Mehmet GÜNDÜZ, Şule Mine BAKANAY, Samet YAMAN, Ahmet USTA, Mehmet ÖZEN, Aysun ŞENTÜRK YIKILMAZ, Selin KÜÇÜKYURT KAYA, Servihan DOĞAN, Sema AKINCI, İmdat DİLEK

Akut lösemili hastalarda perianal hastalıkların prevalansı ve güncel yönetimi

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

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

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

Keywords:

Acute leukemia, perianal diseases, prevalence, current management,

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