Finally attempting to complete this series after a long hiatus. Fungal infections are common in patients with prolonged neutropenia (and therefore predominantly in patients with malignant haematological conditions or after allogeneic stem cell transplantation), and were present in a significant propotion of patients with acute leukaemia in various historical autopsy series. These infections are conventionally divided into yeast […]

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 […]

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 […]

Chemotherapy-induced febrile neutropenia is a life-threatening condition that remains common during the therapy of haematological malignancies, but has become far rarer for patients with solid tumours because of the increased use of targeted therapy. It is traditionally defined as a single oral temperature of 38.3ºC or a temperature of greater than 38.0ºC sustained for more […]

A young woman was recently diagnosed with Stage II breast cancer. Post-resection, she was started on adjuvant 3-weekly docetaxol, doxorubicin and cyclophosphamide. Ten days after the second cycle, she developed fever and headache, with temperature of up to 38.5 degrees Celsius. She had nausea, but no vomiting or diarrhoea. There was no contact or other significant history of […]