Strep Infection

Hello Lisa,

I just happened to come across your site and am so glad I did. My question is that I have a 3 year old daughter who since early this morning has vomited four times in four hours and her morning stool had streaks of blood and when I wiped her there was pinkish red blood on the paper. I'm not sure if this would help but two days ago she broke out in what almost looked like acne on her chin and neck. I counted 13 little bumps. I'm not sure if they could be related but just in case I wanted to mention it. I tend to over react so your opinion would be greatly appreciated.

Thank you in advance.

“Pimples on the chin”

Dear "Pimples on the chin",

Pimples around the mouth in a young child and vomiting can both be signs of a group A beta hemolytic Streptococcus infection or Strep throat. Other signs of Strep throat include fever, painful throat, decreased appetite, drooling, stomach ache, bad breath, headache, runny nose, swollen lymph nodes in the neck, nausea, and abdominal pain. (1,2) Although Strep Pharyngitis is usually associated with fever, some children with Strep have little or no fever at all.(1)

Symptoms that are specific for a Strep infection include pettechiae or red spots on the soft palate and a fine sandpapery like rash on the torso. (1,2) A new type of skin rash associated with Strep pharyngitis has been documented in the literature. It has been described as a painful, itchy, burning rash on the palms of the hands, soles of the feet, buttocks and knees. Once the infection resolves the skin in the area of the rash tends to peel. This new presentation of Strep is thought to be caused by a toxin-mediated immune response. (3)

Young children are known to put their hands in their mouth and touch their buttocks or vagina. This activity puts a child with Strep throat at risk for also developing Rectal Strep (Perianal Streptococcal Dermatitis) and Vaginal Strep. (4) Signs of Rectal Strep include rectal pain with defecation, rectal itching, redness, and rectal bleeding.(4) When a child infected with Rectal Strep scratches her rectal area the skin becomes irritated and bleeding may occur. Signs of Vaginal Strep include itching and redness of the vaginal area. Discomfort with urination is also commonly found.

Blood in the stool can be a sign of a gastro-intestinal infection, especially if diarrhea accompanies the symptoms. An example of a gastro-intestinal infection that causes blood to appear in the stool is Salmonella. When a child experiences blood in her stool it is necessary to determine its cause. It is a good idea to bring the suspicious stool sample to the Doctor’s office with your daughter for the evaluation. There is a test called a Guaiac or Hemoccult that can be performed on a stool specimen to determine if the red color is truly blood.

Blood in the stool may also occur when a child is constipated. The hardness and large size of the stool can cause a tiny cut or laceration when the stool is passed. This tiny laceration can bleed when a child has a bowel movement. A child with a history of constipation who develops vomiting at the same time should be evaluated by a Physician in order to rule out an intestinal obstruction. Other signs of an intestinal obstruction include abdominal pain and abdominal distention.

It is difficult to assess symptoms in the pediatric population because young children do not have the ability to effectively verbalize and describe what they are feeling. To make matters more complicated, a child’s symptoms can be very general or subtle in nature. For example, a change in temperament or sleep pattern is sometimes the only noticeable sign that a child is ill. A young child with a sore throat is not likely to tell her mother that her throat hurts. Instead she may have a decrease in appetite or refuse to eat or drink all together. Health Professionals who have experience with children are aware of the difficulties in assessing a child’s condition. Therefore, you should not be concerned that you are overreacting when it comes to your child's health.

Without physically examining your child I am not able to definitively tell you what is causing your daughter's symptoms. Only the Physician who performs a physical examination on your child and knows her family and medical history can determine the cause of her symptoms and make a diagnosis. I do feel that your daughter’s symptoms warrant an examination by her Physician . Since her symptoms include vomiting, blood in the stool and pimples around her mouth, a Strep infection should be a consideration.

I hope you find the answers that you are looking for real soon.

If you are interested in reading other Pediatric Advice Stories Covering the topics discussed:

Strep Pharyngitis

Scarlet Fever

Scarlatina

Breastfeeding with Strep

Infant Exposed to Strep

Pimples around the mouth

Tonsillectomy

Blood in Stool

Constipation

Fecal Impaction

Salmonella

References:
(1) Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc 1990: 496-498.
(2) American Academy of Pediatrics. Group A Streptococcal Infections. In: Peter G, ed. 1997. Red Book: Report of the Committee on Infectious Disease. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1997:483-485.
(3)Photoclinic. Atypical Rash Associated With Streptococcal Pharyngitis. Consultant for Pediatricians. 2005. Sept:390-391.
(4)Perianal Streptococcal Pharyngitis. Consultant for Pediatricians. 2005. Oct:441.


Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Infectious Diseases