Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- recent chemotherapy
- fever
Outros fatores diagnósticos
- age >65 years
- immunosuppressive therapy
- prior chemotherapy-induced neutropenia
- low performance status (Eastern Cooperative Oncology Group performance status [ECOG PS] >1)
- hematologic malignancies
- advanced-stage disease
- prior antibiotic regimens
- low albumin (<3.5 g/dL)
- elevated bilirubin and liver enzymes (aspartate aminotransferase and alkaline phosphatase)
- pre-existing organ dysfunction and comorbid conditions
- low first-cycle nadir absolute neutrophil count (<500 cells/microliter)
- signs of pneumonia (cough, abnormal breath sounds, shortness of breath)
- abdominal pain
- nausea or vomiting
- diarrhea
- skin erythema, warmth, tenderness
- mucositis or oral ulcers
- infection, inflammation, or ulceration of genital and anal area
- infected indwelling catheters
- pyuria
- chemoradiation therapy
- recent historical features and exposures
- sinus tenderness
Fatores de risco
- age >65 years
- hematologic malignancies
- low albumin (<3.5 g/dL)
- elevated bilirubin
- elevated liver enzymes
- pre-existing organ dysfunction and comorbid conditions
- recent chemotherapy
- low first-cycle nadir absolute neutrophil count (<500 cells/microliter)
- chemoradiation therapy
- prior chemotherapy-induced neutropenia
- female sex
- low performance status (Eastern Cooperative Oncology Group performance status [ECOG PS] >1)
- advanced-stage disease
- immunosuppressive therapy
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- CBC and differential
- urinalysis and renal function tests (BUN and creatinine)
- liver function tests (LFTs)
- blood cultures
- chest x-ray
Investigações a serem consideradas
- gastrointestinal pathogen molecular assay
- urine culture
- lumbar puncture
- fungal cultures and serologies (beta-glucan and galactomannan)
- viral molecular assay
- echocardiogram
- CT scans of the chest, abdomen, and pelvis
Algoritmo de tratamento
high risk of complication or death: initial presentation
low risk of complication or death: initial presentation
persistent fever beyond 3-5 days of treatment
Colaboradores
Autores
Lynne Strasfeld, MD
Professor of Medicine
Department of Medicine, Division of Infectious Diseases
Oregon Health and Science University
Portland
OR
Declarações
LS declares that she has no competing interests.
Agradecimentos
Dr Lynne Strasfeld would like to gratefully acknowledge Dr Kenneth V. I. Rolston, Dr Lior Nesher, Dr Caron Jacobson, and Dr Joseph Antin, previous contributors to this topic.
Declarações
KVIR has research grants from Merck, Shionogi, and JMI Laboratories for the performance of in vitro studies of novel antimicrobial agents. LN has given two educational lectures sponsored by MSD. CJ and JA declare that they have no competing interests.
Revisores
Alison Freifeld, MD
Professor of Medicine, Infectious Diseases Division
University of Nebraska College of Medicine
Omaha
NE
Declarações
AF has received payment by Merck for work as an adjudication committee member for clinical trials of letermovir. AF has received an investigator-initiated study grant from Merck.
John Wingard, MD
Price Eminent Scholar and Professor of Medicine
Director
Bone Marrow Transplant Program
Division of Hematology/Oncology
University of Florida College of Medicine
Gainesville
FL
Declarações
JW has been reimbursed by Pfizer, Merck, Astellas, and Enzon for speaking fees, fees for educational programs, and consulting.
Matthew Falagas, MD, MSc, DSc
Director
Alfa Institute of Biomedical Sciences
Marousi
Athens
Greece
Declarações
MF declares that he has no competing interests.
Ruth Pettengell, MBChB FRACP PhD
Senior Lecturer in Haematology
Honorary Consultant in Medical Oncology
St George's University of London
London
UK
利益声明
RP has received speaker fees and been reimbursed by Roche, Amgen, Chigai, and Bayer for attending several conferences. RP is a co-author of the EORTC guidelines referenced in this topic.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011 Feb 15;52(4):e56-93.全文 摘要
Smith TJ, Bohlke K, Lyman GH, et al. Recommendations for the use of WBC growth factors: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2015 Oct 1;33(28):3199-212. 摘要
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: prevention and treatment of cancer-related infections [internet publication].全文
Taplitz RA, Kennedy EB, Bow EJ, et al. Outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America clinical practice guideline update. J Clin Oncol. 2018 Feb 20;36(14):1443-53.全文 摘要
Klastersky J, de Naurois J, Rolston K, et al. Management of febrile neutropaenia: ESMO Clinical Practice Guidelines. Ann Oncol. 2016 Sep;27(5 suppl):v111-8.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Drug fever
- Tumor fever
- Thromboembolism
更多 鉴别诊断指南
- Prevention and treatment of cancer-related infections
- Hematopoietic growth factors
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