Neutropenic Fever



Neutropenic fever

Pyrexia >38° C for over one hour duration or >38.3°C on one occasion in a neutropenic adult:.

  • If likely to have protracted (> 5 days) neutropenia, patient should be nursed in a room with HEPA filtered air (Ward 2D in CUH)

Neutropenia

  • Defined as neutrophils ≤1
  • Functional neutrophilia - following recent chemotherapy even with levels >1
  • Myelodysplastic patients have functional neutropenia even with "normal" neutrophil levels
  • In general, patients attending haematology OPD monthly, are at risk of neutropenia

Background

  • Bacteraemia in 30%  (60% of which is Gram Positive - Staphylococcus from lines or Strep in mucositis)
  • Most dangerous are Gram negative from patients bowel
  • Fungal infections are uncommon and associated with prolonged neutropenia and broad spectrum antibiotics
  • Netilmicin no longer available
  • 3rd generation cephalosporin use is associated with C difficile and Vancomycin resistant enterococci

Examination

Full clinical examination but note particularly: Pulse, BP, mouth, chest, perineum, line sites, skin, fundi.

Investigations

  • FBC, U&E Cr., LFT, CRP, CXR, sinus or dental x rays if symptomatic
  • Blood culture - peripheral and central line if present
  • Swabs from appropriate inflamed sites
  • MSU if symptomatic
  • Faeces if diarrhoea and/or if fungal infection suspected, check C. difficile toxin
  • Aspergillus precipitans and PCR
  • Serology, mouthwash, vesicle fluid for virology if indicated

Management

Please see https://nchd.ie




Content by Dr Íomhar O' Sullivan 06/09/2004. Last reviewed Ms. Mala Shah,Dr ÍOS 10/06/21.