However, "approximately one-third of people with cellulitis suffer recurrent episodes and the only proven strategy for preventing this is long-term, low-dose oral penicillin." 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. In the case of perianal cellulitis, maintaining the dryness of the site and addressing the infection with topical antifungal ointment is sufficient to prevent recurrent infection for a duration between 3 and 6 weeks. Potential risk factors for perianal streptococcal dermatitis include: poor living conditions, atopic dermatitis, and malnutrition. Routine hygiene practices should also be encouraged in children and adults in order to reduce the risk of recurrent infection. Prescribed antibiotic regimens should also be adhered to until completion, so as to avoid the risk of developing a multi-resistant strain of infection in the future.Proper screening measures should be followed as perianal cellulitis continues to be severely underdiagnosed. Perianal cellulitis is often misdiagnosed as other skin conditions, such as diaper rash (in infants), eczema, psoriasis, hemorrhoids, and more. Epidemiology
The incidence of perianal streptococcal dermatitis in the pediatric population has not been determined. It is believed that the lack of data is due to the difficulty clinicians face recognizing perianal streptococcal dermatitis. Perianal streptococcal dermatitis most commonly affects children between 6 months and 10 years old, with males being more commonly affected than females.
Abdominal guarding is the tensing of the abdominal wall muscles to guard inflamed organs within the abdomen from the pain of pressure upon them. The tensing is detected when the abdominal wall is pressed. Abdominal guarding is also known as défense musculaire. Guarding is a characteristic finding in the physical examination for an abruptly painful abdomen (an acute abdomen) with inflammation of the inner abdominal (peritoneal) surface due, for example, to appendicitis or diverticulitis. The tensed muscles of the abdominal wall automatically go into spasm to keep the tender underlying tissues from being disturbed. Diagnosis
Differential diagnosis
Abdominal aortic aneurysm
Appendicitis
Blunt force trauma to the abdomen
Bowel obstruction
Diverticulitis
Dyspepsia
Ectopic pregnancy
GERD
Ileus
Inflammatory bowel disease
Intussusception
Mesenteric ischemia
Nephrolithiasis
Ovarian cyst
Pancreatitis
Pelvic inflammatory disease
Perforated peptic ulcer disease
Pneumonia
Spontaneous bacterial peritonitis (SBP)
Urinary tract infection/pyelonephritis
Volvulus
Zoster
Skin lesions may not be visible until another day or two
Abdominal migraine
Abdominal wall strain/injury
Abscess (e.g. iliopsoas)
Hepatic or splenic contusion/laceration
Incarcerated hernia
Insect toxins (e.g.