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Published on: February 9, 2011
Deep soft tissue infections in the neutropenic pediatric oncology patient
D L Johnston1, J H Waldhausen, J R Park
1Department of Pediatrics, University of Washington School of Medicine, Seattle, USA.
Purpose:
Necrotizing fasciitis and myonecrosis can be rapidly fatal without prompt and aggressive medical and surgical therapy. We reviewed our experience with necrotizing fasciitis and myonecrosis in neutropenic pediatric oncology patients to describe associated clinical characteristics and outline therapeutic interventions.
Patients And Methods:
A retrospective chart review was performed for all cases of deep soft tissue infection found in neutropenic pediatric oncology patients during an 11-year period.
Results:
Seven cases of necrotizing fasciitis and/or myonecrosis associated with chemotherapy-induced neutropenia were diagnosed during the study period. Deep soft tissue infection was diagnosed a median of 14 days after the initiation of chemotherapy. All of the patients presented with fever and pain, generally out of proportion to associated physical findings. Most patients (86%) also had tachycardia and subtle induration at the site of soft tissue infection. The pathogenic organism in four of seven patients originated in the gastrointestinal tract. Patients were treated with antibiotics, surgical debridements, granulocyte colony-stimulating factor, and hyperbaric oxygen. Granulocyte transfusions were administered if there were no signs of neutrophil recovery. Five patients survived their deep soft tissue infection.
Conclusions:
The diagnosis of necrotizing fasciitis and/or myonecrosis should be considered in any neutropenic patient with fever, tachycardia, and localized pain out of proportion to the physical findings. Appropriate therapy includes broad-spectrum intravenous antibiotics and urgent surgical intervention. Granulocyte colony-stimulating factor should be administered to all patients to enhance neutrophil recovery. Granulocyte transfusions should be considered if a prolonged period of neutropenia is anticipated.
Insights
Necrotizing infections in neutropenic pediatric oncology patients are serious but treatable. Early recognition of fever, tachycardia, and pain, along with prompt antibiotics and surgery, improves survival rates.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Critical Care Medicine
Background:
- Necrotizing fasciitis and myonecrosis are life-threatening infections requiring immediate intervention.
- Neutropenic pediatric oncology patients are at increased risk for severe infections.
- This study reviews the clinical characteristics and treatment of these infections in a specific high-risk population.
Observation:
- Seven cases of necrotizing fasciitis/myonecrosis in neutropenic pediatric oncology patients were identified over 11 years.
- Patients typically presented with fever, tachycardia, and pain disproportionate to physical findings, often linked to gastrointestinal pathogens.
- Infections were diagnosed a median of 14 days post-chemotherapy initiation.
Findings:
- Successful treatment involved broad-spectrum antibiotics, surgical debridement, granulocyte colony-stimulating factor (G-CSF), and hyperbaric oxygen.
- Granulocyte transfusions were used in cases of prolonged neutropenia without neutrophil recovery.
- Five out of seven patients survived the deep soft tissue infection.
Implications:
- Prompt diagnosis of necrotizing infections in neutropenic patients is crucial, based on clinical signs like fever, tachycardia, and localized pain.
- Aggressive management including intravenous antibiotics and urgent surgery is essential for improving outcomes.
- Administration of G-CSF and consideration of granulocyte transfusions are key therapeutic strategies to support neutrophil recovery and combat infection.
