Table 3.
Case reports with perianal infectious dermatitis: Clinical and bacteriological patient characteristics
| Name, yr, country | Case age, sex | Symptoms/signs1; symptom duration | Etiology of PID | Other findings2 |
| Hirschfeld, 1970, United States[59] | 1-2. 6 yr, F and 3 yr brother | 1-2. Painful defecation; several days | GAS (culture) | 1-2. Both had sore throats 2 wk prior |
| 3-4. 5 yr and 3 yr brothers (unrelated family) | 3-4. Same history and symptoms | 3-4. Throat GAS positive (1 case) | ||
| Farmer, 1987, United Kingdom[65] | 1. 4 yr, M | 1. White anal discharge, perianal pustules; 3 wk | GAS (culture) | |
| 2. 5 yr, F | 2. Perianal itching, pain on defecation, dysuria; vulva affected; 3 wk | |||
| Rehder, 1998, United States[61] | 1. 3 yr, M | 1. Rectal irritation; 6 mo | GAS (culture) | 1. Sibling, 6 yr: GAS pharyngitis recently |
| 2. 3 yr, M | 2. Perianal pain and itching; 5 wk | 2. Patient: throat GAS positive; sibling with recent sore throat | ||
| 3. 4 yr, M | 3. Perirectal pain; 6 wk | 3. Identical GAS from anus and throat | ||
| 4. 1 yr, F | 4. GP; 3 wk | |||
| Honig, 1988, United States[62] | 4; 15 mo, 6, 8 and 12 yr; 3 M | Anal pruritus, bloody anal discharge; GP: 2 cases, appeared 9 mo after onset of PID; 1 M with PID history of 2 yr | GAS (culture) | |
| Marks, 1988, United States[63] | 5 yr, M | Perianal irritation and pruritus, bloody discharge; 2 wk | GAS (culture) | |
| Guerrero - Vázquez 1989, Spain[64] | 2 cases | Perianal irritation in both; seropurulent anal and balano-preputial discharge in 1 case | GAS (culture) | |
| Duhra, 1990, United Kingdom[29] | 5 yr, M | Painful defecation, micturition, bloody stool; penile erythema swelling; 4 wk | GAS (culture) | GAS positive from penile skin; members of patient's family: severe sore throat recently |
| Goodyear, 1991, United Kingdom[30] | 4 yr, M | Painful defecation, blood-streaked liquid stool; fecal incontinence; 6 wk | GAS (culture) | |
| Medina, 1992, Spain,[31] | 4 yr, M | Perianal pruritus and bleeding; 3 mo | GAS (culture) | |
| Montemarano, 1993, United States[32] | 3 yr, M | Painful perianal area, satellite pustules; 2 mo | S. aureus (culture) | S. aureus positive in anterior nares and satellite pustule |
| Guppy, 1993, Australia[33] | 1. 7 yr, M | 1. Perianal excoriation; 8 wk | GAS (culture) | The three siblings bathing together |
| 2-3. His 2 brothers, 5 and 2.5 yr | 2-3. Similar history | |||
| 4. 4 yr, M | 4. Typical PID; penis lesions later; 4 wk | |||
| Paradisi, 1993, Italy[34] | 3 yr, M | Perianal itching; 2 mo | GAS (culture) | |
| Paradisi, 1994, Italy[35] | 1. 3 yr, F 2. 5 ½ yr, M, brother | Painful defecation, perianal itching, rectal bleeding, constipation | GAS | |
| van Zeijl, 1996, Netherlands[36] | 4; 3 M (1, 6 and 8 yr, the last 2 brothers); 1 F (2 yr) | Constipation, painful defecation, diarrhea | GAS (culture) | Brothers shared same toilet |
| Saxen, 1997, Finland[37] | 1. 3 yr, M | 1. Itchy anus and bloody stool; 1 w | GAS (T28) | |
| 2-3. Other cases | 2. Same symptoms | 2. Throat GAS positive, identical (T28) | ||
| Berlin, 1997, United States[38] | 3 yr, M | Constipation, myositis | GAS (culture) | His mother had sore throat GAS positive |
| Bugatti, 1998, Italy[39] | 12 yr, M | Perianal discharge, 1 mo | GAS (culture) | |
| Adams, 1999, Canada[40] | 1 yr, M | Typical PID | GAS (culture) | |
| Roos, 1999, Sweden[41] | 5 yr, M | Anal pruritus | GAS T28 (culture) | Case: throat GAS negative; mother: GAS tonsillitis positive; anal and throat GAS identical |
| Velez, 1999, Spain[42] | 2 yr, M | Fever 39-40 °C, erythema: perianal, genitalia and proximal thighs | GAS (culture) | Throat negative |
| Herbst, 2000, Germany[9] | 4 yr, M | GP; 6 w history; PID discovered at physical exam | GAS (culture) | Patient and family members: Negative GAS throat |
| Brilliant, 2000, United States[43] | 1. 4 yr, M | 1. Rectal itching and pain, scant mucoid discharge | GAS (RADT + culture) | |
| 2-3. 2 mo and 30 mo | 2-3. Several days later with similar symptoms | 2-3. Siblings of case 1 | ||
| 4. 4 yr, F | 4. Plus vulvitis | 4. Neighbor of the 3 cases | ||
| Balasubramanian, 2000, India[44] | 1. 13 mo, M | 1. Fever, painful defecation, anal pruritus; 2 d | GAS (culture) | |
| 2. 11 mo, M | 2-3. Fever, painful defecation | |||
| 3. 13 mo, F | ||||
| Heidelberger, Germany, 2000[45] | 1. 6 yr, M | 1. Anal itching and burning; 3 mo | GAS (culture) | |
| 2. 9 yr, M | 2. Balanitis and impetigo | |||
| Nowicki, 2000, United States[46] | 7 yr, M | Perianal itching, painful defecation; 10 d | GAS (culture) | Throat GAS negative |
| Soulliet, 2000, France[13] | 7 yr, F | Vulvar erythema, perirectal pain, painful defecation, constipation; perioral impetigo; 3 wk | GAS (culture) | Perioral GAS positive |
| Lunghi, 2001, Italy[47] | Brother (4 yr) and sister (6 yr) | 1 also vulvo-vaginitis; 4 mo | GAS (culture) | Throat GAS positive in both patients |
| Romano, 2002, Italy[48] | 12 yr, M | PID and GP | GAS | |
| Huang, 2003, Taiwan[49] | 6 yr, M | Perianal itching, painful defecation, scant mucoid discharge | GAS (culture) | Throat GAS positive |
| Reimer, 2004, Sweden[50] | 1. 4 yr, M | 1. Perianal discomfort | 1. GAS (RADT) | |
| 2. 6 yr, M | 2. Purulent discharge plus balanitis | 2. GAS | 2. Penis culture GAS positive; father treated for GAS pharyngitis; brother, 4 yr with GAS PID and brother 2 yr with GAS pharyngitis | |
| 3. 4 yr, F | 3. Perianal pain, vulvar erythema and pain | 3. GAS | ||
| Takeshita, 2006, Japan[51] | 1. 2 yr, F | 1. PID; 2 wk | GAS (culture) | |
| 2. 6 mo, M | 2. PID; 1 wk | |||
| Usuki, 2006, Japan[52] | 5 yr, F | PID | GAS (RADT) | 4 d later: Father with symptoms of PID and GAS positive |
| Ulger, 2007, Turkey[53] | 3 yr, M | Pain on defecation, anal pruritus; 8 d; GP: 2 d | GAS (culture) | Sore throat 2 wk before; no culture, no therapy needed |
| Greisser, 2008, Swiss[54] | 7 yr, M | Perianal pain and pruritus, yellow discharge; 3 d | GAS (RADT + culture) | Throat GAS negative |
| Lehman, 2009, United Kingdom[7] | 3 yr, F | Itchy bottom and painful defecation; 2 wk | GAS (culture) | |
| Ledoux, 2009, France[55] | 4 yr, M | PID for 2 wk; lesions of GP since second week | GAS (culture) | |
| Rasi, 2009, Iran[56] | 4 yr, M | Rectal itching and burning, pain on defecation; plaque type psoriasis; 3 mo | GAS (RADT) | |
| Block, 2013, United States[57] | 1. 2 mo, F | 1. PID and vulvar erythema | GAS | 1. 8 yr sibling: previous GAS pharyngitis |
| 2. 4 mo, F | 2. Blood in diaper | |||
| Theotokatou, 2014, Greece[58] | 1. 8 yr, M | 1. Perianal itching, constipation, blood-streaked stool; 3 wk | Enterococcus faecalis (culture) in both) | |
| 2. 10 yr, M, brother | 2. Perianal itching and mucous discharge (2 wk after onset of symptoms of his brother) | |||
| Zhang 2016, Canada[3] | 1. 4 yr, M | 1. Painful defecation, GP, penile erythema | 1. GAS and S. aureus | 1. Throat GAS positive |
| 2. 4 yr, M | 2. Painful defecation, GP | 2. GBS | 2. Throat culture negative | |
| 3. 3 yr, F | 3. Perivulvar erythema, small amount of greenish-yellowish vaginal discharge | 3. GCS | 3. Throat culture negative; vulvar culture few GCS and scant S. aureus | |
| Garritsen, 2017, Netherlands[60] | 19 mo, M | PID and 1 wk later: GP | GAS | |
| Serban, present study, Romania | 1. 9 yr 4 mo, M | 1. Perianal pain and pruritus, anal mucous and bloody discharge, painful defecation; 6 wk | 1. GBS and S. aureus (culture) | 1. Throat GAS, GBS and S. aureus negative |
| 2. 9 yr 6 mo, M | 2. Anal pruritus, painful defecation, anal mucous and bloody discharge | 2. GAS (culture) | 2. Throat GAS positive | |
| 3. 11 yr 9 mo, M | 3. Anal pruritus, mucous and bloody discharge, painful defecation, constipation | 3. GAS (culture) | 3. Throat GAS negative |
1
Besides typical perianal erythema;
2
Especially throat culture and infections in the family/community. F: Female; GAS: Group A beta-hemolytic streptococci; GBS: Group B beta-hemolytic streptococci; GCS: Group C beta-hemolytic streptococci; GP: Guttate psoriasis; M: Male; PID: Perianal infectious dermatitis; RADT: Rapid antigen detection test; S. aureus: Staphylococcus aureus; T28: T-type 28 of GAS.