Overview: Neutropenic fever also know as febrile neutropenia occurs due to blood infection that can be caused from a chemotherapy complication, renal failure, skin wounds, secondary infection or HIV/AIDS. Its classical symptoms are fever, sepsis, cardiac dysfunction and low white blood cell and neutrophil count. The best way to treat neutropenia is by the empiric antibiotic method in which the treatment duration lasts 3 weeks.
Neutropenic fever or febrile neutropenia is usually seen as a chemotherapy complication or occurs due to renal failure. It’s underlying cause is blood infection that occurs when white blood cells get flooded with toxins. Patients suffering from this fever need urgent treatment, delay of which may lead to death.
Neutropenic Fever- Causes
Other than chemotherapy and renal failure, neutropenia can also be caused due to foreign objects such as a wood splinter or thorn entering the skin, minor abrasions or punctures that allow fungi or bacteria to seep into the body, infections such as typhoid or meningitis that lead to neutropenia as a secondary infection and HIV/AIDS that suppresses the body’s immunity thus making it more susceptible to infection.
Neutropenic Fever- Symptoms and Treatment
The classical symptom of this disease is fever that occurs because the body’s immune system combats infection or sepsis. Neutropenic Sepsis can either be mild in nature that can cause abnormalities in vital signs such as heart rate or severe which might lead to organ dysfunction and can even cause death.
Another typical symptom is that of a low white blood cell count that is observed particularly in those patients undergoing chemotherapy as it decreases the ability of the bone marrow to generate these infection-fighting cells. In such patients, the absolute neutrophil count is found to be less than 0.5 x 109/L. This count along with a body temperature of >100.4oF is indicative of the presence of neutropenia. Patients are also screened for blood pressure and lactic acid levels and if found to be hypertensive or with > 4 lactate levels are put in ICU for immediate treatment of antibiotics.
As a first step towards treating patients, they are generally put on wide spectrum of antibiotics to control spread of infection. In order to be most effective treatment must begin within one hour after confirming the presence of the disease. During this phase, blood and microbiological tests are conducted to target the treatment.
One method to treat neutropenia is by using the empiric antibiotic method. This method involves the use of antibiotics that have been tailored as per the results of microbial cultures and radiography. This treatment is continued until the neutrophil count exceeds 0.5 x 109/L. Such patients continue this therapy for a maximum of 3 weeks or until the fever subsides and might be switched to oral therapy depending on their recovery rate.
In patients in whom the fever does not reduce despite empirical antibiotic therapy other sources of infection are looked into such as secondary, non-bacterial and/or medication reaction infections which are treated by changing the course of antibiotics and by including an antifungal treatment course. For patients who have been severely affected by neutropenic sepsis, doctors typically recommend that the antibiotic course be continued even after the patient has recovered in order to prevent relapse.
Patients suffering from neutropenic fever - febrile neutropenia can recover completely provided they are given timely treatment. Hence, persistent fever along with low blood pressure symptoms should not be disregarded and medical attention sought immediately.