Febrile Neutropenia
Introduction
Fever in a child with cancer is a medical emergency.
Parents of children having chemotherapy for cancer are told to go to an emergency room as soon as their child develops a fever, regardless of their counts.
Neutropenia in a child with cancer is most often due to chemotherapy treatments:
- This is a common complication.
- It is possible to predict when the counts will be lowest depending on what type of chemotherapy has been given.
- Most chemo regimens will cause the nadir of the ANC to occur 7 to 10 days after the chemo has been given.
- A newly diagnosed child with leukemia may have neutropenia at presentation.
Almost all children being treated for cancer have an indwelling catheter (either a VAD or a CVC). Even if bloodwork is "normal", having this ‘foreign body’ in the child's venous system can result in a significant septic episode.
In the absence of treatment, patients with FN may sustain devastating complications of bacterial sepsis.
Most life-threatening infections during periods of neutropenia will be due to bacteria found as part of a patient’s normal flora.
Common infections include:
- Gram negative and anaerobic bacteria from normal gut flora
- Gram positive bacteria from the skin, and
- Normal oral flora such as alpha hemolytic streptococci,
20-30% of patients with FN will have a positive blood culture 1,2. Signs of overt sepsis may be absent.
Prompt assessment of children with FN and administration of wide spectrum antibiotics has been critical in reducing mortality and morbidity in those patients 3.
Clear definitions as well as a good knowledge of common pathogen responsible for bacteriaemia and sepsis are essential to provide optimal care.
Those are reviewed in later sections along with a review of the role of radiological assessment and common antibiotic choices.
