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Causes of fever in cancer patients (prospective study over 477 episodes)

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Abstract

Goals of work

The aim of this study was to determine the causes of fever among cancer patients.

Methods

All febrile cancer patients were followed up prospectively. Clinical, microbiological and radiological documentations were performed. Aetiologies of fever, type of tumour, site of infection, type of microorganism and outcome were assessed and compared between neutropenics and non-neutropenics.

Results

Four hundred and seventy-seven episodes were evaluated. Infection, non-infectious causes and fever of unknown origin represented 67, 23 and 10%, respectively. The respiratory tract is the most frequently involved site in infection (29%), and in microbiologically documented infections, Gram-negative bacilli were predominant. The tumour itself (27%) or an invasive procedure (17%) were the main causes of non-infectious febrile episodes. Mortality from infection was higher among non-neutropenic (11.1%) than neutropenic patients (4.3%).

Conclusion

Fever in cancer patients remains a challenge, and the differentiation between infectious and non-infectious causes at onset of fever is very difficult. Despite all the prophylactic measures, infection is still the principal cause. However, the infection-related mortality is low either in neutropenic or non-neutropenic patients.

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References

  1. Akova M, Paesmans M, Calandra T et al (2005) A European organization for research and treatment of cancer-international antimicrobial therapy group study of secondary infections in febrile, neutropenic patients with cancer. Clin Infect Dis 40:239–245

    Article  PubMed  Google Scholar 

  2. Circiumaru B, Baldock G, Cohen J (1999) A prospective study of fever in the intensive care unit. Intensive Care Med 25:648–651

    Article  PubMed  Google Scholar 

  3. Cometta A, Calandra T, Gaya H et al (1996) Monotherapy with meropenem versus combination therapy with ceftazidime plus amikacin as empiric therapy for fever in granulocytopenic patients with cancer. Antimicrob Agents Chemother 40:1108–1115

    PubMed  CAS  Google Scholar 

  4. Cometta A, Kern WV, De Bock R et al (2003) Vancomcyin versus placebo for treating persistent fever in patients with neutropenic cancer receiving piperacillin-tazobactam monotherapy. Clin Infect Dis 37:382–389

    Article  PubMed  CAS  Google Scholar 

  5. Dinarello CA (1996) Thermoregulation and the pathogenesis of fever. Infect Dis Clin North Am 10:433–449

    Article  PubMed  CAS  Google Scholar 

  6. Dinarello CA, Bunn PA Jr (1997) Fever. Semin Oncol 24:288–298

    PubMed  CAS  Google Scholar 

  7. Ezidiegwu CN, Lauenstein KJ, Rosales LG et al (2004) Febrile nonhemolytic transfusion reactions. Management by premedication and cost implications in adult patients. Arch Pathol Lab Med 128:991–995

    PubMed  Google Scholar 

  8. Fanning J, Neuhoff RA, Brewer JE et al (1998) Frequency and yield of postoperative fever evaluation. Infect Dis Obstet Gynecol 6:252–255

    Article  PubMed  CAS  Google Scholar 

  9. Garcia-Suarez J, Krsnik I, Reyes E et al (2003) Elderly haematological patients with chemotherapy-induced febrile neutropenia have similar rates of infection and outcome of younger adults: a prospective study of risk-adapted therapy. Br J Haematol 120:209–216

    Article  PubMed  Google Scholar 

  10. Hann I, Viscoli C, Paesmans M et al (1997) A comparison of outcome from febrile neutropenic episodes in children compared with adults: results from four EORTC studies. International Antimicrobial Therapy Cooperative Group (IATCG) of the European Organization for Research and Treatment of Cancer (EORTC). Br J Haematol 99:580–588

    Article  PubMed  CAS  Google Scholar 

  11. Henderson RA, Pinder L (1990) Acute transfusion reactions. N Z Med J 103:509–511

    PubMed  CAS  Google Scholar 

  12. Hughes W, Armstrong D, Bodey GP et al (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751

    Article  PubMed  Google Scholar 

  13. Klastersky J (1994) Non-infectious causes of fever in cancer patients. In: Glauser MP, Calandra T (eds) International practice and research on infections in immunocompromised oncological patients, vol. 1. Baillière Tindall, London, pp 439–454

    Google Scholar 

  14. Klastersky J (1998) Science and pragmatism in the treatment and prevention of neutropenic infection. J Antimicrob Chemother 41(suppl. D):13–24

    Article  PubMed  CAS  Google Scholar 

  15. Klastersky J, Weerts D, Hensgens C et al (1973) Fever of unexplained origin in patients with cancer. Eur J Cancer 9:649–656

    PubMed  CAS  Google Scholar 

  16. Le Roux P, de Blic J, Albertini M et al (2004) Flexible bronchoscopy in children. Experience at French centers of pediatric pneumology. Rev Mal Respir 21:1098–1106

    PubMed  Google Scholar 

  17. Luft FC, Rissing JP, White A et al (1976) Infections of neoplasm as causes of prolonged fever in cancer patients. Am J Med Sci 272:65–74

    Article  PubMed  CAS  Google Scholar 

  18. Mackowiak PA, Le Maistre CF (1987) Drug fever: a critical appraisal of conventional concepts. An analysis of 51 episodes in two Dallas hospitals and 97 episodes reported in the English literature. Ann Intern Med 106:728–733

    PubMed  CAS  Google Scholar 

  19. McGeer A, Feld R (1994) Epidemiology of infection in immunocompromised oncological patients. In: Glauser MP, Calandra T (eds) International practice and research on infections in immunocompromised oncological patients, vol. 1. Baillière Tindall, London, pp 415–438

    Google Scholar 

  20. Mulabecirovic A, Gaulhofer P, Auner HW et al (2004) Pulmonary infiltrates in patients with haematological malignancies: transbronchial lung biopsy increases the diagnostic yield with respect to neoplastic infiltrates and toxic pneumonitis. Ann Hematol 83:420–422

    Article  PubMed  CAS  Google Scholar 

  21. Pizzo PA, Robichaud KJ, Wesley R et al (1982) Fever and pediatric and young adult patient with cancer. A prospective study of 1,001 episodes. Medicine 61:153–165

    Article  PubMed  CAS  Google Scholar 

  22. Rossi C, Klastersky J (1996) Initial empirical antibiotic therapy for neutropenic fever analysis of the cause of death. Support Care Cancer 4:207–212

    Article  PubMed  CAS  Google Scholar 

  23. Rubio M, Palau L, Vivas JR et al (1994) Predominance of gram-positive microorganisms as a cause of septicemia in patients with hematological malignancies. Infect Control Hosp Epidemiol 15:101–104

    Article  PubMed  CAS  Google Scholar 

  24. Scharfe T, Alken P, Muller ST et al (1990) Percutaneous litholapaxy. Indications and limitations of the technique in complex nephrolithiasis. Arch Esp Urol 43:311–318

    PubMed  CAS  Google Scholar 

  25. Velasco E, Byington R, Martins CS et al (2004) Bloodstream infection surveillance in a cancer centre: a prospective look at clinical microbiology aspects. Clin Microbiol Infect 10:542–549

    Article  PubMed  CAS  Google Scholar 

  26. Viscoli C (1998) The evolution of the empirical management of fever and neutropenia in cancer patients. J Antimicrob Chemother 41 (suppl. D.):65–80

    Article  PubMed  CAS  Google Scholar 

  27. Viscoli C, Bruzzi P, Castagnola E et al (1994) Factors associated with bacteraemia in febrile, granulocytopenic cancer patients. The International Antimicrobial Therapy Cooperative Group (IATCG) of the European Organization for Research and Treatment of Cancer (EORTC). Eur J Cancer 30A:430–437

    Article  PubMed  CAS  Google Scholar 

  28. Zihlif M, Khanchandani G, Ahmed HP et al (2005) Surgical lung biopsy in patient with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: improved outcome with specific diagnosis. Am J Hematol 78:94–99

    Article  PubMed  Google Scholar 

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Toussaint, E., Bahel-Ball, E., Vekemans, M. et al. Causes of fever in cancer patients (prospective study over 477 episodes). Support Care Cancer 14, 763–769 (2006). https://doi.org/10.1007/s00520-005-0898-0

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  • DOI: https://doi.org/10.1007/s00520-005-0898-0

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