based method. Thirty and 29 distinct prophage-encoded virulence gene profiles were identified among pharyngitis and invasive infection isolates. Thirteen profiles, representing the majority of the strains, were shared between these two classes of isolates. Significant differences were observed in the frequency of occurrence of certain prophage toxin gene profiles and infection type. M28 strains are highly diverse in prophage-encoded virulence gene content and integration site, supporting the key concept that prophages are critical contributors to GAS genetic diversity and population biology. Nucleotide sequence variation in the emm gene (encodes M protein) was also examined. Only three allelic variants were identified in the hypervariable portion of the emm28 gene. All but one strain had the same inferred amino acid sequence in the first 100 amino acids of the mature M28 protein. In contrast, size differences in the emm28 gene and inferred protein due to variable numbers of C-terminal repeats were common. The presence of macrolide resistance genes (mefA, ermB, and ermTR) was analyzed by PCR, and less than 2% of the strains were positive.
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Affiliation(s)
- Nicole M. Green
- Center for Human Bacterial Pathogenesis Research, Department of Pathology, Baylor College of Medicine, Houston, Texas 77030, Laboratory of Human Bacterial Pathogenesis, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana 59840, Department of Pathology, Microbiology, and Immunology, University of California—Davis, Davis, California 95616, Pediatric Medical Group, Houston, Texas 77098, Mount Sinai Hospital, Department of Microbiology, University of Toronto, Toronto, Ontario M5G 1X5, Canada, National Public Health Institute, Helsinki, Finland
| | - Stephen B. Beres
- Center for Human Bacterial Pathogenesis Research, Department of Pathology, Baylor College of Medicine, Houston, Texas 77030, Laboratory of Human Bacterial Pathogenesis, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana 59840, Department of Pathology, Microbiology, and Immunology, University of California—Davis, Davis, California 95616, Pediatric Medical Group, Houston, Texas 77098, Mount Sinai Hospital, Department of Microbiology, University of Toronto, Toronto, Ontario M5G 1X5, Canada, National Public Health Institute, Helsinki, Finland
| | - Edward A. Graviss
- Center for Human Bacterial Pathogenesis Research, Department of Pathology, Baylor College of Medicine, Houston, Texas 77030, Laboratory of Human Bacterial Pathogenesis, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana 59840, Department of Pathology, Microbiology, and Immunology, University of California—Davis, Davis, California 95616, Pediatric Medical Group, Houston, Texas 77098, Mount Sinai Hospital, Department of Microbiology, University of Toronto, Toronto, Ontario M5G 1X5, Canada, National Public Health Institute, Helsinki, Finland
| | - James E. Allison
- Center for Human Bacterial Pathogenesis Research, Department of Pathology, Baylor College of Medicine, Houston, Texas 77030, Laboratory of Human Bacterial Pathogenesis, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana 59840, Department of Pathology, Microbiology, and Immunology, University of California—Davis, Davis, California 95616, Pediatric Medical Group, Houston, Texas 77098, Mount Sinai Hospital, Department of Microbiology, University of Toronto, Toronto, Ontario M5G 1X5, Canada, National Public Health Institute, Helsinki, Finland
| | - Allison J. McGeer
- Center for Human Bacterial Pathogenesis Research, Department of Pathology, Baylor College of Medicine, Houston, Texas 77030, Laboratory of Human Bacterial Pathogenesis, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana 59840, Department of Pathology, Microbiology, and Immunology, University of California—Davis, Davis, California 95616, Pediatric Medical Group, Houston, Texas 77098, Mount Sinai Hospital, Department of Microbiology, University of Toronto, Toronto, Ontario M5G 1X5, Canada, National Public Health Institute, Helsinki, Finland
| | - Jaana Vuopio-Varkila
- Center for Human Bacterial Pathogenesis Research, Department of Pathology, Baylor College of Medicine, Houston, Texas 77030, Laboratory of Human Bacterial Pathogenesis, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana 59840, Department of Pathology, Microbiology, and Immunology, University of California—Davis, Davis, California 95616, Pediatric Medical Group, Houston, Texas 77098, Mount Sinai Hospital, Department of Microbiology, University of Toronto, Toronto, Ontario M5G 1X5, Canada, National Public Health Institute, Helsinki, Finland
| | - Rance B. LeFebvre
- Center for Human Bacterial Pathogenesis Research, Department of Pathology, Baylor College of Medicine, Houston, Texas 77030, Laboratory of Human Bacterial Pathogenesis, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana 59840, Department of Pathology, Microbiology, and Immunology, University of California—Davis, Davis, California 95616, Pediatric Medical Group, Houston, Texas 77098, Mount Sinai Hospital, Department of Microbiology, University of Toronto, Toronto, Ontario M5G 1X5, Canada, National Public Health Institute, Helsinki, Finland
| | - James M. Musser
- Center for Human Bacterial Pathogenesis Research, Department of Pathology, Baylor College of Medicine, Houston, Texas 77030, Laboratory of Human Bacterial Pathogenesis, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana 59840, Department of Pathology, Microbiology, and Immunology, University of California—Davis, Davis, California 95616, Pediatric Medical Group, Houston, Texas 77098, Mount Sinai Hospital, Department of Microbiology, University of Toronto, Toronto, Ontario M5G 1X5, Canada, National Public Health Institute, Helsinki, Finland
- Corresponding author. Mailing address: Department of Pathology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030. Phone: (713) 798-3823. Fax: (713) 798-4595. E-mail:
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Daneman N, McGeer A, Low DE, Tyrrell G, Simor AE, McArthur M, Schwartz B, Jessamine P, Croxford R, Green KA. Hospital-acquired invasive group a streptococcal infections in Ontario, Canada, 1992-2000. Clin Infect Dis 2005; 41:334-42. [PMID: 16007530 DOI: 10.1086/431589] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Accepted: 03/07/2005] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A significant proportion of invasive group A streptococcal infections are hospital acquired. No large, prospective studies have characterized this subgroup of cases and evaluated the risk of transmission in hospitals. METHODS We conducted prospective, population-based surveillance of invasive group A streptococcal infections in Ontario, Canada, from 1992 to 2000. Epidemiologic and microbiologic investigations were conducted to identify cross-transmission. RESULTS We identified 291 hospital-acquired cases (12.4%) among 2351 cases of invasive group A streptococcal disease. Hospital-acquired invasive group A streptococcal infections are heterogeneous, including surgical site (96 cases), postpartum (86 cases), and nonsurgical, nonobstetrical infections (109 cases). Surgical site infections affected 1 of 100,000 surgical procedures and involved all organ systems. Postpartum infections occurred at a rate of 0.7 cases per 10,000 live births and exhibited an excellent prognosis. Nonsurgical, nonobstetrical infections encompassed a broad range of infectious syndromes (case-fatality rate, 37%). Nine percent of cases were associated with in-hospital transmission. Transmission occurred from 3 of 142 patients with community-acquired cases of necrotizing fasciitis requiring intensive care unit (ICU) admission, compared with 1 of 367 patients with community-acquired cases without necrotizing fasciitis admitted to the ICU and 1 of 1551 patients with other cases (P<.001). Fifteen outbreaks were identified; 9 (60%) involved only 2 cases. Hospital staff were infected in 1 of 15 outbreaks, but colonized staff were identified in 6 (60%) of 10 investigations in which staff were screened. CONCLUSIONS Presentation of hospital-associated invasive group A streptococcal infections is diverse. Cross-transmission is common; illness occurs in patients but rarely in staff. Isolation of new cases of necrotizing fasciitis and intervention after a single nosocomial case may also prevent transmission.
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Affiliation(s)
- N Daneman
- University of Toronto, Toronto, Ontario, Canada
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Cruz-Rojo J, Martínez García MM, Fernández López MC. Dermatitis perianal, fisuras y balanopostitis por estreptococo betahemolítico del grupo A. An Pediatr (Barc) 2005; 62:483-4. [PMID: 15871836 DOI: 10.1157/13074628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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40
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Hamel-Teillac D. [Vulvo-vaginal localizations of inflammatory dermatoses in children]. Ann Dermatol Venereol 2005; 131:907-11. [PMID: 15697085 DOI: 10.1016/s0151-9638(04)93797-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- D Hamel-Teillac
- Service de Dermatologie, Hôpital Necker Enfants Malades, 149, rue de Sèvres, 75015 Paris
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41
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Affiliation(s)
- M Larrègue
- Service de Dermatologie, CHU de la Milèterie, BP 577, 86021 Poitiers Cedex
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42
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Muller WJ, Schmitt BD. Group A beta-hemolytic streptococcal vulvovaginitis: diagnosis by rapid antigen testing. Clin Pediatr (Phila) 2004; 43:179-83. [PMID: 15024442 DOI: 10.1177/000992280404300208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- William J Muller
- Department of Pediatrics, The Children's Hospital, University of Colorado School of Medicine, Denver, Colorado, USA
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43
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Evans H. Vaginal discharge in the prepubertal child. ACTA ACUST UNITED AC 2003; 3:194-202. [PMID: 14520081 DOI: 10.1097/01.pca.0000085282.60628.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Hughes Evans
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Alabama at Birmingham, 35294, USA.
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Clegg HW, Dallas SD, Roddey OF, Martin ES, Swetenburg RL, Koonce EW, Felkner MB, Ryan AG. Extrapharyngeal group A Streptococcus infection: diagnostic accuracy and utility of rapid antigen testing. Pediatr Infect Dis J 2003; 22:726-31. [PMID: 12913775 DOI: 10.1097/01.inf.0000078835.72497.ab] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Antigen tests have been well-studied and are widely used in pediatric practice for rapid detection of group A Streptococcus (GAS) infections in the throat, but they have not been examined sufficiently for the detection of infection of skin sites, such as the perineal region or impetiginous lesions. METHODS During the 3-year period 1999 to 2002, we evaluated 239 patients with suspected GAS skin infection, in 5 pediatric practices, using 3 Dacron swabs for each site. The first swab was tested in the pediatric office laboratory with an antigen detection kit. For the first 91 patients, the Abbott Test Pack Plus antigen detection test (ADT) was used. The Abbott Signify Strep A ADT was used to test subsequent patients. The second swab was tested with BD Directigen 1-2-3 ADT in the hospital laboratory. The third swab was placed in modified Stuart's transport medium for comparison of recovery of GAS from culture in broth or on agar. A positive culture served as the reference standard. Test performance and test accuracy were determined for each ADT. RESULTS Of the 247 ADTs and cultures performed on 239 patients, 91 with suspected skin infection were tested with the Test Pack Plus test, 149 with the Signify Strep A test and 247 with the Directigen test. Eighty-six (35%) cultures were positive, 73 from perineal sites (54 rectal, 13 vaginal, 6 penile) and 13 from impetiginous lesions. There was 100% concordance for the 86 cultures positive for GAS in a comparison between dry Dacron swabs and swabs that had been placed in modified Stuart's transport medium. Test Pack Plus and Signify Strep A ADTs had similar performance characteristics for skin infections: sensitivity, 92 and 88%; specificity, 99 and 97%; positive predictive value, 96 and 94%; and negative predictive value, 97 and 93%. Directigen ADT had sensitivity 78%, specificity 100%, positive predictive value 100% and negative predictive value 89%. Accuracy for the tests varied from 92 to 97%. CONCLUSION Tests designed to detect GAS carbohydrate antigen in patients with pharyngitis can be used rapidly and accurately to detect GAS antigen in patients with cutaneous lesions suspected of GAS infection.
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Affiliation(s)
- Herbert W Clegg
- Department of Pediatrics, Eastover Pediatrics, Presbyterian Hospital, Charlotte, NC, USA
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Petersen JP, Kaltoft MS, Misfeldt JC, Schumacher H, Schønheyder HC. Community outbreak of perianal group A streptococcal infection in Denmark. Pediatr Infect Dis J 2003; 22:105-9. [PMID: 12586971 DOI: 10.1097/01.inf.0000048907.22286.b5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Perianal group A streptococcal infection (PASI) occurs primarily in children. There is limited information on the incidence, transmission and treatment of PASI. We report a cluster of cases connected to a Danish kindergarten and observations of the incidence of PASI in the local population. SETTING A Danish rural community with 1765 children 15 years and younger registered with two general practice clinics. METHODS After being alerted of a possible cluster of PASI cases, all isolates of group A beta-hemolytic streptococci were collected and subjected to T typing and pulsed field gel electrophoresis (PFGE) if grown from either a rectal swab or an accompanying throat swab obtained in the offices of local general practitioners during the ensuing 4-month period. Clinical data were obtained from the files of the local general practitioners. RESULTS Twelve cases of PASI were caused by group A beta-hemolytic streptococci T type 28 with an identical PFGE profile: 6 of the cases were in children attending the same kindergarten, 4 were connected otherwise to the cluster and 2 cases seemed to be unrelated. Five cases of PASI with different T types and PFGE profiles were diagnosed during the same period giving an estimated annual incidence of 2 to 7 per 1000 children. Penicillin V was ineffective in 3 cases, and no recurrence was seen after change of the treatment to oral clarithromycin. CONCLUSIONS A clone of T type 28 seemed to be the cause of the largest cluster of PASI cases described thus far. Clarithromycin was effective as second line treatment. An estimated annual baseline incidence of 2 to 7 per 1000 in the local population indicates that PASI may not be as rare as previously estimated.
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