Febrile Neutropenia Tóm tắt về bệnh

Tổng quan

Febrile neutropenia is defined as a single oral temperature of ≥38.3°C (101°F) or two consecutive readings of ≥38.0°C (100.4°F) over 2 hours and an absolute neutrophil count (ANC) of <500/μL (<0.5 x 109/L) or an ANC of <1,000/μL that is expected to decline to ≤500/μL (<0.5 x 109/L) over the next 48 hours, as stated in the Introduction section.

Febrile neutropenia is common among patients receiving cytotoxic chemotherapy. A detailed discussion about the prevalence of febrile neutropenia is in the Epidemiology section.

Bacterial, fungal and viral infections are the causes of febrile neutropenia, with bacteria being the most common cause of infection. Discussion on these pathogens is in the Etiology section. 

The Pathophysiology section states that the factors contributing to febrile neutropenia include a direct effect of chemotherapy or immunosuppressive therapy on the immune system and on mucosal barriers and immunodeficiencies associated with primary malignancy. The development process of febrile neutropenia is in this section.

Febrile Neutropenia_Disease Summary

History and Physical Examination

The Clinical Presentation section emphasizes the need to determine the potential sites of infection and the causative organisms in patients with febrile neutropenia.

A complete history of patients with febrile neutropenia should be taken as stated in the History section. The Physical Examination section states that a thorough physical exam should be done especially at the most common sites of infection.

Tools used to identify the appropriate site of care, risk for medical complications and severe infections, and risk group based on chemotherapy regimen in the evaluation of patients with febrile neutropenia are discussed in the Screening section.

Chẩn đoán

Discussions on blood tests, blood and site-specific cultures, urinalysis, and tests for viral infection in the evaluation of febrile neutropenia are in the Laboratory Tests and Ancillaries section.  

The Imaging section states the need for chest X-rays for patients with respiratory symptoms or for outpatient management in febrile neutropenia.

Other conditions that should be ruled out in the diagnosis of febrile neutropenia are listed in the Differential Diagnosis section.

Xử trí

Site-of-care and evaluation of the type of antibiotic therapy are considered in the management of febrile neutropenia and are discussed in the Evaluation section.

General therapy principles in patients with febrile neutropenia are in the Principles of Therapy section.

The Pharmacological Therapy section discusses in detail empiric antibiotic and fungal therapy, and myeloid growth factors (MGFs) in the treatment of febrile neutropenia.

The Prevention section discusses chemoprophylaxis, granulocyte colony-stimulating factors (G-CSFs), and vaccination as options for the prevention of febrile neutropenia.

The Monitoring section identifies indications for follow-up in patients with febrile neutropenia.