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Single-center prospective study to assess the clinical course of group A streptococcal blistering distal dactylitis in children after antibiotic treatment.
Blistering distal dactylitis are very common in children. About 60% are caused by Staphylococcus aureus and some are caused by Group A Streptococcus (GAS) or Streptococcus pyogenes. While these forms have been known for fifty years, few publications are interested in it. Some studies have confirmed that a single antibiotic treatment against the SGA allows the healing of these dactylitis but few surgical teams have adopted this strategy. As all streptococcal infections, they face the risk of acute complications (septicemia, streptococcal toxic shock, etc.) or late (post-streptococcal glomerulonephritis, acute rheumatic fever, etc.). The involvement of the SGA in these dactylitis is easy to demonstrate through the use of rapid GAS test already widely used in other GAS infections (tonsillitis, scarlet fever, streptococcal perianal infections).
This study aims to assess the clinical course of positive GAS test blistering distal dactylitis in children after antibiotic treatment.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Positive rapid Group A Streptococcus (GAS) test | Experimental | In case of positive rapid GAS test, patients will be treated by antibiotics: amoxicillin 50mg/kg/d during 10 days or cefpodoxime 8mg/kg/d during 10 days in case of betalactamine allergy |
|
| Negative rapid GAS test | Active Comparator | If case of negative rapid GAS test, usual care: local antiseptic or surgical intervention |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Positive rapid GAS test | Procedure | If TDR positive, the child will be treated with antibiotics alone:
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| Measure | Description | Time Frame |
|---|---|---|
| Rate healed blistering distal dactylitis with positive GAS test after 10 days of antibiotherapy directed against streptococcus pyogenes | The main objective of this study is to evaluate the effectiveness of antibiotic treatment only if paronychia subungual child collected or not collected with a in distal blistering dactylitis with positive GAS test | 10 days |
| Measure | Description | Time Frame |
|---|---|---|
| Frequency of distal blistering dactylitis with positive GAS test in children | 18 months | |
| Frequency of collected distal blistering dactylitis with positive GAS test in children | 18 months | |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Camille Jung, MD, PhD | CHIC Créteil | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHI Creteil | Créteil | 94000 | France |
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| Negative rapid GAS test | Procedure | Usual care |
|
| Frequency of germs involved in distal blistering dactylitis after pus culture in children |
| 18 months |
| Sensitivity of GAS test compared to pus culture | Describe the sensitivity of GAS test in distal blistering dactylitis according to different age groups. | 18 months |
| Specificity of GAS test compared to pus culture | Describe the specificity of GAS test in distal blistering dactylitis according to different age groups. | 18 months |
| Correlation between GAS test and pus culture in different age groups | 18 months |
| Number of General anesthesia avoided by use of antibiotics treatment instead of surgical procedure in case of collected distal blistering dactylitis | 18 months |
| Number of surgical procedures avoided by use of antibiotics treatment instead of surgical procedure in case of collected distal blistering dactylitis | 18 months |
| Comparison between the cost of antibiotics versus surgical or local treatments of positive GAS test distal blistering dactylitis in children | Evaluate the medical and economic impact of the single antibiotic treatment of distal blistering dactylitis with positive GAS test | 18 months |
| Rate of healed collected distal blistering dactylitis with positive GAS test after antibiotic treatment | 18 months |
| Number of Nail dystrophy at 3 months of follow-up | 3 months |