Summary
Definition
History and exam
Key diagnostic factors
- fever
Other diagnostic factors
- tachycardia
- tachypnea
- hypotension
- poor capillary refill
- acute mental confusion
- decreased urine output
- low oxygen saturation
- rash
- hepatosplenomegaly
- hypothermia
Risk factors
- use of central venous catheter
- exposure to broad-spectrum antibiotics
- hemodialysis
- surgery
- parenteral nutrition
- immunosuppressants (e.g., chemotherapy, systemic corticosteroids, biologic and other immunosuppressants)
- colonization at multiple sites
- intravenous drug use
Diagnostic tests
1st tests to order
- blood culture
- CBC
- ABG
- lactate levels
- coagulation studies
- renal function tests
- liver function test
- serum glucose
Tests to consider
- 1,3-beta-D-glucan
- T2 magnetic resonance assay
- tissue biopsy
Emerging tests
- polymerase chain reaction
- matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry
Treatment algorithm
suspected diagnosis
confirmed diagnosis: non-neutropenic patients (no complications)
confirmed diagnosis: neutropenic patients (no complications)
confirmed diagnosis: with complications
Contributors
Authors
Brenda L. Tesini, MD
Assistant Professor
Infectious Diseases
Departments of Medicine and Pediatrics
University of Rochester Medical Center
Rochester
NY
Disclosures
BLT has received honoraria from Merck for educational contributions unrelated to this topic.
Acknowledgements
Dr Brenda L. Tesini would like to gratefully acknowledge Dr Jack D. Sobel and Dr Sanjay G. Revankar, previous contributors to this topic.
Disclosures
JDS declares that he has no competing interests. SR has received grants for research from Astellas, Gilead, and Merck, and has been involved in clinical trials for Cidara and Astellas.
Peer reviewers
John Fisher, MD
Professor of Medicine
Department of Medicine
Medical College of Georgia
Augusta
GA
Disclosures
JF is an author of a number of references cited in this topic. JF is a member of the speaker's bureau for the following companies: Pfizer, Merck, and Astellas.
Jean-Michel Livrozet, MD
Praticien hospitalier
Service de medecine de la Transplantation et d'Immunologie clinique
Hopital Edouard Herriot
Lyon
France
Disclosures
JML has been invited by Astellas, the manufacturer of micafungin, to attend a symposium, and invited by Gilead Sciences, manufacturer of liposomal amphotericin B, to attend different HIV conferences, and has been paid by Gilead Sciences for running HIV educational programs.
Matthew Falagas, MD, MSc, DSc
Director
Alfa Institute of Biomedical Sciences
Marousi
Athens
Greece
Disclosures
MF declares that he has no competing interests.
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