Febrile neutropenia is the development of fever, often with other signs of infection, in a patient with neutropenia, an abnormally low number of neutrophil granulocytes (a type of white blood cell) in the blood. Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris An infection is the detrimental Colonization of a host Organism by a foreign Species. Neutropenia (adjective neutropenic) from Latin Prefix neutro- and Greek Suffix -πενία (deficiency is Neutrophil granulocytes, generally referred to as neutrophils, are the most abundant type of White blood cells in humans and form an essential part of the The term neutropenic sepsis is also applied, although it tends to be reserved for patients who are more unwell. Fever is actually caused by infection in 50% of cases, and bacteremia (bacteria in the bloodstream) may be present in as many as 20% of all patients with an absolute neutrophil count under 1. Bacteremia ( Bacteræmia in British English is the presence of bacteria in the Blood. 0. [1]
Febrile neutropenia can develop in any form of neutropenia, but is most generally recognized as a complication of chemotherapy when this is myelosuppressive (suppresses the bone marrow from producing blood cells). Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. Bone marrow suppression or myelotoxicity (adjective myelotoxic) is a serious side-effect of Chemotherapy and certain drugs affecting the immune system Bone marrow is the flexible tissue found in the hollow interior of Bones In adults marrow in large bones produces new Blood cells It constitutes 4% of Generally, patients with febrile neutropenia are treated with empirical antibiotics until the neutrophil count has recovered and the fever has abated; if the neutrophil count does not improve, treatment may need to continue for two weeks or occasionally more. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa Guidelines issued in 2002 by the Infectious Diseases Society of America recommend the use of particular combinations of antibiotics in specific settings; mild low-risk cases may be treated with a combination of oral co-amoxiclav and ciprofloxacin, while more severe cases require cefalosporins with activity against Pseudomonas aeruginosa (e. The Infectious Diseases Society of America (IDSA is a medical association representing physicians scientists and other health care professionals who specialize in Infectious diseases Co-amoxiclav is the British Approved Name, in the British Pharmacopoeia, for the combination antibiotic containing amoxicillin trihydrate a β-lactam The cephalosporins (ˌsɛfələˈspɔrən/ /ˌkɛfə- are a class of β-lactam antibiotics. Pseudomonas aeruginosa is a Gram-negative, aerobic, rod-shaped Bacterium with unipolar motility. g. ceftazidime), or carbapenems (imipenem or meropenem). Ceftazidime ( INN) (sɛfˈtæzɨdiːm/ /kɛf- is a third-generation Cephalosporin Antibiotic. Carbapenems are a class of Beta-lactam antibiotics with a broad spectrum of antibacterial activity and have a structure which renders them highly resistant to Beta-lactamases Imipenem is an Intravenous &beta-lactam Antibiotic developed in 1985 Meropenem is an ultra-broad spectrum injectable Antibiotic used to treat a wide variety of infections including Meningitis and Pneumonia. [1] A subsequent meta-analysis published in 2006 found that cefepime was associated with more negative outcomes, and that carbapenems (while causing a higher rate of pseudomembranous colitis were the most straightforward in use. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses Cefepime ( INN) (ˈsɛfəpiːm/ /ˈkɛfəpiːm is a fourth-generation Cephalosporin Antibiotic developed in 1994. Clostridium difficile Pseudomembranous colitis is an infection of the colon often but not always caused by the Bacterium Clostridium difficile [2]
The Multinational Association for Supportive Care in Cancer (MASCC) Risk Index can be used to identify low-risk patients (score ≥21 points) for serious complications of febrile neutropenia (including death, intensive care unit admission, confusion, cardiac complications, respiratory failure, renal failure, hypotension, bleeding, and other serious medical complications). An intensive care unit (ICU critical care unit (CCU intensive therapy unit or intensive treatment unit (ITU is a specialized department used in Respiratory failure is a medical term for inadequate Gas exchange by the Respiratory system. Renal failure or kidney In Physiology and Medicine, hypotension refers to an abnormally low Blood pressure. Bleeding, technically known as hemorrhaging / haemorrhaging (see American and British spelling differences) is the loss of Blood from [3] The score was developed to select patients for therapeutic strategies that could potentially be more convenient or cost-effective. Prospective studies evaluating the use of the MASCC score to identify patients that can be managed with early oral antibiotics or out-of-hospital are ongoing.
References
- ^ a b Hughes WT, Armstrong D, Bodey GP, et al (2002). "2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer". Clin. Infect. Dis. 34 (6): 730–51. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 11850858.
- ^ Paul M, Yahav D, Fraser A, Leibovici L (2006). "Empirical antibiotic monotherapy for febrile neutropenia: systematic review and meta-analysis of randomized controlled trials". J. Antimicrob. Chemother. 57 (2): 176–89. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16344285.
- ^ Klastersky J, Paesmans M, Rubenstein EB, et al (2000). "The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients.". J Clin Oncol. 18 (16): 3038–51. PMID 10944139.
External links
- Febrile neutropenia entry in the public domain NCI Dictionary of Cancer Terms
- Online Febrile Neutropenia MASCC Calculator
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