title: Deep soft tissue infections in the neutropenic pediatric oncology patient.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Johnston
authors.forename: J H
authors.initials: JH
authors.lastname: Waldhausen
authors.forename: J R
authors.initials: JR
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D009135:Muscular Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D009503:Neutropenia / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D015996:Survival Rate
chemical_list: D000900:Anti-Bacterial Agents; D016179:Granulocyte Colony-Stimulating Factor