Perineal group A streptococcal disease in a pediatric practice.

OBJECTIVE: This study was designed to document the frequency and define the clinical, epidemiologic, and microbiologic characteristics of perineal disease caused by group A beta-hemolytic streptococci (GAS) in a pediatric practice in which increased numbers of cases had been observed. METHODS: Clinical, epidemiologic, and microbiologic data were collected on all culture-confirmed cases of perineal GAS disease during the calendar year 1997. GAS isolates from clinical cases and a comparison group of children with GAS pharyngitis were analyzed by T typing, emm gene analysis, and pulsed-field gel electrophoresis (PFGE). RESULTS: Twenty-three cases of GAS perineal disease were diagnosed during 4530 office visits in 1997. Thirteen cases had perianal disease, 8 had vulvovaginal infection, and 2 were infected at both sites. No cases of penile disease were identified. Infections peaked in late winter and early spring and affected children with an average age of 5 years with a range of perineal, gastrointestinal, and genitourinary symptoms. Analysis of T and emm types showed the majority (82%) of perineal isolates to be T 28 emm 28, showing 2 closely related PFGE patterns. In contrast, the pharyngeal isolates were distributed among 6 different T and emm types. CONCLUSION: Perineal infection caused by GAS may be a relatively common diagnosis in a pediatric or family practice setting. There may be specific GAS types that have a tropism for perineal tissues but the mechanism of infection is yet to be established.

Prospective study of alcoholism treatment. Eight-year follow-up.

One hundred patients admitted for alcohol withdrawal were followed for eight years. At the eight year mark, 25 percent had achieved stable abstinence of three years' duration or more, and 29 percent had died. Only 26 percent experienced continued serious problems with alcohol. Premorbid social stability and sustained abstinence made independent contributions to good psychosocial outcome at eight years. Premorbid social stability and Alcoholics Anonymous attendance made independent contributions to sustained abstinence. Review of these data and other major longitudinal studies suggests that factors other than professionally organized treatment per se exert substantial effect upon long-term outcome.

Impending child abuse. Psychosomatic symptoms in adults as a clue.

Adult patients involved in or threatened by the possibility of committing child abuse may develop acute functional symptoms that result in their seeking emergency medical help. Three cases are presented as examples of this relationship. In two, the functional symptom was paralysis or paresis. In the third, symptoms were more diffuse. Recognition of the association between functional symptoms and child abuse may permit intervention before serious child injury occurs.