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Generally, patients with febrile neutropenia are treated with empirical antibiotics until the neutrophil count has recovered (absolute neutrophil counts greater than 500/mm 3) and the fever has abated; if the neutrophil count does not improve, treatment may need to continue for two weeks or occasionally more. In cases of recurrent or persistent ...
In both cases, the treatment is considered investigational. [7] [8] Granulocyte transfusion is still used in some cases, such as in cases of severe neutropenia and where the patient has a life-threatening infection that does not respond to antimicrobial treatment. [2]
Neutropenia generally develops in the second week. During this period, many clinicians recommend pegfilgrastim or prophylactic use of ciprofloxacin . [1] If a fever develops in the neutropenic period, urgent medical assessment is required for neutropenic sepsis , as infections in patients with low neutrophil counts may progress rapidly.
[38] [39] Conditions that indicate the presence of neutropenic fever are implanted devices; leukemia induction; the compromise of mucosal, mucociliary and cutaneous barriers; a rapid decline in absolute neutrophil count, duration of neutropenia >7–10 days, and other illnesses that exist in the patient. [31] Signs of infection can be subtle.
Neutropenic enterocolitis, also known as typhlitis, is an inflammation of the cecum (part of the large intestine) that may be associated with infection. [1] It is particularly associated with neutropenia , a low level of neutrophil granulocytes (the most common form of white blood cells ) in the blood.
Any patient presenting with signs or symptoms of bacteremia or a positive blood culture should be started on intravenous antibiotics. [23] The choice of antibiotic is determined by the most likely source of infection and by the characteristic organisms that typically cause that infection.
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Fever of unknown origin (FUO) refers to a condition in which the patient has an elevated temperature for which no cause can be found despite investigations by one or more qualified physicians. [ 1 ] [ 2 ] [ 3 ] If the cause is found, it is usually a diagnosis of exclusion , eliminating all possibilities until only the correct explanation remains.