Nötropenik ateş ve laboratuvar

Year 2022, Volume: 5 Issue: 2, 85 - 88, 27.06.2022

Selim Öncel

https://doi.org/10.53446/actamednicomedia.1036810

Abstract

Nötropenik ateş, özellikle kemoterapi sonucu meydana geldiğinde gerekli laboratuvar tetkiklerinin süratle tamamlanıp uygun bir antimikrobiyal rejiminin başlanmaması durumunda ciddi bakteri enfeksiyonu olasılığının yüksek olması nedeniyle çocuğun yaşamını tehlikeye sokabilen bir durumdur.
Tam kan sayımı ve periferik yayma, serum elektrolitleri, kreatinin, kan üre azotu, transaminazlar, toplam bilirübin ve kan kültürü her nötropenik ateşli hastadan istenmesi gereken tetkiklerdir.
İdrar yolu enfeksiyonu bulunan nötropenik çocuklarda piyüri saptanmama olasılığı çok yüksektir; bu nedenle böyle hastalarda tam idrar tahlilinde piyüri olmamasına bakarak idrar yolu enfeksiyonu enfeksiyonu bulunmadığına karar vermek doğru değildir.
Boğaz kültürü, solunum yolu patojenleriyie ilgili moleküler testler, akciğer grafisi, sinüs bilgisayarlı tomografisi ve lomber ponksiyon rutin değildir, ancak gereğinde istenmeli veya yapılmalıdır.
Karın ağrısı veya ishali olan çocuklarda nötropenik enterokolit (tiflit) bulunabilir. Bu hastalara mutlaka abdominal ultrasonografi yapılmalıdır. İshal varsa Clostridioides difficile ve diğer gastrointestinal patojen testleri istenebilir.
β-D-glükan, kanda fungal polimeraz zincir reaksiyonu ve serumda galaktomannan çalışılması, rutin olarak önerilmemektedir.
Kaynağı belirlenemeyen tüm nötropenik ateşli hastalarda ağır akut respiratuar sendrom koronavirüsü 2 enfeksiyonunun araştırılması ve bunun için moleküler yöntemlerin kullanılması tavsiye edilmektedir.

Keywords

Febril Nötropeni, belirteç, laboratuvar, Lomber ponksiyon, Clostridioides difficile

Supporting Institution

Yok

Project Number

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Thanks

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Neutropenic fever and laboratory

Abstract

Neutropenic fever is a situation jeopardizing children's lives unless suitable laboratory tests are ordered and an appropriate antimicrobial regimen is started especially in chemotherapy-induced cases.
Complete blood count with differentials, serum electrolytes, creatinine, blood urea nitrogen, transaminases, total bilirubin, and blood cultures should be ordered for every child with neutropenic fever .
Detection of pyuria may not be of high yield in neutropenic children. For that reason, it is erroneous to exclude urinary tract infections on the basis of absence of pyuria.
Throat culture, molecular tests related to respiratory pathogens, chest x-ray, computed tomography of sinuses, and lumber puncture are not routine tests, thus should be ordered only when indicated.
In children with abdominal pain or diarrhea, neutropenic colitis (typhlitis) may be present. These patients should undergo abdominal ultrasonography. Clostridioides difficile and other gastrointestinal pathogen tests may be ordered if the patient is passing watery stools.
β-D-glucan, fungal polimerase chain reaction in blood, and serum galactomannan are not routinely recomennded.
In all neutropenic fever syndromes without an identified source, severe respiratory syndrome coronavirus 2 infection should be sought by means of molecular methods.

Keywords

febrile neutropenia, marker, laboratory, lumbar puncture, Clostridioides difficile

Project Number

Yok

References

• Ahmed NM, Flynn PM. Fever in children with chemotherapy-induced neutropenia. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.; 2020. https://www.uptodate.com.
• Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4). doi:10.1093/cid/cir073.
• Lehrnbecher T, Robinson P, Fisher B, et al. Guideline for the management of fever and neutropenia in children with cancer and hematopoietic stem-cell transplantation recipients: 2017 update. J Clin Oncol. 2017;35(18):2082-2094. doi:10.1200/JCO.2016.71.7017.
• Santolaya ME, Alvarez AM, Becker A, et al. Prospective, multicenter evaluation of risk factors associated with invasive bacterial infection in children with cancer, neutropenia, and fever. J Clin Oncol. 2001;19(14):3415-3421. doi:10.1200/JCO.2001.19.14.3415.
• Ammann RA, Hirt A, Lüthy AR, Aebi C. Identification of children presenting with fever in chemotherapy-induced neutropenia at low risk for severe bacterial infection. Med Pediatr Oncol. 2003;41(5):436-443. doi:10.1002/mpo.10320.
• National Institute for Health and Care Excellence. Neutropenic sepsis: prevention and management in people with cancer. https://www.nice.org.uk/guidance/cg151. Published 2020. Accessed December 5, 2020.
• Neemann K, Yonts AB, Qiu F, Simonsen K, Lowas S, Freifeld A. Blood cultures for persistent fever in neutropenic pediatric patients are of low diagnostic yield. J Pediatric Infect Dis Soc. 2016;5(2):219-221. doi:10.1093/jpids/piu145.
• National Comprehensive Cancer Network. Prevention and Treatment of Cancer-Related Infections (Version 2.2020). https://www.nccn.org/professionals/physician_gls/pdf/infections.pdf. Published 2020. Accessed December 15, 2020.
• Doganis D, Asmar B, Yankelevich M, Thomas R, Ravindranath Y. How many sources should be cultured for the diagnosis of a blood stream infection in children with cancer? Pediatr Hematol Oncol. 2013;30(5):416-424. doi:10.3109/08880018.2013.783892.
• Adamkiewicz T V., Lorenzana A, Doyle J, Richardson S. Peripheral vs. central blood cultures in patients admitted to a pediatric oncology ward. Pediatr Infect Dis J. 1999;18(6):556-558. doi:10.1097/00006454-199906000-00018.
• Robinson JL. Sensitivity of a blood culture drawn through a single lumen of a multilumen, long-term, indwelling, central venous catheter in pediatric oncology patients. J Pediatr Hematol Oncol. 2002;24(1):72-74. doi:10.1097/00043426-200201000-00019.
• Franklin JA, Gaur AH, Shenep JL, Hu XJ, Flynn PM. In situ diagnosis of central venous catheter-related bloodstream infection without peripheral blood culture. Pediatr Infect Dis J. 2004;23(7):614-618. doi:10.1097/01.inf.0000128779.34716.ee.
• Rodríguez L, Ethier MC, Phillips B, Lehrnbecher T, Doyle J, Sung L. Utility of peripheral blood cultures in patients with cancer and suspected blood stream infections: A systematic review. Support Care Cancer. 2012;20(12):3261-3267. doi:10.1007/s00520-012-1471-2.
• The Children’s Oncology Group. COG Supportive Care Endorsed Guidelines (Version date: September 9, 2020). https://childrensoncologygroup.org/downloads/COG_SC_Guideline_Document.pdf. Published 2020. Accessed December 15, 2020.
• Klaassen ILM, de Haas V, van Wijk JAE, Kaspers GJL, Bijlsma M, Benkamp A. Pyuria is absent during urinary tract infections in neutropenic patients. Pediatr Blood Cancer. 2011;56(5):868-870. doi:10.1002/pbc.22799.
• Korones DN. Is routine chest radiography necessary for the initial evaluation of fever in neutropenic children with cancer? Pediatr Blood Cancer. 2004;43(7):715-717. doi:10.1002/pbc.20226.
• Renoult E, Buteau C, Turgeon N, Moghrabi A, Duval M, Tapiero B. Is routine chest radiography necessary for the initial evaluation of fever in neutropenic children with cancer? Pediatr Blood Cancer. 2004 Sep;43(3):224-8. doi: 10.1002/pbc.20127.
• Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition / European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: Update 2014. J Pediatr Gastroenterol Nutr.2014;59(1):132-152. doi:10.1097/MPG.0000000000000375.
• Granado-Villar D, Cunill-De Sautu B, Granados A. Acute gastroenteritis. Pediatr Rev. 2012;33(11):487-494. doi:10.1542/pir.33-11-487.
• Novak-Weekley SM, Marlowe EM, Miller JM, et al. Clostridium difficile testing in the clinical laboratory by use of multiple testing algorithms. J Clin Microbiol. 2010;48(3):889-893. doi:10.1128/JCM.01801-09.
• Miller JM, Binnicker MJ, Campbell S, et al. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2018 update by the Infectious Diseases Society of America and The American Society for Microbiology. Clin Infect Dis. 2018;67(6):e1-e94. doi:10.1093/cid/ciy381.
• Goldenberg SD, Cliff PR, Smith S, Milner M, French GL. Two-step glutamate dehydrogenase antigen real-time polymerase chain reaction assay for detection of toxigenic Clostridium difficile. J Hosp Infect. 2010;74(1):48-54. doi:10.1016/j.jhin.2009.08.014.
• McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):e1-e48. doi:10.1093/cid/cix1085.
• Silverman R, Kwiatkowski T, Bernstein S, et al. Safety of lumbar puncture in patients with hemophilia. Ann Emerg Med. 1993;22(11):1739-1742. doi:10.1016/s0196-0644(05)81315-0.
• Howard SC, Gajjar A, Ribeiro RC, et al. Safety of lumbar puncture for children with acute lymphoblastic leukemia and thrombocytopenia. JAMA. 2000;284(17):2222-2224. doi:10.1001/jama.284.17.2222.
• Wu CW, Wu JY, Chen CK, et al. Does procalcitonin, C-reactive protein, or interleukin-6 test have a role in the diagnosis of severe infection in patients with febrile neutropenia? A systematic review and meta-analysis. Support Care Cancer. 2015;23(10):2863-2872. doi:10.1007/s00520-015-2650-8.
• Lehrnbecher T, Robinson PD, Fisher BT, et al. Galactomannan, β-d-glucan, and polymerase chain reaction-based assays for the diagnosis of ınvasive fungal disease in pediatric cancer and hematopoietic stem cell transplantation: a systematic review and meta-analysis. Clin Infect Dis. 2016;63(10):1340-1348. doi:10.1093/cid/ciw592.
• Zaleska-Dorobisz U, Olchowy C, Lasecki M, et al. Low-dose computed tomography in assessment of pulmonary abnormalities in children with febrile neutropenia suffering from malignant diseases. Adv Clin Exp Med. 2017;26(4):695-701. doi:10.17219/acem/68292.
• COVID-19 Treatment Guidelines Panel. COVID-19 Treatment Guidelines. National Institutes of Health. https://www.covid19treatmentguidelines.nih.gov/. Published 2020. Accessed December 16, 2020.
• National Comprehensive Cancer Network. Infectious disease management and considerations in cancer patients with documented or suspected COVID-19 [Version 1 (4/11/2020)]. https://www.nccn.org/covid-19/pdf/COVID_Infections.pdf. Published 2020. Accessed December 16, 2020.