Management Pseudomonas

of Anorectal/Perineal in Children

aeruginosa

Infections Caused by With Malignant Diseases

Carlos Angel, Christian C. Patrick, Thorn Lobe, Bhaskar Rao, and Ching-Hon Pui Memphis, l The role of operation for anorectal infections associated with perineal gangrene and cellulitis in children with myelosuppression from cancer chemotherapy is unclear. We evalu-

ated anorectal/perineal infections caused by Pseudomonas aeruginosa in 16 children with malignant diseases seen over 27 years. In 12 of 16 patients, leukemia was the underlying malignancy (ALL 10, AML 2). and in 13 of 16, severe neutropenia (absolute neutrophil count 38.5”(Z), which were present in 14 of the patients. In only 4 patients did spontaneous drainage of the lesion(s) occur. Ten patients had lesions involving only the perirectal areas, and six patients had lesions that involved the perianal and genital areas. Most of the lesions were erythematous and indurated or ulcerated and only 3 patients had necrotizing infections that involved the perirectal and genital areas; 2 of these patients healed completely with medical treatment alone and 1, who developed this problem while on terminal care, died. Thirteen patients received chemotherapy in the 30 days before diagnosis. Seven patients had received steroids and 14 patients had received antibiotic treatment of febrile illnesses, mainly fever and sepsis of unknown origin. These antibiotics included antiPseudomonas coverage in 10 of the cases. No patient had radiotherapy in the month before developing anorectal lesions. Four of six patients who had perirectal and genital lesions had received steroids in

the month before their diagnosis compared with 3 of 10 who developed perirectal lesions only. The absolute neutrophil count (ANC) ranged from 0 to 1,680/mm3 (mean, 210/mm3); 13 patients had an ANC