Presentation
It is crucial to monitor patients for signs and symptoms of infection, which may present as fever, chills, or sweats. [ajmc.com]
Three patients infected with documented malaria during a febrile neutropenic episode are presented. [ncbi.nlm.nih.gov]
[…] risk” and having had chemotherapy within 1 month of presentation. [dovepress.com]
Entire Body System
- 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]
In 10 out of 11 PCR-positive cases, fever could be managed by empirical therapy. In the empirical-therapy-resistant case, the identification of Stenotrophomonas maltophilia by PCR led to improvement of fever. [ncbi.nlm.nih.gov]
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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Eyes
- Conjunctival Pallor
On admission to the hospital, her vital signs were stable, and physical examination was notable only for conjunctival pallor. Chemotherapy was administered as scheduled over 5 days. [psnet.ahrq.gov]
Workup
Published on Apr 9, 2013 We discuss the definition of febrile neutropenia, as well as, how to diagnose febrile neutropenia We review the workup involved in properly identifying the source of infection and what treatments are necessary in febrile neutropenia [youtube.com]
Definition Diagnostics The diagnostic workup should be guided by the pre-test probability of the diagnoses under consideration. [amboss.com]
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]
[…] to 30 miles away), willingness to follow up frequently (daily for at least 3 days), 24-hour access to a caregiver, a telephone, transportation, and no history of noncompliance.1 Outpatient Treatment Recommendations During the initial assessment and workup [uspharmacist.com]
Microbiology
- Eikenella
Other commensals of the mouth flora less frequently reported include Leptotrichia buccalis, Capnocytophaga spp., Eikenella corrodens, Rothia dentocariosa, Eubacterium spp. and Prevotella buccae. [antimicrobe.org]
- Malassezia Furfur
Catheter-site cellulitis and tunnelitis are caused by S. aureus, coagulase-negative Staphylococcus (CNS), Bacillus spp., Corynebacterium jeikeium, Candida spp., Fusarium spp.,Hansenula anomala, Rhodotorulaand Malassezia furfur in case of total parenteral [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
Piperacillin‐tazobactam might be the preferred antibiotic for the treatment of cancer patients with fever and neutropenia, while cefepime should not be used. Empiric treatment should be started within 60 minutes of being admitted. [en.wikipedia.org]
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]
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]
These data show that outpatient treatment and early discharge is safer and much research has shown lower costs for outpatient treatment in low-risk patients with febrile neutropenia. [scielo.br]
Antibiotics are the mainstay of treatment in febrile neutropaenia. Miadema and her Dutch colleagues are presently undertaking a Cochrane Review of intravenous vs oral empiric treatment of febrile neutropaenia. [dontforgetthebubbles.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]
Empirical antibiotic therapy should be started as soon as possible, as a delay may compromise the patient's prognosis. [elsevier.es]
Freifeld showed presence of abdominal pain, nausea and/or vomiting, diarrhoea, hemodynamic instability, neurological or mental changes, catheter-related infection, pulmonary infiltrates, renal failure, and liver insufficiency are associated with poor prognosis [acanceresearch.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]
Etiology
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]
[…] piperacillin-tazobactam Suspected or documented C. difficile infection: Add vancomycin 125 mg po QID *NOTE: Re-assessment within 24-48 hours based on clinical status and culture results Re-evaluate therapy on Day 3 If Afebrile x48 hours No Infectious etiology [sunnybrook.ca]
Neutropenia: etiology and pathogenesis. Clin Cornerstone. 2006; 8 (Suppl 5):S5-S11. National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology. Prevention and Treatment of Cancer-Related Infections v 2.2011. [En línea]. [revistaseug.ugr.es]
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]
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]
About 50% of patients with febrile neutropenia will develop an infection, of which 20% with profound neutropenia will observe bacteremia.[6] Pathophysiology Neutropenic fever is the most common and serious complication associated with hematopoietic cancers [ncbi.nlm.nih.gov]
[…] 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]
Pathophysiology and treatment of severe chronic neutropenia. Ann Hematol. 1996 Apr. 72(4):158-65. [Medline]. Young NS. Agranulocytosis. JAMA. 1994 Mar 23-30. 271(12):935-8. [Medline]. Berliner N, Horwitz M, Loughran TP Jr. [medscape.com]
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]
When some cancer medication regimens are used, FN cannot be prevented, but additional procedures can be applied to prevent severe complications. [medcraveonline.com]
Preventability assessment scale showed that 27.27% of reactions are not preventable and 72.72% reactions are probably preventable. [ijmpo.org]
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]