The most notable feature is a very distinct redness around the anus, and other signs of inflammation which can include swelling and itching at the site. Other associated symptoms with perianal cellulitis include pain when defecating and bleeding. These symptoms can often be confused with other skin conditions, such as diaper rash, eczema, psoriasis, hemorrhoids, and more. These symptoms can cause extreme discomfort, especially in diaper-wearing infants, and serious complications can arise if left untreated. In about 10% of cases, balanitis or vulvovaginitis can develop concomitantly. In even rarer instances, tonsillopharyngitis can develop concomitantly as well.Complications most often occur when perianal cellulitis remains undiagnosed and untreated for an extended period of time. In cases where perianal cellulitis is left untreated, it can cause more serious symptoms such as abscess formation and rheumatic fever. Additionally, untreated perianal cellulitis poses a risk of transmission to other people, such as caretakers or family members. Perianal cellulitis can also cause post-streptococcal nephritis, which should be monitored with urinalysis to assess kidney function. Diagnosis
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. In order to confirm diagnosis of perianal streptococcal dermatitis, the anus and genitalia require examination followed by 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 group A β-hemolytic streptococci.
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. Treatment
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. Perianal streptococcal dermatitis does not resolve on its own. 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. Prevention & Recurrence
There is little data that currently exists on the prevention of perianal cellulitis.