Gualtieri Renato, Bronz Gabriel, Bianchetti Mario G, Lava Sebastiano A G, Giuliano Elena, Milani Gregorio P, Jermini Luca M M
Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland.
Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
Eur J Pediatr. 2021 Jun;180(6):1867-1874. doi: 10.1007/s00431-021-03965-9. Epub 2021 Feb 2.
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.
A组链球菌与肛周感染有关。我们在三个数据库（医学文摘数据库、美国国立医学图书馆数据库和科学网数据库）中对有关儿童链球菌性肛周炎的文献进行了系统综述。主要目的是记录临床特征、复发倾向、与无症状性链球菌性咽携带的关联、快速链球菌检测的准确性以及这种感染可能的发病机制。超过80%的病例为7.0岁及以下有排便障碍、肛周疼痛、局部瘙痒、直肠出血或肛裂以及肛周红肿界限分明的男孩。约五分之一的病例中，肛周炎与链球菌性扁桃体咽炎有关。65%的病例诊断时间≥3周。约20%的病例在3个半月内复发。63%的病例存在无症状A组链球菌性咽携带。与肛周A组链球菌培养相比，快速链球菌检测的阳性预测值为80%，阴性预测值为96%。据推测，从鼻咽到肛门的指接种是肛周炎的发病基础。许多病例可能直接由A组链球菌的咽喉和鼻腔携带者儿童引起。一些病例可能发生在由患有链球菌性扁桃体咽炎或携带链球菌的护理人员擦拭臀部的儿童身上。结论：肛周炎是一种具有独特表现且诊断时间较长的感染。医疗保健专业人员需要更广泛地认识这种疾病。已知信息：• A组链球菌可能导致儿童肛周炎。• 全身用抗菌药物（青霉素V、阿莫西林或头孢呋辛）优于局部治疗。新发现：• 临床表现独特（排便障碍、肛周疼痛、局部瘙痒、直肠出血或肛裂以及肛周红肿界限分明）。• 诊断时间通常≥3周。约20%的病例会复发。
