A young man (in his 30s) from South Asia presented with progressively worsening headache over 4 weeks. This was associated with low-grade fever over a week, followed by diplopia (double vision) over the past 4 days. He had previously been well, with no medical co-morbidities. There was no significant contact history. He had received some […]
In the previous post, we discussed the situation where the fever has resolved. How long should antibiotics be continued? If the cultures are negative, antibiotics can be stopped immediately with neutrophil recovery (the situation where neutropenia remains persistent is controversial and was also discussed previously). There is a tendency locally to continue intravenous antibiotics for […]
Back to the febrile neutropenia management series. Two questions frequently arise during the course of management, particularly with regards to febrile neutropenia (FN) in patients with haematological malignancies where the duration of neutropenia may be very long: In the presence of neutropenia, can there be “de-escalation” of antibiotic therapy if a sensitive bacterium is cultured […]
Almost two weeks ago, Channel News Asia reported that terrapins may harbour non-typhoidal Salmonella bacteria. Non-typhoidal Salmonella, as the term suggests, are Salmonella species other than the exclusively human-adapted Salmonella spp. that cause enteric (i.e. typhoid and paratyphoid) fever. The former tend to cause gastroenteritis for the large part, although they may also cause severe infections in immunocompromised persons, including […]
Happy Chinese New Year of the Fire Monkey! I am privileged to have a second contribution by another fellow (non-infectious diseases) colleague. Although I suppose in some ways a respiratory specialist is close… A middle-aged non-smoking local woman had cough associated with whitish sputum for 2 months. No significant contact or travel history. No other […]
A contribution by a fellow (non-infectious diseases) colleague, with an offer of a small prize for one local (i.e. Singapore) medical student who provides the correct answer. Question: What is the clinical sign demonstrated in the photo and what are possible underlying causes? [Updated 11th February 2016] The patient in question had chemotherapy resulting in […]
The Singapore Chess Federation (SCF) held an extraordinary general meeting (EOGM) two nights ago at the Bishan Community Club. The event even made it into the mainstream newspaper. As can be seen from today’s news, the incumbents survived the leadership challenge, although the picture painted from the news report did not accurately reflect events on the […]
We move on from outpatient management of febrile neutropenia – which is backed by good science and is conceptually attractive but not straightforward to implement – to inpatient management of “high risk” (by MASCC or other criteria) febrile neutropenia, specifically in the area of antibiotic therapy. Here, there are a bewildering number of options (basically, […]
After the rates of Pseudomonas aeruginosa infections fell in patients with febrile neutropenia, it became tacit knowledge to many oncologists (and haematologists) that the majority of patients with febrile neutropenia – especially those with solid organ cancers – recovered uneventfully. How could this knowledge be codified into a predictive model that could reliably separate out patients at […]
MIPHIDIC 