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Child has itchy, red and swollen anus. No improvement after medication. Cause and cure?

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hello, my daughter 2,5 years, has been having ichy, red and swollen anus. she complained a lot about it being painflul. went to the doctor, he gave her antiparasites drugs, (FLUVERMAL, 3 days one measuring spoon), it was 10 days ago (i will repeat it in 5 days). he also prescribed a zinc cream for the bum.
since then she had an eye infection, which continued to a very painflul ear infection.went to the doctor again, he gave her antibiotics drops for the eyes and ears and also ORELOX (antibiotics). she finished the antibiotics 3 days ago and this morning she woke up again with a red, runny eye, full of puss. forgot to write that at the same time as giving us the antiparasites drug, the doctor gave us MONAZOL cream for the bum, but it made it MUCH worse, so we stopped it after 3 days and then changed for the ZINC cream.
help please!
Posted Sat, 2 Mar 2013 in Skin Hair and Nails
Answered by Dr. Shoaib Khan 2 hours later

Thank you for writing to us.

Regarding the problem around her anus, could you please answer a few questions:
Does she have diarrhea or constipation? Has her stool been analysed for infections or parasites? Does she have a fever? Blood in her stools?
If she has been diagnosed to have parasites then the treatment prescribed by the doctor will surely help. Please be patient.

You daughter was prescribed oflox (ofloxacin) which is prescribed for bacterial conjunctivitis. If the short course has not helped, you could discuss continuing this course for longer or substitute it with other stronger antibiotic (eg. Tobramycin or erythromycin) for her eye. But only under your doctors supervision.

I hope this information helps. Do write back to me for any further clarifications and I would be glad to help.
Wishing your daughter a speedy recovery and a healthy life thereafter.
Best wishes.
Above answer was peer-reviewed by
Follow-up: Child has itchy, red and swollen anus. No improvement after medication. Cause and cure? 4 hours later

Thank a lot for your answer.

About the problem with her anus. She doesnt have diarrhea, she had it maybe once in her life. She has been a very healthy child. On the contrary, constipation is a long term issue. Although lately it has been better. She usually passes stool every 2 day, sometimes every day, rarely on the 3 day. (eats veggies, fruits, fluids...runs in the garden..) Her stool has been analysed for parasites, so far nothing found (3 consecutive stool samples have been tested -still waiting for the last sample results, plus a scotch test done).

As far as the medication, she has been prescribed ORELOX (Cefpodoxine) to treat the ear infection (twice a day for 6 days), plus PANOTILE drops for the ears (once a day, both ears for 3 days), and TOBREX drops (twice a day, both eyes for 5 days) to treat the eyes.

As regards the chronology, the itchy, painful anus started about 3-4 weeks ago. two weeks ago, on 28/01 we went to the doctor and got the antiparasites treatment (FLUMERMAL, once a day, for 3 days, to be repeated in 15 days), plus the MONAZOL cream which we stopped using as it seemed to make the bum much worse (bigger, more swollen, red, amost bloody). So 31/01 we changed the MONAZOL for ALOPLASTINE (oxide of zinc). I also applied a tea from camomille and oak bark and sodium bicarbonate to calm the anus. (It seemed to have help, its still a little sore but much better and not painful any more.) We returned to the doctor day later, on 01/02, with the red, runny, full of puss left eye and doctor diagnosed an ear infection too. Pain in the ear started just some 30min after his diagnoses to confirm it. She had a fever for 1,5 day, 38,5-39 degrees C.

What worries me is that the antibiotics treatment at the begining worked very well, after a day of antibiotics, the ear pain disapeared, fever too, the left eye (where the infection started) cleared too, but on the 5 day of taking antibiotics she woke up with a red right eye, much less puss then in the left eye originally, but red and a bit runny. The eye cleared in 2days. However, today, 3 days after we finished all the antibiotics streatment, she woke up again with a red, a bit runny right eye, less puss, but quite some anyway.

I had a conjunctivitis once and the healing took much longer than it does for her, for her it has been cleared in cca 2 days when taking the antibiotics. It was also not as runny as I would have expected and she didnt complain much about pain, more it seemed it was just itchy.

She had more medication in the last two weeks than in all her life. The doctor has also suggested to give her a 15-21 days treatment of FLUCONAZOLE - for the bum, but we are not doing it now. It has been too much medicine, she is refusing more. And we still have to redo the antiparasites treatment.

I wonder whether there could be a connection between her anus problem and the eyes... it has appeared at almost the same time. We have a cat at home, but I give the cat antiparasites mediciation every 2 months, so the cat should be ok. I never had parasites in my life, its a bit new to me, could a parasite cause all this, what are the symptoms? How long does it take to clear this problem, if its parasites? What other tests could we do?

Also, she has been off a nursery for the last 3 weeks, should I keep her at home longer, or not. Here in France, kids often go to schools while on antibiotics treatment so the doctor might be happy to give her a XXXXXXX card to nursery, what do you think? Her doctor is a good doctor, i do trust him, however, the amount of medication and the fact that she is not getting better made me to look for a second opinion.

And thank a lot for your help.
Answered by Dr. Shoaib Khan 10 hours later

Thank you for your follow up question.

A re-infection is very common with eye and ear infections, this requires a long course of antibiotics, to ensure the infection is dealt with well enough, thus antibiotics are to be continued for a while even after visible symptoms are absent.
Close contact with cats could lead to parasite infections as they are host to many parasites. Continue with the prescribed anti-parasite treatment for your cat; regular baths with lukewarm water can also help.

There are a many different parasites that infest humans, thus there are varying symptoms, without a positive stool examination, we cannot say which parasite has affected your daughter. But following are the most common symptoms:
-Abnormalities in blood picture
-Abdominal pain
-Weight loss
-Bowel obstruction signs
-Itching around anus and/or vaginal area
-Worms seen in stool
-Generalized weakness
-Generalized body pain

A parasite infection that is prevalent in the gastrointestinal tract (GIT) causing an infection of the ear and eye is highly unlikely. These are two different infections. Treatment of parasite infections range from 3 weeks - 4 months (usually).
All major intestinal parasitic infections are still solely dependent on stool microscopy for diagnosis. Only once the organism is identified a laboratory confirmatory test is done, specific for the type of parasite (eg. PCR, immunoblot, EIA, ELISA, etc.).

Your daughter should be safe to be sent to the nursery, all that is required is someone to monitor her hygiene when she visits the toilet. Other than that there should be no other issue of concern.

I hope I have succeeded in providing you with the information you were looking for. Feel free to write back to me for any further clarifications. Wishing your daughter a speedy recovery. Take care XXXXXXX.
Best wishes.
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