Chapter 229. Fever and Infection in the Immunocompromised Patient

Management of Fever in the Neutropenic Child

David B. Haslam and Jeffrey Scott Mckinney

Topics Discussed: fever; immunocompromised host, infection in; immunology; infectious diseases; neutropenia; neutropenia, febrile .

Sections: Management of Fever in Solid Organ Transplant Recipients, Outcome of Infection, Prognosis and Outcomes, Prevention of Infection, Vaccination, References.

Excerpt:"Management of fever in the child with profound neutropenia provides one paradigm for the care of suspected infection in a child with severe immunocompromise. Obviously, this approach is not universally applicable to all immunocompromised children, but it includes core concepts that can be generally applied to children with immune deficit. These concepts include the association between certain defects of immunity and propensity for specific infections, empiric therapy choice and modification, step-wise diagnostic evaluation, treatment duration decisions, and interval assessment parameters. In the context of antineoplastic therapy, neutropenia is traditionally defined as an absolute neutrophil count (ANC) <500 cells/mm³, or as an ANC of 1000 cells/mm³ with a predicted decrease to <500 cells/mm³. Quite distinct from the prolonged fever duration required for classic definitions of fever of unknown origin (FUO), fever is here defined as a single oral temperature ≥38.3°C (101°F), or ≥38.0°C (100.4°F), for at least 1 hour.¹ ..."

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