Fever along with Neutropenia in immune
compromised patients can be a serious problem if not
treated in time
Definition-
Persistent fever for greater than 72 to 96 hours
with Temperature of body 37.5 C (Celsius) along with
white blood cells count < 1.0 X 109/L is febrile
neutropenia. This is always an alarming condition.
This is the complication of immune suppression for
transplants or chemotherapy. The number of infection
fighting cells is reduced because of suppression of
bone marrow so that the body becomes prone to any
infection - bacterial, viral or fungal leading to
medical emergency. These organisms live in
intestine, lung or skin. Some organisms live
normally in healthy persons without causing
infection but in immune compromised persons the same
can cause infection called opportunistic infection.
Symptoms
Even fever with severe infection may not show major
symptoms and taking paracetamol may mask the real
condition. The specialist should only manage the
condition.
-neutropenia leading to reduced humoral and cell
mediated immunity
-opportunistic organisms living in gut, lung or on
the skin
-Leukemias, CLL, myeloma, Lymphomas, Hodgkin's
disease
-I.V. lines, Catheters, Central line, Prosthetic
devices
-Diabetes, steroids, chemotherapy other immune-supressent
-Infection occurring in oral cavity
-Infections in perianal area
Factors responsible for infection are
The patient should be thoroughly investigated
clinically and in the labs for any cause of fever.
The blood culture is a must if fever does not
subside within 24 hours.
Treatment
Many times the organisms could not be identified and
empirical antimicrobial/antibiotic therapy is
started. Broadspectrum antibiotics like
cephalosporin and aminoglycoside antibiotics (Ticarcillin,
Gentamicin, Vancomycin) covering all groups of
bacteria are started.
After 48 hours if fever does not come down the
patient is re-examined in detail along with lab
investigations and treatment is revised.
If after 5-7 days, still fever persists antifungal
therapy is started. Amphotericin B is the drug of
choice. FUNGISOME™ the Liposomal Amphotericin B 1-3
mg should be started as soon as possible.
Along with the antibiotics, supportive treatment
should also be started. Some bone marrow stimulating
factors like granulocyte stimulating factor is given
so that the bone marrow is stimulated to produce
more white blood cells.
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