Febrile neutropenia
Overview
Neutrophils are a type of white blood cell that plays a crucial role in the body’s defense, especially against bacteria and fungi. Neutropenia occurs when someone has too few neutrophils in the blood. This may be either due to a disease (e.g., cancer or an autoimmune disease) or, more commonly, to the treatment of a disease, such as chemotherapy for cancer. Neutropenia is usually reversible, either spontaneously or through therapeutic intervention. Depending on the number of remaining neutrophils, neutropenia is classified as mild, moderate, severe or marked. Additionally, depending on its duration, it is classified as prolonged (>7 days) or not. If a patient with neutropenia has a fever, this is called febrile neutropenia, and it is a reason to seek medical attention. If the patient’s neutropenia is severe or marked and it is classified as prolonged, or there are other associated risk factors, any fever is considered a medical emergency.
For oncological patients, the odds of a fever occurring at some point during their neutropenic phases ranges from 10% to 50% for patients with solid organ tumors, and exceeds 80% for patients with hematological malignancies. In about 1/3 of patients with febrile neutropenia an infectious agent is detected by microbiological tests as the cause of the fever. However, in several of the remaining 2/3 of febrile neutropenia cases the cause of the fever may be due to an infection which could not be documented by microbiological methods. Without appropriate and timely interventions, mortality rates are particularly high among these patients. Mortality rates depend both on factors related to the specific patient (such as their age, type of cancer, severity and duration of their neutropenia, presence of other serious diseases, or a history of infections) and on factors that are not patient specific (such as the type of chemotherapy, type of infectious agent, availability of innovative antimicrobial treatments, or the local epidemiology of multidrug-resistant bacteria).
Diagnosis
Febrile neutropenia may be accompanied by a clinically evident source of infection (such as cellulitis or pneumonia), or it may be documented microbiologically (such as through a culture of body fluids or by newer molecular methods applied to various samples). In many cases, however, the above does not occur and it appears as a fever of unknown origin. In any case, it is vital that the patient is assessed by a physician.
Treatment
A patient must be immediately assessed using the appropriate diagnostic methods depending on the specific case. This is followed by the appropriate treatment, when needed, which can include the removal of catheters and administering individualized antimicrobial medications. These are prerequisites for a positive outcome. At the same time, preventative measures must be taken to avoid febrile neutropenia occurring in the first place. These can include the administration of neutrophil count-enhancing drugs, antimicrobial prophylaxis with antibiotics, antifungals, and antivirals, and, of course, vaccinating the patient and, in some cases, the people who the patient lives with and comes into regular contact.
Why GMI
The Department of Infectious Diseases of the German Medical Institute can provide these patients with the most innovative diagnostic and therapeutic options available. We can also guide a patient who is at risk of developing neutropenic fever on all preventative measures.
Additionally, the GMI team will never offer a simple “one size fits all” approach to any patient. We believe each patient’s case is as individual as they are and strive to find the best solution for each of our patients, taking their specific case and diagnosis, their lifestyle, and choices into account.
