Prevalence and current management of perianal diseases in patients with acute leukemia

Yıl 2018, Cilt: 10 Sayı: 4, 454 - 459, 01.12.2018

Mehmet Gündüz , Şule Mine Bakanay Samet Yaman Ahmet Usta Mehmet Özen , Aysun Şentürk Yıkılmaz Selin Küçükyurt Kaya Servihan Doğan Sema Akıncı İmdat Dilek

https://doi.org/10.21601/ortadogutipdergisi.412212

Öz

Aim: Perianal
infection is one of the most important causes of infection in acute leukemia
which puts the life of patients at risk, increases their morbidity and impairs
quality of life.

Material and Method: At
the Ankara Atatürk Training and Research Hospital Hematology Clinic, 125
patients who received standard chemotherapy for acute leukemia between 2009 and
2017 werestudied, retrospectively.

Results
: Of
these 125 acute leukemia patients, 25(20%) developed perianal disease and
13(10.4%) developed perianal infection. Perianal disease and infection
developed in 34% and 21% of patients with ALL ; in 16% and 7% of patients with
AML (p = 0.03 and p=0.04), respectively. 
Perianal disease was present in 29% of the patients with a leukocyte
count greater than 10,000 at diagnosis, but remained at 12% in those with a
leukocyte count below 10,000 (p = 0.02). Perianal disease and perianal
infection developed in 64% and 69% of the patients during induction and  at a median of 13 days (range: 1-40) and 17
days (range: 3-34), respectively. It was observed that 60% of the patients with
perianal disease had fever, 28% had positive blood culture, 16% had sepsis and
20% required surgical treatment.  Among 7
patients with perianal disease and positive blood cultures, all had gram (-)
bacilli (5 Klebsiella pneumonia and 2
E. Coli). Of the 6 patients who had
masses in physical examination under went pelvic magnetic resonance imaging
(MRI). All patients diagnosed with abscesses on MRI. Five patients who under
went surgery; 3 abscess drainage, 1 colostomy and 1 polypectomy was performed.

Conclusion: It was observed that perianal disease and infection
developed more frequently in ALL patients compared with AML patients; perianal
disease could be controlled mainly with conservative treatment and MRI could be
an important guide in the management of these patients

Anahtar Kelimeler

Acute leukemia, perianal diseases, prevalence, current management

Akut lösemili hastalarda perianal hastalıkların prevalansı ve güncel yönetimi

Öz

Amaç: Perianal
enfeksiyon akut lösemi hastalarının sağkalımını tehlikeye atan, morbiditelerini
artıran ve yaşam kalitelerini bozan en önemli enfeksiyon nedenlerinden
birisidir.

Gereç ve Yöntem:
Ankara Atatürk Eğitim ve Araştırma Hastanesi Hematoloji Kliniği’nde 2009-2017
arasında akut lösemi nedeniyle standart kemoterapi tedavisi alan 125 hasta
geriye dönük olarak çalışmaya alındı.

Bulgular:
Bu 125 akut lösemi hastasının 25’inde perianal hastalık gelişmiş olup perianal
hastalık gelişim riski % 20 olarak saptandı. Perianal enfeksiyon ise 13 hastada
gelişirken perianal enfeksiyon gelişim riski % 10,4 olarak hesaplandı. ALL
tanılı hastaların %34’ünde ve AML tanılı hastaların %16’sında perianal hastalık
gelişti (p=0,03). Tanıdaki lökosit sayısı 10,000’in üzerinde olanların %29’unda
perianal hastalık gelişirken, bu oran lökosit sayısı 10,000’in altında
olanlarda %12’de kaldı (p=0,02). ALL hastaları arasında perianal enfeksiyon
gelişim riski %21 iken AML hastaları açısından risk %7 olarak saptandı (p=0,04)
(Tablo 2). Perianal hastalık gelişen hastaların %64’ünde perianal hastalığın
indüksiyon sırasında geri kalanında ise konsolidasyonda geliştiği ortanca
gelişme gününün 13 (aralık:1-40) olduğu gözlendi. Perianal hastalık gelişen
hastaların %60’ında ateş gözlendiği, %28’inde kan kültüründe üreme olduğu,
%16’sında sepsis geliştiği ve %20’sinde ilerleyen dönemde cerrahi tedavi
gerektiği gözlendi. Perianal enfeksiyon gelişimi açısından hastalar
incelendiğinde ise hastaların %69’unda enfeksiyonun indüksiyon sırasında
geliştiği ve ortanca gelişme gününün 17 (aralık:3-34) olduğu gözlendi. Perianal
enfeksiyon saptanan hastaların %62’sinde ateş gözlendiği, %46’sında kan
kültüründe üreme gözlendiği, hastaların %15’inde sepsis geliştiği ve hastaların
%23’ünün ilerleyen dönemde cerrahi tedavi yapıldığı gözlendi. Perianal
hastalığı olup kan kültüründe üremesi olan 7 hasta incelendiğinde tüm
hastalarda gram (-) basil ürediği bunların 5’inin Klebsiella Pnömonia ve 2’sinin E.
Coli olduğu gözlendi. Fizik incelemede abse saptanan ve MRG yapılan 6 hasta
mevcuttu. Tüm hastalarda MRG’de de abse olduğu gözlendi. Cerrahi girişim
yapılan 5 hastaya bakıldığında 3 hastada apse drenajı, 1 hastaya kolostomi
açılması yapıldığı, 1 hastaya da polipektomi yapıldığı saptandı.

Sonuç:
ALL hastalarında AML hastalarına göre daha fazla perianal hastalık ve
enfeksiyon geliştiği, perianal hastalığın konservatif tedavi ile büyük oranda
düzeltilebileceği ve MRG’nin bu hastaların yönetiminde yol gösterici
olabileceği gözlendi.

Anahtar Kelimeler

Akut lösemiler, perianal hastalık, prevalans, güncel yaklaşım

Kaynakça

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