The diagnostic and therapeutic approach to lower respiratory tract infections in the neutropenic patient

Mulinde, Jean; Joshi, Manjari

doi:10.1093/jac/41.suppl_4.51

Cited by 12 publications

(15 citation statements)

References 21 publications

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“…In this series of 170 febrile episodes, 157 CXRs were obtained and 20 (12.7%) of them showed abnormalities. Eight (5%) admission CXR detected abnormalities compatible with bacterial infections 3,10 and were diagnosed and treated as such. Six children had lobar consolidations on admission and two other patients with abnormal admission CXR subsequently developed clear clinical and radiological signs of pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Is routine chest radiography necessary for the initial evaluation of fever in neutropenic children with cancer?

Renoult

Buteau

Turgeon

et al. 2004

Pediatric Blood & Cancer

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Section: Discussionmentioning

confidence: 99%

Is routine chest radiography necessary for the initial evaluation of fever in neutropenic children with cancer?

Renoult

Buteau

Turgeon

et al. 2004

Pediatric Blood & Cancer

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“…[3] Nedeni bilinmeyen ateşi (NBA) olanlar: Klinik ve laboratuvar olarak gösterilebilmiş infeksiyon bulgusu olmayan, üç gün ve daha fazla süren izole ateşi olan hastalar.…”

Section: Yöntemlerunclassified

“…Etken mikroorganizma türünün serum PCT düzeyleri üzerine etkisi olabileceği düşü-nüldü. [3] Ciddi sepsis tanımlanan olgularda, PCT değerle-rinde istatistiksel olarak anlamlı düzeyde artışın saptanması ve yüksek mortalite saptanan bu grupta serum PCT düzey-lerindeki artışın devam etmesi, nötropenik hasta grubundaki ciddi infeksiyonların tanısında ve izleminde serum PCT dü-zeylerinin yararlı olabileceği ve inatçı PCT yüksekliklerinin kötü prognozla ilişkili olabileceği görüşünü doğruladı. [4] Tedaviye yanıt alınan olgularda, ateşin kontrol altına alındığı gün saptanan PCT düzeylerindeki hızlı gerileme, serum PCT düzeylerinin tedavi başarısını izlemede de yararlı olabileceği-ni düşündürdü.…”

Section: İrdelemeunclassified

The Evaluation of Procalcitonin as a Diagnostic and Prognostic Marker of Bacterial Infections in Febrile Neutropenic Patients

Yetkin¹,

Şenol²,

Yalcin³

et al. 2011

Klimik Dergisi

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ÖzetAmaç: Maligniteli hastalardaki febril nötropeni ataklarında prokalsitonin (PCT)'in bakteriyel infeksiyonların tanısal ve prognostik bir göstergesi olarak standard bir parametre olan C-reaktif protein (CRP) ile karşılaştırılıp değerlendirilmesi amaçlandı. Yöntemler: Kemoterapiye bağlı 37 hastadaki 40 febril nötropenik atak üç gruba ayrıldı: nedeni bilinmeyen ateş (NBA), mikrobiyolojik olarak tanımlanmış infeksiyon ve klinik olarak tanımlanmış infeksiyon. Nötropeni başlangıcında, ateşin ilk ve üçüncü günü, ateşin düştüğü gün ya da tedaviye yanıtsız hastalarda tedavinin 5-7. günü olmak üzere toplam dört kan örneği alındı. Bulgular: Tüm ataklarda nötropeni başlangıcında PCT düzeyleri normal değerlerde bulunurken, CRP düzeyleri normal değerlerin üzerinde saptandı. Ateşin üçüncü günü PCT'deki yüksekliğin tanımlanmış infeksiyonu olan gruplarda, NBA grubuna göre daha fazla olduğu gözlendi (p<0.05). Sepsisi olan ve olmayan gruplarda PCT düzeyleri farklı bulundu (p<0.001) ve en yüksek değerle-rine sepsis grubunda ateşin 3. gününde ulaştı. Tedaviye yanıtsız grupta PCT düzeylerindeki artış anlamlı ölçüde sürerken, tedaviye yanıtı olan grupta, ateşin düşmesi ile birlikte hızla normal değer-lere geriledi (p<0.001). Sonuçlar: Bu bulgular ışığında, febril nötropenik hastalarda PCT'nin, dokümante infeksiyonların erken tanısında, infeksiyonun şiddetini ve tedaviye yanıtı belirlemede yararlı olacağı ve CRP'den daha üstün olduğu sonucuna varıldı. AbstractObjective: The aim of this study was to evaluate the role of procalcitonin (PCT) in the diagnosis, prognosis and follow-up of bacterial infections in febrile neutropenic patients in comparison to the standard parameter, C-reactive protein (CRP). Methods: 40 febrile neutropenic episodes of 37 patients with cancer undergoing chemotherapy were classified as fever of unknown origin (FUO), microbiologically or clinically documented infection. Four sequential serum samples were obtained at the onset of neutropenia, on the first and third days of fever and on the day of defervescence, or on day 5 or 7 of an unresolved fever. Results: At the onset of neutropenia, the PCT levels were found to be normal whereas CRP levels were found to be elevated in all patients. With the febrile episode, PCT levels were elevated in all types of infections which were significantly higher for documented infections compared to FUO (p< 0.05). Procalcitonin levels differed significantly between patients with and without severe sepsis (p<0.001), and the highest levels were seen on the third day of fever. PCT levels decreased rapidly in afebrile patients treated successfully, whereas they remained significantly higher for patients unresponsive to therapy (p<0.001). Conclusions: In conclusion, PCT could be suggested as a useful marker, and was superior to CRP for early diagnosis of documented infections, assessment of the severity of infection and response to therapy in febrile neutropenic patients.

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“…X‐rays showing localized consolidation usually indicate an infection of bacteria including MRSA, Klebsiella or Pseudomonas aeruginosa 8 …”

Section: Characteristics Of Pneumonia In the Immunocompromised Hostmentioning

confidence: 99%

Pneumonia in immunocompromised patients

2009

Respirology

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SUMMARY • The diagnosis and identification of causative microorganisms of pneumonia are often difficult in immunocompromised patients. • Immunosuppression can divided into three categories; neutropenia (or neutrophil dysfunction); humoral immunodeficiency and cellular immunodeficiency. Presumptive pathogen identifications of pneumonia could be made systematically based on the type of impaired immune function. • Since there are a number of diseases that must be differentiated, the collection of respiratory tract specimens and appropriate serum antigen tests should be done whenever possible to identify the causative microorganisms. • Empirical antibiotic therapy should be started as soon as possible. • If initial treatment proves ineffective, invasive diagnostic procedures, including surgical lung biopsy, should be considered.

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The diagnostic and therapeutic approach to lower respiratory tract infections in the neutropenic patient

Cited by 12 publications

References 21 publications

Is routine chest radiography necessary for the initial evaluation of fever in neutropenic children with cancer?

Is routine chest radiography necessary for the initial evaluation of fever in neutropenic children with cancer?

The Evaluation of Procalcitonin as a Diagnostic and Prognostic Marker of Bacterial Infections in Febrile Neutropenic Patients

Pneumonia in immunocompromised patients

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