PEDIATRICS Vol. 121 No. 2 February 2008, pp. 447 (doi:10.1542/peds.2007-3276)
LETTER TO THE EDITOR |
Perianal Abscesses
Richard B. Johnston, Jr, MDDepartment of Pediatrics
University of Colorado School of Medicine and National Jewish Medical and Research Center
Denver, CO 80262
Leslie L. Barton, MD
Department of Pediatrics
University of Arizona Health Sciences Center
Tucson, AZ 85724
To the Editor.—
Christison-Lagay et al1 reported that the combination of antibiotics and medical management of perianal abscesses in the first year of life was as effective in clearing the abscess as surgical drainage and was less likely to result in fistula in ano. Of 140 infants in their study, 94% were male. As Abbott noted,2 the study was limited by the fact that treatment was not randomized; larger abscesses might have been more likely to have been surgically drained. Certainly, however, the results make the important point that antibiotics should be used to manage this condition regardless of whether the abscess is drained.
An additional point can be made: Infants with perianal abscess might have chronic granulomatous disease (CGD). In reviews of detailed case reports3–5 and in cases reported to the CGD registry,6 15% to 18% of patients with CGD had at least 1 perianal abscess. This infection is 1 of the few that is significantly more common in boys with the X-linked form of CGD than in children with the autosomal form.6 Approximately 75% of CGD cases reported in large studies from the United States and Japan have been boys with proven X-linked disease,7 and this form usually presents with infection in year 1.3,4
These findings, of course, do not argue that most infants with perianal abscess have CGD, but they do raise the distinct possibility that some may. Isolation from the abscess of Serratia or Burkholderia species further increases that possibility. Although presentation of CGD in year 1 is the rule,3,4 the mean age at diagnosis is 3 to 7.4 years.7 Thus, CGD is too often diagnosed after the child has suffered preventable infections. A perianal abscess should at least raise suspicion that this defect of phagocyte killing might underlie the problem.
REFERENCES
1. Christison-Lagay ER, Hall JF, Wales PW, et al. Nonoperative management of perianal abscess in infants is associated with decreased risk for fistula formation. Pediatrics. 2007;120 (3). Available at: www.pediatrics.org/cgi/content/full/120/3/e548
2. Abbott MB. Surgeons say no to surgery for perianal abscesses in infants.
Pediatrics. 2007;120
(3):646
3. Johnston RB Jr, Baehner RL. Chronic granulomatous disease: correlation between pathogenesis and clinical findings.
Pediatrics. 1971;48
(5):730
–739
4. Johnston RB Jr, Newman SL. Chronic granulomatous disease. Pediatr Clin North Am. 1977;24 (2):365 –376[Web of Science][Medline]
5. Barton LL, Moussa SL, Villar RG, Hulett RL. Gastrointestinal complications of chronic granulomatous disease: case report and literature review.
Clin Pediatr (Phila). 1998;37
(4):231
–236
6. Winkelstein JA, Marino MC, Johnston RB Jr, et al. Chronic granulomatous disease: report on a national registry of 368 patients. Medicine (Baltimore). 2000;79 (3):155 –169[CrossRef][Medline]
7. Johnston RB Jr. Clinical aspects of chronic granulomatous disease. Curr Opin Hematol. 2001;8 (1):17 –22[CrossRef][Web of Science][Medline]
PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics
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