Persistent Peri-Anal Strep: Understanding Gram Stain Results in My Daughter's Case
My daughter, who is 4.5 years old and weighs 40 pounds, initially developed peri-anal strep in March. This was during a time when her siblings were suffering from strep throat, but she and one of her brothers tested positive specifically for the peri-anal strain. At that time, she exhibited a bright red, well-defined rash coupled with an itchy anus and painful bowel movements. In April, she completed a full treatment regimen with amoxicillin. Shortly after, her brother also finished his course of the same antibiotic, but a few weeks later he had to switch to cephalexin after a rapid strep test returned a positive result once more. Unfortunately, by July 1st, my daughter’s rash had reappeared, appearing raw and inflamed. I decided to take her back to urgent care, where the doctor prescribed a week's course of cephalexin. Once the treatment concluded, I followed up for culture results, which revealed the following: - Culture from the wound: numerous mixed skin flora detected. - Gram stain: few gram-positive cocci in pairs, which is unusual. - Gram stain: absence of white blood cells, considered abnormal. Despite this, the physician assistant informed me that no strep was identified in her culture, while my daughter’s rash remained persistent. I was advised to be patient, as healing might take some time. Two weeks have passed since she completed the antibiotics, but her condition seems to be deteriorating, with increased rash, pus, and weeping, along with complaints of pain during urination and defecation. At this juncture, I find myself uncertain about the next steps. Would it be prudent to seek a referral to a pediatric infectious disease specialist? What other issues could these gram stain findings suggest?
Answers (1)
7/22/2025, 11:01:47 PM
OpenHealth AI
It sounds like you're dealing with a challenging situation regarding your daughter's persistent peri-anal condition. The key points here include the recurring rash, the pain she is experiencing, and the somewhat unclear gram stain results which indicate a potential infection but do not align with typical findings seen in strep infections.
Explanation
Your daughter's condition seems indicative of a possible infection that isn’t responding to standard antibiotic treatment. The gram stain showing few gram-positive cocci without white blood cells could suggest a low-grade infection or even a non-infectious process such as irritation or dermatitis rather than a classical bacterial infection. Mixed skin flora could point to a variety of bacteria, indicating that the initial treatment may not have been effective against the specific organisms present.
Given the persistence and worsening of symptoms (including pus and weeping), it is crucial to address this effectively to avoid further complications.
Next Steps
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Seek a Referral to a Pediatric Infectious Disease Specialist: Given the repeated infections and resistant symptoms, this step can provide a more focused evaluation and tailored treatment options. They can perform more specialized tests if needed and recommend advanced therapeutic options.
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Maintain Proper Hygiene: Until you can see the specialist, ensure your daughter’s peri-anal area is kept clean and dry. Try to avoid any irritants such as soaps or wipes that may cause further irritation. Use plain water for gentle cleansing during baths.
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Monitor Symptoms Closely: Keep a detailed record of her symptoms, including any changes in the rash, pain level during urination or defecation, and any new developments. This documentation can be very helpful for the specialist.
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Consider a Dermatology Consultation: If the rash worsens or does not improve, a pediatric dermatologist may provide valuable insights into whether there's an underlying skin condition contributing to her symptoms.
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Soothing Measures: Over-the-counter barrier ointments (like zinc oxide) can help protect the skin and soothe irritations, but be sure to consult with the specialist to see what’s safe for her situation.
It’s understandable to feel frustrated and worried about your daughter’s condition. You’re advocating for her health, which is very important. Please keep an open line of communication with her healthcare providers and express your concerns during appointments. This will ensure you receive the best care possible for her situation.
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