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Neutropenia Fever

Jaime S Rosa Duque, Kelvin K W To, Alan K S Chiang, Godfrey C F Chan, Rosana W S Poon, Kwok-Yung Yuen, Shau-Yin Ha, Daniel K L Cheuk
We report the first case of microabscesses detected by polymerase chain reaction (PCR) amplification of nucleic acid from ultrasound-guided aspirated fluid in a three-year old boy with acute lymphoblastic leukemia and febrile neutropenia during induction chemotherapy. Fever persisted despite effective antifungal treatment. The addition of corticosteroid therapy successfully controlled the suspected immune reconstitution inflammatory syndrome (IRIS). This case highlights the utility of PCR and adjunctive corticosteroid in the approach of Candida tropicalis renal microabscesses in leukemic patients undergoing chemotherapy...
February 14, 2019: International Journal of Infectious Diseases: IJID
Hiroki Uda, Yukio Suga, Eriko Toriba, Angelina Yukiko Staub, Tsutomu Shimada, Yoshimichi Sai, Masami Kawahara, Ryo Matsusita
Background: Medical staff should promptly administer antimicrobials to patients with febrile neutropenia (FN) to decrease the mortality related to cancer chemotherapy. Corticosteroids, which are used in cancer chemotherapy, have a fever-suppressive effect. This effect could lead to a blunt fever response and any local signs of infection, especially in patients receiving multiday corticosteroid administration. The aim of this study was to determine whether multiday corticosteroid administration in cancer chemotherapy delays the diagnosis of and antimicrobial treatment for FN...
2019: Journal of Pharmaceutical Health Care and Sciences
Yair Herishanu, Tamar Tadmor, Andrei Braester, Osnat Bairey, Ariel Aviv, Naomi Rahimi-Levene, Riva Fineman, Itai Levi, Mona Yuklea, Rosa Ruchlemer, Lev Shvidel, Aaron Polliack
Chronic lymphocytic leukemia (CLL) is a disease of elderly patients. The fludarabine, cyclophosphamide and rituximab (FCR) regimen is considered the treatment of choice for young fit patients with CLL, however, this combination is toxic for older patients. At the time this study was first planned and initiated, there was no standard chemo-immunotherapy regimen regarded as standard therapy for the less fit elderly patient with CLL. Here we conducted a single arm, phase II trial to examine the efficacy and safety of lower-dose fludarabine and cyclophosphamide combined with a standard dose of rituximab (LD-FCR) in elderly patients with previously untreated CLL...
February 12, 2019: Hematological Oncology
Saba Sheikhbahaei, Alireza Mohammadi, Roya Sherkat, Alireza Emami Naeini, Majid Yaran, Somaye Najafi
BACKGROUND: Patients with hematological malignancies undergoing cytotoxic chemotherapy are susceptible to develop invasive fungal infections particularly Aspergillus and Candida spp.. Early detection of these infections is required to start immediate antifungal therapy and increase survival of these patients. METHOD: Our study included consecutive patients of any age with hematologic malignancies who were hospitalized to receive chemotherapy and suffer from persistent fever (rectal temperature >38...
February 11, 2019: Endocrine, Metabolic & Immune Disorders Drug Targets
Martin Schmidt-Hieber, Daniel Teschner, Georg Maschmeyer, Enrico Schalk
Infections are among the most frequent complications in patients with hematological and oncological diseases. They might be classified as fever of unknown origin, and microbiologically or clinically documented infections. Optimal duration of antimicrobial treatment is still unclear in these patients. Areas covered: We provide an overview on the management of febrile neutropenia in the perspective of antimicrobial de-escalation and discontinuation. Expert opinion: Patients with febrile high-risk neutropenia should be treated empirically with an anti-pseudomonal agent such as piperacillin/tazobactam...
January 28, 2019: Expert Review of Anti-infective Therapy
Dona S Raju, Aadharsa Sugunan, Pavithran Keechilattu, Arun Philip, Remya Reghu
Trichosporon asahii is a rare opportunistic fungal pathogen that causes fatal systemic infection in immunocompromised patients. Neutropenia developing due to malignancies is an important risk factor for fungal infection. Invasive infections due to T. asahii can be divided into disseminated and localized forms. The disseminated form is more common and usually occurs in neutropenic patients. The patient typically has an acute febrile illness that progresses rapidly to multiorgan failure. Here, we are presenting a case of fungal sepsis by invasive T...
January 22, 2019: Journal of Pediatric Hematology/oncology
Olivier Ballo, Ikram Tarazzit, Jan Stratmann, Claudia Reinheimer, Michael Hogardt, Thomas A Wichelhaus, Volkhard Kempf, Hubert Serve, Fabian Finkelmeier, Christian Brandts
INTRODUCTION: The global spread of multidrug-resistant organisms (MDRO) complicates treatment and isolation measures in hospitals and has shown to increase mortality. Patients with disease- or therapy-related immunodeficiency are especially at risk for fatal infections caused by MDRO. The impact of MDRO colonization on the clinical course of AML patients undergoing intensive induction chemotherapy-a potentially curative but highly toxic treatment option-has not been systematically studied...
2019: PloS One
Lisa T VanHouwelingen, Laura V Veras, Martin Lu, Lynn Wynn, John Wu, Hasmukh J Prajapati, Robert E Gold, Andrew J Murphy, Israel Fernandez-Pineda, Ankush Gosain, Ching-Hon Pui, Andrew M Davidoff
BACKGROUND: The risk of infection associated with subcutaneous port (SQP) placement in patients with neutropenia remains unclear. We reviewed the rate of early infectious complications (<30 days) following SQP placement in pediatric oncology patients with or without neutropenia [absolute neutrophil count (ANC) <500/mm3 ]. METHODS: Baseline characteristics and infectious complications were compared between groups using univariate and multivariate analyses...
January 2019: Journal of Pediatric Surgery
R Garcia-Sanz, A Sureda, F de la Cruz, M Canales, A P Gonzalez, J L Piñana, A Rodriguez, A Gutiérrez, E Domingo-Domenech, B Sánchez-González, G Rodriguez, J Lopez, M Moreno, M J Rodríguez-Salazar, S Jimenez-Cabrera, M D Caballero, C Martinez
Purpose: In this work, we assessed the efficacy and safety of Brentuximab Vedotin (BV) plus ESHAP [BRESHAP] as second-line therapy for Relapsed/Refractory Hodgkin lymphoma RRHL to improve the results before autologous stem cell transplantation (ASCT). Patients and Methods: This was a multicenter, open-label, phase I-II trial of patients with RRHL after first-line chemotherapy. Treatment had three 21-day cycles of etoposide, solumedrol, high-dose AraC, and cisplatin...
January 18, 2019: Annals of Oncology: Official Journal of the European Society for Medical Oncology
Maxime G Zermatten, Christa Koenig, Annina von Allmen, Philipp Agyeman, Roland A Ammann
Fever in neutropenia (FN) is the most frequent potentially life threatening complication of chemotherapy for cancer. Prediction of the risk to develop complications, integrated into clinical decision rules, would allow for risk-stratified treatment of FN. This retrospective, single center cohort study in pediatric patients diagnosed with cancer before 17 years, covered two decades, 1993 to 2012. In total, 703 FN episodes in 291 patients with chemotherapy (maximum per patient, 9) were reported here. Twenty-nine characteristics of FN were collected: 6 were patient- and cancer-related, 8 were characteristics of history, 8 of clinical examination, and 7 laboratory results in peripheral blood, all known at FN diagnosis...
January 15, 2019: Scientific Data
Andrea J Zimmer, Alison G Freifeld
Febrile neutropenia remains an important complication of treatment with cytotoxic chemotherapy. It is often the first and sometimes the only sign or symptom of infection in this vulnerable patient population. Urgent and appropriate evaluation and treatment are imperative because delay in initiating appropriate antibiotic therapy may be life threatening. Selection of antibiotics should be based on the patient's symptoms, previous culture data, and institutional antibiograms. Ongoing therapy should be guided by culture and clinical data...
January 2019: Journal of Oncology Practice
Anat Stern, Elena Carrara, Roni Bitterman, Dafna Yahav, Leonard Leibovici, Mical Paul
BACKGROUND: People with cancer with febrile neutropenia are at risk of severe infections and mortality and are thus treated empirically with broad-spectrum antibiotic therapy. However, the recommended duration of antibiotic therapy differs across guidelines. OBJECTIVES: To assess the safety of protocol-guided discontinuation of antibiotics regardless of neutrophil count, compared to continuation of antibiotics until neutropenia resolution in people with cancer with fever and neutropenia, in terms of mortality and morbidity...
January 3, 2019: Cochrane Database of Systematic Reviews
J A A S Jayaweera, W P H Abeydeera, G R Ranasinghe
BACKGROUND: Bacteremia following Staphylococcus aureus is a serious clinical condition which is often associated with distant metastatic infections. One of the most dreaded complications of Staphylococcus aureus bacteremia is infective endocarditis. Cloxacillin is a common antibiotic prescribed for suspected staphylococcal infections and confirmed methicillin-sensitive Staphylococcus aureus infections. Prolonged use of cloxacillin may lead to neutropenia. CASE PRESENTATION: A 38-year-old Sinhalese man presented to Teaching Hospital Kurunegala, Sri Lanka, complaining of a 3-week history of fever; he was found to have a pansystolic murmur over the apex of his heart...
December 29, 2018: Journal of Medical Case Reports
Akanksha Garg, Anshul Gupta, Ashish Mishra, Manoj Singh, Sanjeev Yadav, Soniya Nityanand
Bacterial and fungal infections still remain an important cause of mortality in patients with hematological malignancies and in recipients of hematopoietic stem cell transplants (HSCT) especially in developing countries like India. Granulocyte transfusions (GTX) from healthy donors may lead to early clearance of index infection and thus prevent mortality. The aim of the present study was to evaluate the efficacy of GTX in combating life-threatening infections and preventing mortality in patients of hematological disorders/recipients of HSCT with severe neutropenia...
2018: PloS One
Khadijat O Isezuo, Usman M Sani, Usman M Waziri, Bilkisu I Garba, Yahaya Mohammed, Joy F Legbo, Nazish P Aquil, Fatima I Abubakar, Memuna Omar
Introduction: Ecthyma gangrenosum (EG) is a cutaneous lesion commonly caused by Pseudomonas aeruginosa that involves mainly the lower limbs and gluteal region, seen more in immunosuppressed patients with neutropenia. Cancrum oris (Noma) is a gangrenous necrosis of the face that begins as a gingival ulcer and progresses rapidly to destroy contiguous tissues in malnourished children. Case Presentation: This article reports a case of facial EG which was similar to Noma in a malnourished child: a 16-month old girl with fever, cough, weight loss, watery stool and swelling on right cheek...
2018: African Journal of Laboratory Medicine
Justyna Roszkiewicz, Krzysztof Orczyk, Elżbieta Smolewska
Objectives: The aim of the study was to evaluate the efficacy and long-term safety of tocilizumab treatment in children with systemic-onset juvenile idiopathic arthritis in a single centre. Material and methods: The study was based on a retrospective analysis of a cohort of 10 patients with systemic-onset juvenile idiopathic arthritis who were treated with tocilizumab in the period September 2011-July 2017. Their medical records were analysed taking into consideration the effectiveness of tocilizumab treatment and frequency of side effects...
2018: Reumatologia
Kieron Dunleavy, Michelle A Fanale, Jeremy S Abramson, Ariela Noy, Paolo Fabrizio Caimi, Stefania Pittaluga, Samir Parekh, Ann Lacasce, John W Hayslip, Deepa Jagadeesh, Sunil Nagpal, Mary Jo Lechowicz, Rakesh Gaur, Andrea Lucas, Christopher Melani, Mark Roschewski, Seth M Steinberg, Elaine S Jaffe, Brad Kahl, Jonathan W Friedberg, Richard F Little, Nancy L Bartlett, Wyndham H Wilson
BACKGROUND: MYC gene rearrangement is present in approximately 10% of aggressive B-cell lymphomas, with half also harbouring a BCL2 gene rearrangement. Multiple retrospective studies of R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone or prednisolone) have shown a worse outcome in patients with MYC rearrangement (alone or with rearrangement of BCL2 or BCL6, or both) than in patients without MYC rearrangement, and suggest improved outcomes after more intensive treatment...
December 2018: Lancet Haematology
Oguz Resat Sipahi, Hasip Kahraman, Huseyin Aytac Erdem, Funda Yetkin, Selcuk Kaya, Tuna Demirdal, Ozlem Guzel Tunccan, Omer Karasahin, Ebru Oruc, Yasemin Cag, Behice Kurtaran, Mehmet Ulug, Murat Kutlu, Meltem Avci, Nefise Oztoprak, Bilgin Arda, Husnu Pullukcu, Meltem Tasbakan, Tansu Yamazhan, Ozlem Kandemir, Murat Dizbay, Hilal Sipahi, Sercan Ulusoy
PURPOSE: In this multicentre, retrospective, matched cohort study we aimed to evaluate the outcomes of neutropenic fever cases that were treated with daptomycin or a glycopeptide (vancomycin or teicoplanin). METHODS: Data and outcomes of adult (aged > 18-years old) patients with neutropenic fever [(1) without clinical and radiological evidence of pneumonia, (2) who were treated with daptomycin or a glycopeptide (teicoplanin or vancomycin) for any reason and for at least 72 h] were extracted from the hospital databases...
November 29, 2018: Infection
Clare Warnock, Peter Totterdell, Angela Mary Tod, Rachel Mead, Jamie-Lee Gynn, Barry Hancock
PURPOSE: The primary aim of this study was to examine the value of temperature as a diagnostic and prognostic indicator of infection and sepsis in neutropenic patients. A secondary aim was to gain insight into the presenting symptoms reported by these patients at home or on their initial admission assessment. METHODS: A cohort study was carried out using a case note review of 220 emergency admissions to a regional cancer centre. All participants were neutropenic and were diagnosed with infection on admission...
December 2018: European Journal of Oncology Nursing: the Official Journal of European Oncology Nursing Society
Thomas Lehrnbecher
PURPOSE OF REVIEW: Fever during neutropenia is a common occurrence in children with cancer. A number of studies have recently been performed to refine algorithms regarding initiation, modification, and termination of antimicrobial treatment and are the basis for international pediatric-specific guidelines for the treatment of fever and neutropenia in children with cancer. RECENT FINDINGS: Although hospitalization and prompt initiation of intravenous broad-spectrum antibiotics remains the mainstay in the treatment of febrile neutropenic children with cancer, recent research has addressed a number of questions to optimize the management of these patients...
February 2019: Current Opinion in Pediatrics
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