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Febrile Neutropenia


Presentation

  • It is crucial to monitor patients for signs and symptoms of infection, which may present as fever, chills, or sweats.[ajmc.com]
  • Here, we shall present a 50-year-old female patient who was using steroids and antimalarial drugs for AOSD, and who developed MAS during follow-up. The patient presented with febrile neutropenia, and the neutropenic period lasted for 15 days.[ncbi.nlm.nih.gov]
  • Script Download on iTunes Related Content: Podcast: Approach to Acute Leukemia in Children Specialty Area: Clinical Presentation:[pedscases.com]
Fever
  • How should the patient use the fever card? The patient should keep the fever card readily available and refer to it if he/she develops a fever of 38 C.[lhsc.on.ca]
  • Viral infection was defined as fever both typical exanthema.[jpma.org.pk]
  • These patients often have high fevers. This paper is a survey of haematologists (blood specialists) in New Zealand, which asks how they manage fever in patients who have had chemotherapy.[nzma.org.nz]
  • Among patients who have a fever and have no identified source of infection, about 40% of the time, an infection is never identified. And when the white blood cell count comes up and the neutropenia resolves, the fevers typically go away.[cancer.net]
  • Bottom Line Fever in the setting of neutropaenia may be the only herald of a severe, potentially life-threatening infection. Febrile neutropenia is an oncologic emergency.[dontforgetthebubbles.com]
Vietnamese
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Pharyngitis
  • […] attention directed to the oropharynx and periodontium, sites of catheters, recent procedures, the perineum area, nail beds, nares, and external auditory canals. 20,21 The assessment should also include mental status; hydration status; condition of oral and pharyngeal[uspharmacist.com]
  • Head and neck sites of infection were the most prevalent representing 21% and include oral mucositis grade 3 or 4, pharyngitis and sinusitis. Lower respiratory tract of infections accounted for 15%.[antimicrobe.org]
Abdominal Distension
  • The clinical manifestations include fever, abdominal pain , diarrhea , right lower quadrant pain and abdominal distension.[antimicrobe.org]
Confusion
  • About this tool The Multinational Association for Supportive Care in Cancer (MASCC) Risk Index can be used to identify low-risk patients (score 21 points) for serious complications of febrile neutropenia (including death, intensive care unit admission, confusion[qxmd.com]
  • The Multinational Association for Supportive Care in Cancer (MASCC) risk index can be used to identify low-risk patients (score 21 points) for serious complications of febrile neutropenia (including death, intensive care unit admission, confusion, cardiac[en.wikipedia.org]

Workup

  • However, fever remains an important sign that should trigger an infectious workup and empiric antibiotic therapy.( 7 ) Febrile neutropenia occurs in 10% to 50% of solid tumor patients and in greater than 80% of patients with hematologic malignancies.([psnet.ahrq.gov]
  • Zygomycetes Echinocandins Caspofungin Cryptococcus Micafungin Zygomycetes Anidulafungin Fusarium Paecilomyces lilacinus Trichosporon Schedosporium prolificans Schedosporium inflatum Candida parapsilosis Pre-emptive antifungal therapy implies a diagnostic workup[wjgnet.com]
Neutrophil Count Increased
  • However, a low neutrophil count increases the risk of developing an infection even when usual infection prevention methods are utilized ( TABLE 2 ).[uspharmacist.com]
Eikenella
  • ., Eikenella corrodens , Rothia dentocariosa, Eubacterium spp. and Prevotella buccae. Necrotizing gingivitis is associated with Bacteroides species and esophagitis is mainly due to Candida spp. or Herpes simplex virus .[antimicrobe.org]
Malassezia Furfur
  • ,Hansenula anomala, Rhodotorulaand Malassezia furfur in case of total parenteral nutrition. Furonculosis due toS. aureusand perionyxis due toS. aureusor fungi are important clues for adequate management.[antimicrobe.org]
Plasmodium Falciparum
  • Effect of paracetamol on parasite clearance time in Plasmodium falciparum malaria. Lancet. 1997;350:704-9. Graham NM, Burrell CJ, Douglas RM, et al.[nzma.org.nz]

Treatment

  • Febrile neutropenia (FN) is a serious complication of cancer chemotherapy that can lead to delays in treatment and necessary dose reductions of chemotherapy, which compromise treatment efficacy.[ajmc.com]
  • The observations reported here indicate the importance of periodontal treatment in clinical management of patients undergoing leukemia treatment to prevent FN, although all blood cultures were negative.[ncbi.nlm.nih.gov]
  • Without treatment, infections can lead to devastating sequelae including septic shock and death. These patients require prompt antibiotic treatment and protection from further sources of infection within the hospital.[cna-aiic.ca]
  • We constructed a logistic regression model to estimate a propensity score for each patient’s probability of receiving a treatment given pre-treatment characteristics.[aspergillus.org.uk]
  • Risk assessment and treatment of low-risk patients with febrile neutropenia . Clin Infect Dis. 2006:42:533-540. 36. Rolston KV, Frisbee-Hume SE, Patel S, et al. Oral moxifloxacin for outpatient treatment of low-risk, febrile neutropenic patients.[uspharmacist.com]

Prognosis

  • General prognosis proportional to the number of organ failures involved as opposed to underlying malignancy outcomes following ICU admission not as dismal as traditionally thought Factors improving ICU survival: better patient selection early admission[lifeinthefastlane.com]
  • Prognosis Mortality of untreated Febrile Neutropenia in high risk patients: 20-50% Images: Related links to external sites (from Bing) Ontology: Febrile Neutropenia (C0746883) Definition (MSH) Fever accompanied by a significant reduction in the number[fpnotebook.com]
  • Prognosis is worst in patients with proven bacteraemia, with mortality rates of 18% in Gram-negative and 5% in Gram-positive bacteraemia.[academic.oup.com]
  • Improved prognosis for granulocytopenic patients with gram-negative bacteremia. Am J Med. 1980;68(5):643-8. [ Links ] 8. Talcott JA, Finberg R, Mayer R, Goldman L. The medical course of cancer patients with fever and neutropenia.[scielo.br]
  • CONCLUSION During the past 50 years, FN prognosis has dramatically changed as a result of better supportive care in patients with cancer and namely the use of empirical broad spectrum anti-microbial therapy.[wjgnet.com]

Etiology

  • If patient decompensates hemodynamically on piperacillin-tazobactam, consider: The addition of tobramycin, OR Broadening therapy to meropenem Re-evaluate therapy on Day 3 Afebrile (Temperature 38.3 C) No etiology identified Consider oral stepdown in patients[sunnybrook.ca]
  • Brucellosis might be considered in the etiology of febrile neutropenia in endemic regions and must be treated effectively to prevent possible morbidity and mortality during or after chemotherapy.[ncbi.nlm.nih.gov]
  • ., c‑reactive protein and white blood cell count) Consider aortitis in patients who develop these signs and symptoms without known etiology.[neulastahcp.com]
  • Given the sustained inflammatory response with fever resulting from mucosal barrier injury, it is not always clear whether infection is the true underlying cause. 6 The infectious etiology will not be determined in most cases; clinically documented infections[ptcommunity.com]

Epidemiology

  • Epidemiology The epidemiology of FN is also variable according to several factors. It has been reported that 50% of deaths in patients receiving chemotherapy for solid tumours is attributable to FN.[medcraveonline.com]
  • Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Clin Infect Dis. 2003; 36 :1103–1110. [ PubMed ] 12.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • It’s worth considering yhe pathophysiology of erythema; local inflammatory mediators (IL-1, IL-6, TNFa) signal neutrophils to marginate, roll and undergo diapedesis to the area of action.[dontforgetthebubbles.com]
  • […] specialist Hospital, Saudi Arabia Citation: Rasmy A, Amal A, Fotih S, Selwi W (2016) Febrile Neutropenia in Cancer Patient: Epidemiology, Microbiology, Pathophysiology and Management.[medcraveonline.com]
  • […] bacteremia. 4-13 Although there have been improvements in clinical treatment of infections, FN remains a major cause of morbidity, mortality, and cost among patients with cancer and may limit the delivery of full-dose chemotherapy on schedule. 4,11,13,15 Pathophysiology[uspharmacist.com]
  • The PK of antibiotics is amenable to pathophysiology-driven alterations in some special patient populations with marked infections or inflammation, including those with neutropenic fever and malignancy.[aac.asm.org]

Prevention

  • If that were the case, ensuring a culture of safety in which all care team members felt comfortable voicing their concerns may have helped prevent the medication error.[psnet.ahrq.gov]
  • Competitive inhibition of gut mucosal colonization by pathogenic microorganisms using synbiotics could represent one of the potential options for its prevention. Synbiotics represent combination of two components: probiotics and prebiotics.[clinicaltrials.gov]
  • In this setting, patients should be considered for use of prophylaxis with antibiotics to prevent the neutropenia from developing into a more serious infection.[cancer.net]
  • When some cancer medication regimens are used, FN cannot be prevented, but additional procedures can be applied to prevent severe complications.[medcraveonline.com]
  • Can Febrile Neutropenia Be Prevented? Certain chemotherapy treatments are known to have a higher risk of febrile neutropenia than others.[jamanetwork.com]

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