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{{For|patient information page|Febrile neutropenia (patient information)}}
{{Siren|Febrile neutropenia}}
{| class="infobox"
| style="vertical-align: middle; padding: 5px;" align=center | [[File:Siren.gif|30px|link=Febrile neutropenia resident survival guide]]
| style="vertical-align: middle; padding: 5px;" align=center | [[Febrile neutropenia resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|}
{{Febrile neutropenia}}
{{Febrile neutropenia}}
{{CMG}}
{{Seealso|Neutropenia causes}}
{{CMG}}; {{AE}} {{Ochuko}}


{{SK}} F and N; fever and neutropenia; FN; hot and low; hot leuk; neutropenic fever; neutropenic fever syndrome; neutropenic sepsis
{{SK}} F and N; fever and neutropenia; FN; hot and low; hot leuk; neutropenic fever; neutropenic fever syndrome; neutropenic sepsis


== Overview ==
== Overview ==
[[Septicemia|Bloodstream infections]] caused by endogenous flora and reactivation of latent infections account for a majority of initial febrile episode in neutropenic patients with cancer.
[[Septicemia|Bloodstream infections]] caused by endogenous flora and reactivation of latent infections account for a majority of initial febrile episode in neutropenic patients with cancer. Bacterial isolates commonly cause bacteremia in the setting of neutropenia followed by fungi and viruses.<ref>{{Cite journal | doi = 10.1007/s00277-011-1373-2 | issn = 1432-0584 | volume = 91 | issue = 5 | pages = 767–774 | last = Pagano | first = L. | coauthors = M. Caira, G. Rossi, M. Tumbarello, R. Fanci, M. G. Garzia, N. Vianelli, N. Filardi, P. De Fabritiis, A. Beltrame, M. Musso, A. Piccin, A. Cuneo, C. Cattaneo, T. Aloisi, M. Riva, G. Rossi, U. Salvadori, M. Brugiatelli, S. Sannicolò, M. Morselli, A. Bonini, P. Viale, A. Nosari, F. Aversa, Hema e-Chart Group, Italy | title = A prospective survey of febrile events in hematological malignancies | journal = Annals of Hematology | date = 2012-05 | pmid = 22124621 }}</ref>.  Certain endogenous microorganisms may be reactivated and exit latency during immunosuppression. These include [[herpes simplex virus]], [[varicella-zoster virus]], [[Epstein-Barr virus]], [[cytomegalovirus]], [[HBV|hepatitis B]] and [[HCV|C]] viruses, and ''[[Mycobacterium tuberculosis]]''.  Exogenous pathogens carried by contaminated blood products, medical equipment and devices, water sources, and health care workers represent less common sources of infection. These include ''[[Clostridium difficile]]'', [[respiratory syncytial virus]], [[vancomycin]]-resistant [[enterococci]], and other multidrug resistant bacteria.<ref>{{Cite book | edition = 5 edition | publisher = Saunders | isbn = 9781455728657 | last = MD | first = John E. Niederhuber | coauthors = James O. Armitage MD, James H. Doroshow MD, Michael B. Kastan MD PhD, Joel E. Tepper MD | title = Abeloff's Clinical Oncology: Expert Consult Premium Edition - Enhanced Online Features and Print, 5e | location = Philadelphia, Pennsylvania | date = 2013-11-05 }}</ref>.  Fungal infections often take place in the setting of prolonged or profound neutropenia after administration of empirical therapy.  [[Candidiasis]] may range in severity from mucosal or cutaneous infection to [[septicemia]], [[endocarditis]], or disseminated infection.  [[Aspergillus]], on the contrary, typically causes life-threatening infection of the sinuses and lungs, particularly after protracted neutropenia.<ref>{{Cite journal | doi = 10.1093/cid/ciq147 | issn = 1537-6591 | volume = 52 | issue = 4 | pages = 427–431 | last = Freifeld | first = Alison G. | coauthors = Eric J. Bow, Kent A. Sepkowitz, Michael J. Boeckh, James I. Ito, Craig A. Mullen, Issam I. Raad, Kenneth V. Rolston, Jo-Anne H. Young, John R. Wingard, null Infectious Diseases Society of Americaa | title = Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America | journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America | date = 2011-02-15 | pmid = 21205990 }}</ref>
 
==Causes==
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.  Febrile neutropenia is a life threatening condition and must be treated as such irrespective of the underlying cause.
 
===Common Causes===
* [[Acinetobacter spp]]
* [[citrobacter|Citrobacter spp]]
* [[staphylococcus aureus|Coagulase-negative staphylococci]]
* [[enterobacter|Enterobacter spp]]
* [[enterococcus|Enterococcus spp, including vancomycin-resistant strains]]
* [[Escherichia coli]]
* [[klebsiella|Klebsiella spp]]
* [[Pseudomonas aeruginosa]]
* [[staphylococcus aureus|Staphylococcus aureus, including methicillin-resistant strains]]
* [[Stenotrophomonas maltophilia]]
* [[Streptococcus pneumoniae]]
* [[Streptococcus pyogenes]]
* [[streptococcus viridans|Viridans group streptococci]]


== Causes ==
===Causes by Organ System===
{| style="float: right; width: 500px; margin: 5px 10px;"
{|style="width:80%; height:100px" border="1"
! style="font-size: 85%; background: #545454; color: #F8F8FF; padding: 5px 10px;" | Table 1. Common Bacterial Pathogens in Neutropenic Patients
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Cellulitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Chemotherapy]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-
! style="font-size: 85%; background: #DCDCDC;" | Gram-Positive Pathogens
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Acinetobacter]], [[anaerobes]], [[aspergillus]], [[babesia]], [[bacillus]], [[candida]], [[capnocytophaga canimorsus]], [[cellulitis]], [[citrobacter]], [[clostridium difficile]], [[staphylococcus aureus|coagulase-negative staphylococci]], [[coccidioides spp]], [[corynebacterium|corynebacterium jeikeium]], [[cryptococcus]], [[cytomegalovirus]], [[enterobacter]], [[enterococcus]], [[enteroviruses]], [[Epstein-Barr virus]], [[escherichia coli]], [[hemophilus influenzae]], [[herpes simplex virus]], [[histoplasma capsulatum]], [[human herpesvirus 6]], [[influenza virus]], [[klebsiella ]], [[legionella]],[[listeria monocytogenes]], [[moraxella]], [[mucorales]], [[mycobacteria]], [[neisseria meningitidis]], [[nocardia]], [[parainfluenza virus]], [[plasmodium]],[[pneumocystis jirovecii]], [[pneumonia]], [[proteus]], [[pseudomonas aeruginosa]], [[respiratory syncytial virus]], [[serratia]], [[staphylococcus aureus]], [[stenotrophomonas maltophilia]], [[micrococcaceae|stomatococcus]], [[streptococcus pneumoniae]], [[streptococcus pyogenes]], [[strongyloides stercoralis]], [[toxoplasma]], [[varicella zoster virus]], [[streptococcus viridans|viridans group streptococci]]
|-
|-
| style="font-size: 85%; background: #F5F5F5;" |
|-bgcolor="LightSteelBlue"
:* Coagulase-negative staphylococci
| '''Musculoskeletal/Orthopedic'''
:* Staphylococcus aureus, including methicillin-resistant strains
|bgcolor="Beige"| No underlying causes
:* Enterococcus species, including vancomycin-resistant strains
:* Viridans group streptococci
:* Streptococcus pneumoniae
:* Streptococcus pyogenes
|-
|-
! style="font-size: 85%; background: #DCDCDC;" | Gram-Negative Pathogens
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"|[[Malignancy]]
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"|[[Pneumonia]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|-
| style="font-size: 85%; background: #F5F5F5;" |
:* Escherichia coli
:* Klebsiella species
:* Enterobacter species
:* Pseudomonas aeruginosa
:* Citrobacter species
:* Acinetobacter species
:* Stenotrophomonas maltophilia
|}
|}


{{Seealso|Neutropenia causes}}
===Causes in Alphabetical Order===
 
{{columns-list|
[[Septicemia|Bloodstream infections]] caused by endogenous flora and reactivation of latent infections account for a majority of initial febrile episode in neutropenic patients with cancer.  Common bacterial isolates that cause bacteremia in the setting of neutropenia are listed in Table 1.<ref>{{Cite journal | doi = 10.1007/s00277-011-1373-2 | issn = 1432-0584 | volume = 91 | issue = 5 | pages = 767–774 | last = Pagano | first = L. | coauthors = M. Caira, G. Rossi, M. Tumbarello, R. Fanci, M. G. Garzia, N. Vianelli, N. Filardi, P. De Fabritiis, A. Beltrame, M. Musso, A. Piccin, A. Cuneo, C. Cattaneo, T. Aloisi, M. Riva, G. Rossi, U. Salvadori, M. Brugiatelli, S. Sannicolò, M. Morselli, A. Bonini, P. Viale, A. Nosari, F. Aversa, Hema e-Chart Group, Italy | title = A prospective survey of febrile events in hematological malignancies | journal = Annals of Hematology | date = 2012-05 | pmid = 22124621 }}</ref>  Certain endogenous microorganisms may be reactivated and exit latency during immunosuppression. These include [[herpes simplex virus]], [[varicella-zoster virus]], [[Epstein-Barr virus]], [[cytomegalovirus]], [[HBV|hepatitis B]] and [[HCV|C]] viruses, and ''[[Mycobacterium tuberculosis]]''.  Exogenous pathogens carried by contaminated blood products, medical equipment and devices, water sources, and health care workers represent less common sources of infection. These include ''[[Clostridium difficile]]'', [[respiratory syncytial virus]], [[vancomycin]]-resistant [[enterococci]], and other multidrug resistant bacteria.<ref>{{Cite book | edition = 5 edition | publisher = Saunders | isbn = 9781455728657 | last = MD | first = John E. Niederhuber | coauthors = James O. Armitage MD, James H. Doroshow MD, Michael B. Kastan MD PhD, Joel E. Tepper MD | title = Abeloff's Clinical Oncology: Expert Consult Premium Edition - Enhanced Online Features and Print, 5e | location = Philadelphia, Pennsylvania | date = 2013-11-05 }}</ref>
*[[Acinetobacter]]
 
*[[Anaerobes]]
Fungal infections often take place in the setting of prolonged or profound neutropenia after administration of empirical therapy.  [[Candidiasis]] may range in severity from mucosal or cutaneous infection to [[septicemia]], [[endocarditis]], or disseminated infection.  [[Aspergillus]], on the contrary, typically causes life-threatening infection of the sinuses and lungs, particularly after protracted neutropenia.<ref>{{Cite journal | doi = 10.1093/cid/ciq147 | issn = 1537-6591 | volume = 52 | issue = 4 | pages = 427–431 | last = Freifeld | first = Alison G. | coauthors = Eric J. Bow, Kent A. Sepkowitz, Michael J. Boeckh, James I. Ito, Craig A. Mullen, Issam I. Raad, Kenneth V. Rolston, Jo-Anne H. Young, John R. Wingard, null Infectious Diseases Society of Americaa | title = Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America | journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America | date = 2011-02-15 | pmid = 21205990 }}</ref>
*[[Aspergillus]]
*[[Babesia]]
*[[Bacillus]]
*[[Candida]]
*[[Capnocytophaga canimorsus]]
*[[Cellulitis]]
*[[Chemotherapy]]
*[[Citrobacter]]
*[[Clostridium difficile]]
*[[staphylococcus aureus|Coagulase-negative staphylococci]]
*[[Coccidioides spp]]
*[[corynebacterium|Corynebacterium jeikeium]]
*[[Cryptococcus]]
*[[Cytomegalovirus]]
*[[Enterobacter]]
*[[Enterococcus]]
*[[Enteroviruses]]
*[[Epstein-Barr virus]]
*[[Escherichia coli]]
*[[Hemophilus influenzae]]
*[[Herpes simplex virus]]
*[[Histoplasma capsulatum]]
*[[Human herpesvirus 6]]
*[[Influenza virus]]
*[[Klebsiella]]
*[[Legionella]]
*[[Listeria monocytogenes]]
*[[Malignancy]]
*[[Moraxella]]
*[[Mucorales]]
*[[Mycobacteria]]
*[[Neisseria meningitidis]]
*[[Nocardia]]
*[[Parainfluenza virus]]
*[[Plasmodium]]
*[[Pneumocystis jirovecii]]
*[[Pneumonia]]
*[[Proteus]]
*[[Pseudomonas aeruginosa]]
*[[Respiratory syncytial virus]]  
*[[Serratia]]  
*[[Staphylococcus aureus]]
*[[Stenotrophomonas maltophilia]]
*[[micrococcaceae|Stomatococcus]]
*[[Streptococcus pneumoniae]]
*[[Streptococcus pyogenes]]
*[[Strongyloides stercoralis]]
*[[Toxoplasma]]  
*[[Varicella zoster virus]]
*[[streptococcus viridans|Viridans group streptococci]]
}}


== References ==
==References==
{{reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Infectious disease]]
[[Category:Crowdiagnosis]]
[[Category:Primary care]]
[[Category:Signs and symptoms]]
[[Category:Symptoms]]

Latest revision as of 21:43, 29 July 2020

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Template:Seealso Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Synonyms and keywords: F and N; fever and neutropenia; FN; hot and low; hot leuk; neutropenic fever; neutropenic fever syndrome; neutropenic sepsis

Overview

Bloodstream infections caused by endogenous flora and reactivation of latent infections account for a majority of initial febrile episode in neutropenic patients with cancer. Bacterial isolates commonly cause bacteremia in the setting of neutropenia followed by fungi and viruses.[1]. Certain endogenous microorganisms may be reactivated and exit latency during immunosuppression. These include herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, hepatitis B and C viruses, and Mycobacterium tuberculosis. Exogenous pathogens carried by contaminated blood products, medical equipment and devices, water sources, and health care workers represent less common sources of infection. These include Clostridium difficile, respiratory syncytial virus, vancomycin-resistant enterococci, and other multidrug resistant bacteria.[2]. Fungal infections often take place in the setting of prolonged or profound neutropenia after administration of empirical therapy. Candidiasis may range in severity from mucosal or cutaneous infection to septicemia, endocarditis, or disseminated infection. Aspergillus, on the contrary, typically causes life-threatening infection of the sinuses and lungs, particularly after protracted neutropenia.[3]

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Febrile neutropenia is a life threatening condition and must be treated as such irrespective of the underlying cause.

Common Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic Cellulitis
Drug Side Effect Chemotherapy
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease Acinetobacter, anaerobes, aspergillus, babesia, bacillus, candida, capnocytophaga canimorsus, cellulitis, citrobacter, clostridium difficile, coagulase-negative staphylococci, coccidioides spp, corynebacterium jeikeium, cryptococcus, cytomegalovirus, enterobacter, enterococcus, enteroviruses, Epstein-Barr virus, escherichia coli, hemophilus influenzae, herpes simplex virus, histoplasma capsulatum, human herpesvirus 6, influenza virus, klebsiella , legionella,listeria monocytogenes, moraxella, mucorales, mycobacteria, neisseria meningitidis, nocardia, parainfluenza virus, plasmodium,pneumocystis jirovecii, pneumonia, proteus, pseudomonas aeruginosa, respiratory syncytial virus, serratia, staphylococcus aureus, stenotrophomonas maltophilia, stomatococcus, streptococcus pneumoniae, streptococcus pyogenes, strongyloides stercoralis, toxoplasma, varicella zoster virus, viridans group streptococci
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Malignancy
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Pneumonia
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

References

  1. ↑ Pagano, L. (2012-05). "A prospective survey of febrile events in hematological malignancies". Annals of Hematology. 91 (5): 767–774. doi:10.1007/s00277-011-1373-2. ISSN 1432-0584. PMID 22124621. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)
  2. ↑ MD, John E. Niederhuber (2013-11-05). Abeloff's Clinical Oncology: Expert Consult Premium Edition - Enhanced Online Features and Print, 5e (5 edition ed.). Philadelphia, Pennsylvania: Saunders. ISBN 9781455728657. Unknown parameter |coauthors= ignored (help)
  3. ↑ Freifeld, Alison G. (2011-02-15). "Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (4): 427–431. doi:10.1093/cid/ciq147. ISSN 1537-6591. PMID 21205990. Unknown parameter |coauthors= ignored (help)

Template:WH Template:WS

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