User:Kaileync/Perianal cellulitis

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Perianal cellulitis, also known as perianitis or perianal streptococcal dermatitis, is a bacterial infection of the inner layers of the skin around the anus. It presents as bright redness (with distinct borders) in the skin surrounding the anus and can be accompanied by pain, difficulty defecating, itching, and bleeding.

perianitis, perianal streptococcal dermatitis, perianal dermatitis, streptococcal anitis, streptococcal perianitis

Perianal cellulitis, also known as perianitis or perianal streptococcal dermatitis, is a bacterial infection affecting the deeper layers of the skin (cellulitis) around the anus. It presents as bright redness in the skin and can be accompanied by pain, difficulty defecating, itching, and bleeding. It is most commonly caused by group A beta-hemolytic streptococcus bacteria (Streptococcus pyogenes) and occurs mainly in children between six months and 10 years of age.

Perianal cellulitis, also known as perianitis or perianal streptococcal dermatitis, is a bacterial infection affecting the lower layers of the skin (cellulitis) around the anus. It presents as bright redness in the skin and can be accompanied by pain, difficulty defecating, itching, and bleeding. It is most commonly caused by group A beta-hemolytic streptococcus bacteria (Streptococcus pyogenes) and occurs mainly in children between six months and 10 years of age.

**need update reference

("perianal" meaning around, or about, the anus)

** Group A Strep colonize human throat & skin, Group B strep normally resides in vagina & passed on at birth

for chapter 15, the gram positive cocci

old:

It presents as sharply demarcated, bright, perianal erythema extending 2–3 cm around the anal verge. It is caused by group A beta-hemolytic streptococcus and occurs mainly in children between six months and 10 years of age. Symptoms include fever, discomfort with bowel movements, and redness around the anus. new:

Classification
Epidemiology - Copied to Main Article

Perianal streptococcal dermatitis most commonly affects patients between the ages of 6 month and 10 years old. While typically though to be a pediatric disease, there have been case reports of perianal streptococcal dermatitis in adults. In a systematic literature review of perianal streptococcal disease in childhood, results found that "more than 80% of cases of perianal streptococcal dermatitis are males ≤7.0 years of age with defecation disorders, perianal pain, local itch, rectal bleeding, or fissure and a sharply demarcated perianal redness." "Males are more commonly affected than females with a ratio between 3 to 1 and 2 to 1."

Causes (kailey) - copied to main article
In most cases of perianal streptococcal dermatitis in children, swab cultures indicate that infection is caused by the bacteria Streptococcus pyogenes, more specifically classified as beta-hemolytic streptococci from group A. There have been reported cases, however, that have found perianal streptococcal dermatitis infections to be caused by beta-hemolytic streptococci from group B and (in rare cases) other groups of beta-hemolytic streptococci or Staphylococcus aureus. It is important to note, however, that in the rare adult cases of perianal streptococcal dermatitis that have been identified, the most common cause is by beta-hemolytic streptococci from group B specified as Streptococcus agalactiae.

Based on cases studied of children with perianal streptococcal dermatitis, there has been a pattern of perianal infection occurring after being diagnosed with previous streptococcal infections (i.e. "strep throat"). It is believed that bacteria from these infections may be introduced to the skin of the perianal region after touching the nose or mouth and then proceeding to use the toilet or touching the area for any other reason.

While perianal streptococcal dermatitis is a treatable condition, there are serious consequences that may arise if left undiagnosed and/or untreated in patients with an infection. Failure to properly diagnose and treat perianal streptococcal dermatitis may lead to more serious infections that could result in injury or death.

Mechanism(kailey)
Upon the initial exposure of Streptococcus pyogenes (group A beta-hemolytic streptocci) bacteria to the skin surrounding the perianal region, the bacteria adheres to the skin's surface with filaments on its cell wall surface called adhesins. An adhesin found in group A beta-hemolytic streptococci of particular importance is called the M protein, which utilizes complex mechanisms to recognize various receptors on human cell types for attachment. After attachment, colonization of Streptococcus pyogenes occurs and the bacteria release many toxins that are responsible for the manifestation of symptoms of perianal cellulitis such as inflammation, fever, and itching. As the streptococci continue to colonize, the formation of a biofilm may arise and its protective properties may make it more difficult to treat the infection with antibiotics.

In cases of perianal cellulitis infections that are not treated properly, group A beta-hemolytic streptococci may cross into the bloodstream through the epithelium of the perianal area to cause serious infections such as necrotizing fasciitis or toxic shock syndrome. The group A beta-hemolytic streptococci bacteria that enter the bloodstream are able to cause serious infections by overpowering natural immune responses and allowing bacteria to rapidly multiply to cause harm to the body.

Diagnosis - Copied to Main Article
The diagnosis of perianal cellulitis is made either through a rapid strep test or by swabbing the affected areas for a bacterial culture indicating infection by group A β-hemolytic streptococci (GABHS). In order to confirm diagnosis of perianal streptococcal dermatitis, bacterial swabbing of the exudate from the affected area is preferred. The swabs will be sent for microbiological analysis of the culture to confirm the growth of GABHS. "The time to diagnosis of perianal streptococcal dermatitis is ≥3 weeks in 65% of cases."

Within the pediatric population, it is common for the management of rashes to occur under the collaboration of an inter-professional team. Due to the diverse causes of rashes in the pediatric population, it may be necessary to refer pediatric patients to a pediatrician or a dermatologist to prevent misdiagnosis of perianal streptococcal dermatitis. Across the different disciplines of care, nurses have an opportunity to provide education on proper hygiene techniques to reduce the risk of recurrent infection. Pharmacists can provide patient and caretaker counseling on the selected medication therapy and improve medication adherence. By working together as an inter-professional team, all types of clinicians can improve patient health outcomes by reducing both time to diagnosis and recurrence of perianal streptococcal dermatitis infection.

The management of rashes in the pediatric population requires an inter-professional team. There are many causes of rashes in infants, and the presentation is diverse. Thus, when in doubt, the primary care clinicians and nurses should refer these patients to a pediatrician or a dermatologist. Across the spectrum of care, nurses have an opportunity to provide education on proper hygiene techniques to reduce the risk of recurrent infection. Pharmacists can provide patient and caretaker counseling on the selected medication therapy and medication adherence to improve patient health outcomes.

Differential Diagnosis - Slade

Due to the non-specific presentation of the symptoms of perianal streptococcal dermatitis, it is frequently misdiagnosed by clinicians. To reach the correct diagnosis of perianal streptococcal dermatitis often ranges from weeks to months and can extend to even longer. During this time, the patient can undergo treatment for a variety of differential diagnoses. Perianal streptococcal dermatitis imitates other common diseases in the anal region and therefore can be mistaken for "candidiasis, irritant diaper dermatitis, pinworm infestation, chronic inflammatory bowel disease, seborrheic dermatitis, or even sexual abuse." The delay in diagnosis of perianal streptococcal dermatitis can result in prolonged discomfort and additional symptoms of constipation, anal discharge or oozing, and anal fissures.

Treatment and/or management: drugs, procedures - Copied to Main Article
After the diagnosis of perianal streptococcal dermatitis has been confirmed, the most successful treatment regimens utilize a combination of topical and systemic antibiotics. Oral antibiotics are the recommended first-line treatment for perianal streptococcal dermatitis. The treatment of choice for oral antibiotics include "penicillin V, azithromycin, clarithromycin, clindamycin, erythromycin, penicillinase-resistant penicillin, or cephalosporins." Oral antibiotics work best in combination with a topical antibiotic such as mupirocin, or an antiseptic such as chlorhexidine. Due to the affect that perianal streptococcal dermatitis has on the deeper layers of the skin, topical antimicrobial therapy alone appears to be poorly effective. Treatment duration ranges from 14 to 21 days and treatment success is determined by clinical examination and post-treatment swabbing of the affected area to confirm that the infection is no longer present.

Recurrences

Performing post-treatment swabbing and confirming eradication of group A β-hemolytic streptococci infection reduces the chance of perianal streptococcal dermatitis recurrence. In about 20% of cases, recurrence of perianal streptococcal dermatitis infection occurs within 3.5 months

Signs and symptoms
"Perianitis presents without signs consistent with a systemic illness. The local features include a sharply demarcated perianal redness accompanied by signs of local inflammation such as superficial edema, infiltration, and tenderness. Further features include defecation disorders, perianal pain, local itch, rectal bleeding, and fissure. Concomitant balanitis or vulvovaginitis occurs in about 10% of cases. Finally, perianitis is associated with a tonsillopharyngitis in about every fifth case."

Special populations*
Difference between Dermatitis VS. Cellulitis See this reference:

https://www.ncbi.nlm.nih.gov/books/NBK547663/