What is the management for recurrent furuncles (boils) and the appropriate laboratory workup for a suspected neutrophil disorder?

From the Guidelines

For patients with recurrent furuncles (boils) and suspected neutrophil disorder, a comprehensive laboratory workup and management strategy prioritizing morbidity, mortality, and quality of life is crucial. The management of recurrent furuncles involves a combination of antibiotic therapy, decolonization protocols, and surgical intervention. Initial evaluation should include a complete blood count with differential to assess neutrophil count and morphology, along with C-reactive protein and erythrocyte sedimentation rate to evaluate inflammation, as recommended by 1 and 1.

Laboratory Workup

Specific neutrophil function tests are crucial, including:

• Dihydrorhodamine (DHR) flow cytometry to screen for chronic granulomatous disease
• Neutrophil oxidative burst assay
• Chemotaxis studies Genetic testing should be considered for suspected hereditary disorders like leukocyte adhesion deficiency or specific granule deficiency, as suggested by 1.

Management Strategy

While awaiting results, management typically includes:

• Topical antibiotics like mupirocin for small lesions
• Systemic antibiotics such as trimethoprim-sulfamethoxazole (7-10 days for uncomplicated cases) or clindamycin (300-450mg orally three times daily) for more extensive infections, as recommended by 1 and 1
• Decolonization protocols using chlorhexidine washes and intranasal mupirocin for recurrent cases, as suggested by 1 and 1
• Incision and drainage remains the primary treatment for fluctuant boils, as recommended by 1 and 1

Neutrophil Disorders

Neutrophil disorders impair the body's ability to fight bacterial infections, particularly those caused by Staphylococcus aureus, which explains the recurrent nature of skin boils in these patients, as noted by 1 and 1. Early identification of underlying neutrophil dysfunction allows for targeted prophylaxis and management strategies to prevent recurrent infections. Adult patients should be evaluated for neutrophil disorders if recurrent abscesses began in early childhood, as recommended by 1.

Key Recommendations

• Recurrent abscesses should be drained and cultured early in the course of infection 1
• Consider a 5-day decolonization regimen twice daily of intranasal mupirocin, daily chlorhexidine washes, and daily decontamination of personal items 1
• Adult patients should be evaluated for neutrophil disorders if recurrent abscesses began in early childhood 1

From the FDA Drug Label

Obtain a complete blood count (CBC) and platelet count before instituting ZARXIO therapy and monitor twice weekly during therapy. Prior to starting ZARXIO in patients with suspected chronic neutropenia, confirm the diagnosis of severe chronic neutropenia (SCN) by evaluating serial CBCs with differential and platelet counts‚ and evaluating bone marrow morphology and karyotype

The management for recurrent furuncles (boils) is not directly addressed in the provided drug labels. However, for a suspected neutrophil disorder, the appropriate laboratory workup includes:

• Complete Blood Count (CBC): to be obtained before instituting ZARXIO therapy and monitored twice weekly during therapy
• Platelet count: to be obtained before instituting ZARXIO therapy and monitored twice weekly during therapy
• Serial CBCs with differential and platelet counts: to confirm the diagnosis of severe chronic neutropenia (SCN)
• Bone marrow morphology and karyotype: to confirm the diagnosis of severe chronic neutropenia (SCN) 2 2

From the Research

Management of Recurrent Furuncles (Boils)

• The management of recurrent furuncles (boils) is not directly addressed in the provided studies, but it can be inferred that immunosuppressants and treatments targeting the underlying cause of the condition may be effective 3.
• In cases where an underlying immunological disease is present, such as inflammatory bowel disease (IBD), treatment of the underlying condition may help alleviate symptoms of recurrent furuncles 3.

Laboratory Workup for Suspected Neutrophil Disorder

• A laboratory workup for a suspected neutrophil disorder may include tests such as dihydrorhodamine-1,2,3 (DHR) flow cytometry and cytochrome c reduction assays to evaluate neutrophil respiratory burst 4.
• Western blot and flow cytometric analysis of individual NADPH oxidase components may also be useful in diagnosing neutrophil disorders 4.
• Genetic analysis may be necessary to confirm the diagnosis of certain neutrophil disorders, such as chronic granulomatous disease (CGD) 4, 5.
• Other tests, such as those evaluating neutrophil adhesion, migration, and oxidative killing, may also be relevant in diagnosing and managing neutrophil disorders 5.

Neutrophil Disorders and Recurrent Infections

• Neutrophil disorders, such as CGD and leukocyte adhesion deficiencies, can increase the risk of recurrent infections, including those caused by oxidant-sensitive pathogens 4, 5.
• Treatment of underlying neutrophil disorders may help reduce the risk of recurrent infections 3, 5.
• Granulocyte-colony stimulating factor (G-CSF) application has been shown to elevate blood neutrophils and reduce the risk of infections in conditions such as human cyclic neutropenia 6.