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jennapow

Perianal strep?

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Just throwing this out here to see if anyone has had perianal testing done for strep? My son just finished 14 days of Augmentin, and according to Dr. K, his positive response to the abx confirms a diagnosis of PANDAS. All of his strep titers were low, and tests for mycoplasma and EBV were negative. I am trying to cover every possible source of infection. I didn't even think of it until now, but my son (age 10) has had a bright red rash around his anus for a while. Occasionally there are also little pimple like spots near it or on his bottom. I suspected it was yeast, and I had been treating it with coconut oil and an antifungal essential oil blend. I just found this article and thought I would see if anyone has experience with this. Sounds like antibiotic treatment for this would need to last longer than 2 weeks. We just finished 2 weeks of Augmentin but I'm afraid it's not enough. Dr. K says 2 weeks should be long enough to wipe out whatever infection was there and we should wait and see if the improvements hold. If he relapses in the next 2-4 weeks he wants to do IVIG.

Here is the article: http://neuro.psychiatryonline.org/doi/pdf/10.1176/appi.neuropsych.12050126

 

Just throwing this out there to see if anyone has experience with this.

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Though our triggers are more varied now - PANDAS morphed to PANS - I can say DS had perianal strep two times in his younger years. It was bright red (around the anus) and caused him discomfort. He could not really say if it was itching if I recall correctly - he just kept saying he was uncomfortable. At home and at first we thought yeast, and then pin worms, until eventually the pediatrician took one look and said "strep bottom." Antibiotics cleared the infection. As said, for us this was not a PANDAS/PANS event -- but of course it happened prior to our diagnosis. So maybe it did trigger a flare...

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I have heard of kids w Perianal Strep though the Dr who told me about it said that most doctors do not check for it. Only obstetricians check for it he said. It sounds like that's what is going on -- also thinking it could be yeast though time of year strep seems more obvious.

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Thanks for bringing this topic up. In hindsight both of our kids had the red ring. Combined with our knowledge of PANDAS, it was likely strep.

 

What I found curious was the authors' claim that both throat and anal swabs be done for ALL family members. I have also read that noses should also be swabbed. My kids also have these bumps on their arms that went away on rifampin. And just recently my daughter had a rash around the sides of her mouth that while it dissipated when on amoxicillin. Neither of those areas were swabbed/scraped and cultured though. So...is there any definitive list of areas to culture?

Edited by dasu

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Our dd had perianal strep during her first flare. She had throat 1st, had 14 days Amoxicillin and a few days later she developed very angry (scald-like), well demarcated red rash around anus that was very uncomfortable. We switched to azithromycin and it cleared. Both the throat and perianal strep caused flaring.

 

Our ped now swabs throats and butts if there is any butt discomfort at all. Based on our experience, I would say that 2 weeks of antibiotics doesn't always clear infection and would hesitate moving to IVIG without, first, making sure that all infection is gone.

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