Febrile neutropenia

Key Information

Appropriate Tests

The causative organisms of fever presenting in the patient with underlying neutropenia are listed.

Full blood count, White cell count differential, Blood culture

See also Neutropenia for cause of neutropenia and Infection (increased susceptibility).

Aseptic collection of Blood culture, (note from central line as well as peripheral blood), Urea, Electrolytes, Glucose, Liver function tests, consider Calcium, Phosphate, Albumin, Full blood count, Blood group and antibody screen, MCS.

See Guideline on Pathology testing in the Emergency department: Appendix 2.

Bacterial septicaemia, especially

 

  • Pseudomonas aeruginosa
  • Clostridium perfringens
  • Other Gram-negative bacilli
  • Staphylococcus aureus

 

Pneumonia, especially

  • Streptococcus pneumoniae
  • Haemophilus influenzae

 

See Haemophilus influenzae infection

Lung infiltrate, nodules, especially

  • Aspergillus spp

Bronchial brush, wash, MCS bronchoalveolar lavage if response to appropriate empirical antibiotic regimen has not occurred. Consider CT guided biopsy.

See Aspergillosis.

Mouth, oesophageal ulceration, especially

  • Candida albicans
  • Herpes simplex virus
  • Cytomegalovirus

If response to initial therapy is unsatisfactory: endoscopy with biopsy for microscopy, MCS fungal (yeasts), Virus detection.

See Candidiasis.

See Herpes simplex virus infection.

See Cytomegalovirus infection.

Cellulitis, especially

  • Streptococcus pyogenes
  • Aeromonas hydrophila
  • Mucormycosis

 

Cannula site infection, especially

  • Staphylococcus aureus
  • Corynebacterium jeikeium
  • Streptococci

Wound swab of cannula site. Culture tip of intravenous cannula.