The Immunological Differences Between Fournier Gangrene and Perianal Abscess

Study Overview
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Brief Summary
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Although it is rarely observed, necrotizing fasciitis progresses with high mortality and serious complications. Fournier's gangrene is a specific form of necrotizing fasciitis. In laboratory tests, leukocytosis or leukopenia, anemia, lymphopenia can be observed. Perianal abscess is a surgical emergency that is observed much more frequently than necrotizing fasciitis. Although Fournier's gangrene has many different etiologies, it rarely occurs due to the progression of perianal abscess, and although it is difficult to distinguish between these two diseases at diagnosis, the two diseases manifest themselves as different entities. In this study, blood cytokine levels will be evaluated in patients with Fournier's gangrene and perianal abscess, and the role of blood cytokine levels in the differential diagnosis of these two diseases will be investigated.

Detailed Description
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Although it is rarely observed, necrotizing fasciitis progresses with high mortality and serious complications. Fournier's gangrene is a specific form of necrotizing fasciitis and is located in the external genital organs and perianal region, causing thrombosis in the arteries feeding this region, gangrene in the skin and subcutaneous tissues, sepsis, and multiorgan failure. The prognosis of Fournier's gangrene is closely related to the time of initiation of treatment. In cases where treatment is delayed, high mortality can be observed due to septic shock and related complications. In laboratory tests, leukocytosis or leukopenia, anemia, and lymphopenia can be observed. In a study evaluating conditions that increase mortality with soft tissue necrosis, it was reported that high body mass index, abnormal leukocytes, CRP and platelet values were proportional to the severity of the disease. Perianal abscess is a surgical emergency that is observed much more frequently than necrotizing fasciitis. Patients usually present with an erythematous swelling near the anus and hesitate to be examined. About 90% of idiopathic perianal abscesses occur due to infection of the cryptoglandular glands. Although Fournier's gangrene has many different etiologies, it rarely occurs due to the progression of perianal abscess, and although it is difficult to distinguish between these two diseases in the diagnosis, the two diseases manifest themselves as different entities. In a study, higher IL17 levels were found in perianal abscess patients compared to the control group. Apart from this, we did not find any study on blood cytokine levels in patients with perianal abscess or Fournier's gangrene in our literature review. In this study, blood cytokine levels will be evaluated in patients with Fournier's gangrene and perianal abscess, and the role of blood cytokine levels in the differential diagnosis of these two diseases will be investigated.

Official Title
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The Cytokines and Immune Checkpoint Differences Between Fournier Gangrene and Perianal Abscess

Conditions
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Fournier Gangrene, Perianal Abscess

Intervention / Treatment
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* Diagnostic Test: Cytokine levels


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients applying to the emergency department with Fournier's gangrene and perianal abscess. Exclusion Criteria: Patients with primary immunodeficiency Crohn's patients HIV patients, Cancer patients, Pregnancy, Patients younger than 18 years and older than 88 years Patients who did not agree to participate in the study

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 88 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Control<br>Healthy volunteers with no known chronic or cancer disease | Diagnostic Test: Cytokine levels<br>* Preoperative cytokine levels of the patients<br>|
| Fournier's gangrene<br>Fournier's gangrene patients | Diagnostic Test: Cytokine levels<br>* Preoperative cytokine levels of the patients<br>|
| Perianal abscess<br>Perianal abscess patients | Diagnostic Test: Cytokine levels<br>* Preoperative cytokine levels of the patients<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cytokines | Values in pg/ml of IL-1β, IFN-α2, IFN-γ, TNF-α, MCP-1 (CCL2), IL-6, IL-8 (CXCL8), IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-33 | 1 day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cytokine, inflammation, Fournier Gangrene, Perianal Abscess