小结
定义
病史和体格检查
关键诊断因素
- 近期化疗
- 发热
其他诊断因素
- 年龄>65 岁
- 免疫抑制疗法
- 化疗所致中性粒细胞减少既往史
- 体能状态不佳（东部肿瘤协作组织体能状态评分 [ECOG PS] >1 分）
- 血液系统恶性肿瘤
- 晚期疾病
- 既往抗生素治疗方案
- 低白蛋白（<35 g/L [<3.5 g/dL]）
- 胆红素和肝酶（天冬氨酸氨基转移酶和碱性磷酸酶）升高
- 已有器官功能障碍和共存疾病
- 第一轮化疗后中性粒细胞绝对计数的最低值较低（＜500 cells/μl）
- 肺炎征象（咳嗽、异常呼吸音、呼吸急促）
- 腹痛
- 恶心或呕吐
- 腹泻
- 皮肤红斑、温热、压痛
- 黏膜炎或口腔溃疡
- 生殖器和肛门区域的感染、炎症或溃疡
- 留置导管感染
- 脓尿
- 放化疗
- 近期病史特征和暴露
- 鼻窦压痛
危险因素
- 年龄>65 岁
- 血液系统恶性肿瘤
- 低白蛋白（<35 g/L [<3.5 g/dL]）
- 胆红素升高
- 肝酶升高
- 已有器官功能障碍和共存疾病
- 近期化疗
- 第一轮化疗后中性粒细胞绝对计数的最低值较低（＜500 cells/μl）
- 放化疗
- 化疗所致中性粒细胞减少既往史
- 女性
- 体能状态不佳（东部肿瘤协作组织体能状态评分 [ECOG PS] >1 分）
- 晚期疾病
- 免疫抑制疗法
诊断性检查
首要检查
- 全血细胞计数和分类计数
- 尿液分析和肾功能检查（尿素和肌酐）
- 肝功能检查 (LFTs)
- 血培养
- 胸部 X 线检查
需考虑的检查
- 胃肠道病原体分子检测
- 尿液培养
- 腰椎穿刺术：
- 真菌培养和血清学检测（β-葡聚糖和半乳甘露聚糖）
- 病毒分子检测
- 超声心动图
- 胸部、腹部和盆腔 CT 检查
治疗流程
并发症或死亡高风险：发病早期
合并症或死亡低风险：初始表现
治疗 3-5 日后仍发热
撰稿人
作者
Lynne Strasfeld, MD
Associate Professor of Medicine
Department of Medicine, Division of Infectious Diseases
Oregon Health and Science University
Portland
OR
利益声明
LS declares that she has no competing interests.
鸣谢
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.
利益声明
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.
同行评议者
Alison Freifeld, MD
Professor of Medicine, Infectious Diseases Division
University of Nebraska College of Medicine
Omaha
NE
利益声明
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
利益声明
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
利益声明
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.
鉴别诊断
- 药物性发热
- 肿瘤性发热
- 血栓栓塞
更多 鉴别诊断指南
- 肿瘤临床实践指南：肿瘤相关感染的预防和治疗
- 肿瘤临床实践指南：造血生长因子
更多 指南
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