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Febrile Neutropenia

 
 


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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