This document provides an outline for a presentation on the pathophysiology and management of febrile neutropenia. It begins with definitions of febrile neutropenia and discusses the epidemiology, including common underlying malignancies. The pathophysiology of fever and neutropenia is explained. Clinical features, differential diagnosis, and guidelines for risk stratification and treatment approaches including monotherapy versus duotherapy are summarized. Treatment is tailored based on risk factors and includes broad-spectrum intravenous antibiotics with options for transitioning to oral antibiotics in low risk patients.
Febrile neutropenia by DR saqib ahmad shah PG radiation oncology SKIMS KASHMIRDR Saqib Shah
This document discusses granulopoiesis, neutrophils, and neutropenia. It defines neutropenia as an abnormally low level of neutrophils in the bloodstream. Severe neutropenia, when neutrophil counts drop below 500 cells/mm3, can lead to life-threatening infections. The document outlines risk factors for infections in neutropenic cancer patients and describes the evaluation and treatment of febrile neutropenia, including assessing patient risk level to determine treatment approach.
Management of infections in immunocompromised patientsSujay Iyer
This document provides an overview of managing infections in immunocompromised patients. It discusses various conditions that can cause immunosuppression like cancer, HIV, malnutrition, and immunosuppressive drugs. It focuses on febrile neutropenia, describing the definition, etiology, risk stratification, diagnosis, and management depending on if the patient is high-risk or low-risk. It also covers catheter-related infections, pneumonia, gastrointestinal infections, and prevention of infections. The management of febrile neutropenia involves broad-spectrum antibiotics, monitoring response, and modifying treatment based on culture results and patient risk factors.
This case report describes an adult female patient presenting with fever, cough, joint pain, and skin rash. Laboratory tests revealed elevated white blood cell count with neutrophilia. Imaging showed pulmonary nodules. She fulfilled criteria for adult onset Still's disease (AOSD), which can involve the lungs in 50% of cases. AOSD is diagnosed based on Yamaguchi or Fautrel criteria, which this patient met. Treatment involves corticosteroids and immunosuppressants to control the abnormal cytokine levels caused by AOSD. Pulmonary involvement requires close monitoring for serious complications like acute respiratory distress syndrome.
This document discusses fever in the intensive care unit. It begins with definitions of terms like fever and hypothermia. It then discusses the pathogenesis and significance of fever. Fever can both enhance immune function but also lead to poor outcomes in some cases like stroke patients. In the ICU, fever often complicates many admissions and can be caused by infectious or non-infectious etiologies. Common infectious causes are discussed like ventilator-associated pneumonia, catheter-associated bloodstream infections, and urinary tract infections. Non-infectious causes such as drug reactions, adrenal crisis, and blood transfusions are also outlined. The document concludes with a discussion of antibiotic use and strategies to optimize treatment in the ICU.
This document provides an overview of pneumonia, including its definition, epidemiology, etiology, clinical features, diagnosis, severity assessment, management, and treatment guidelines. It discusses community-acquired pneumonia and outlines 4 patient categories based on risk factors and symptoms. Key points include that pneumonia has many potential causes, symptoms often include cough and fever, and treatment involves antibiotics with consideration of atypical pathogens and severity of illness. Hospitalization is recommended for higher-risk patients or those not improving after 2 days.
The hypothalamus controls body temperature through neurons that receive signals from temperature receptors in the skin and blood. These signals are integrated in the hypothalamus' temperature regulation center to maintain a normal temperature of around 37°C. Fever is defined as a temperature greater than 37.2°C in the morning or 37.7°C in the afternoon. Common causes of fever in the ICU include infections like ventilator-associated pneumonia as well as non-infectious causes like drug reactions. Blood cultures, sputum cultures, urine cultures and imaging tests may help diagnose the cause, and treatment is aimed at the underlying condition.
This document discusses pyrexia of unknown origin (PUO). It defines PUO as a fever over 38°C lasting more than 3 weeks without an obvious cause despite evaluations. Common causes include infections (40%), malignancies (25%), and autoimmune diseases (15%). The document outlines the pathogenesis of fever and classifications of PUO. It describes the approach to evaluating a PUO patient through history, exam, and staged laboratory/imaging investigations. Empirical treatment trials are generally not recommended until a cause is found due to risks of misleading outcomes. The prognosis is determined by the underlying disease, with neoplasms having the worst outcomes.
19. presenting problems in infectious diseasesAhmad Hamadi
This document discusses the evaluation and management of fever. It notes that the differential diagnosis for fever is broad and initial screening investigations should include blood tests, imaging, and cultures of potential sites of infection depending on symptoms. For patients where the cause is not obvious, further targeted investigations are needed. The document also discusses considerations for evaluating fever in people who inject drugs, including risks related to injection practices and common infections in this population.
Febrile neutropenia by DR saqib ahmad shah PG radiation oncology SKIMS KASHMIRDR Saqib Shah
This document discusses granulopoiesis, neutrophils, and neutropenia. It defines neutropenia as an abnormally low level of neutrophils in the bloodstream. Severe neutropenia, when neutrophil counts drop below 500 cells/mm3, can lead to life-threatening infections. The document outlines risk factors for infections in neutropenic cancer patients and describes the evaluation and treatment of febrile neutropenia, including assessing patient risk level to determine treatment approach.
Management of infections in immunocompromised patientsSujay Iyer
This document provides an overview of managing infections in immunocompromised patients. It discusses various conditions that can cause immunosuppression like cancer, HIV, malnutrition, and immunosuppressive drugs. It focuses on febrile neutropenia, describing the definition, etiology, risk stratification, diagnosis, and management depending on if the patient is high-risk or low-risk. It also covers catheter-related infections, pneumonia, gastrointestinal infections, and prevention of infections. The management of febrile neutropenia involves broad-spectrum antibiotics, monitoring response, and modifying treatment based on culture results and patient risk factors.
This case report describes an adult female patient presenting with fever, cough, joint pain, and skin rash. Laboratory tests revealed elevated white blood cell count with neutrophilia. Imaging showed pulmonary nodules. She fulfilled criteria for adult onset Still's disease (AOSD), which can involve the lungs in 50% of cases. AOSD is diagnosed based on Yamaguchi or Fautrel criteria, which this patient met. Treatment involves corticosteroids and immunosuppressants to control the abnormal cytokine levels caused by AOSD. Pulmonary involvement requires close monitoring for serious complications like acute respiratory distress syndrome.
This document discusses fever in the intensive care unit. It begins with definitions of terms like fever and hypothermia. It then discusses the pathogenesis and significance of fever. Fever can both enhance immune function but also lead to poor outcomes in some cases like stroke patients. In the ICU, fever often complicates many admissions and can be caused by infectious or non-infectious etiologies. Common infectious causes are discussed like ventilator-associated pneumonia, catheter-associated bloodstream infections, and urinary tract infections. Non-infectious causes such as drug reactions, adrenal crisis, and blood transfusions are also outlined. The document concludes with a discussion of antibiotic use and strategies to optimize treatment in the ICU.
This document provides an overview of pneumonia, including its definition, epidemiology, etiology, clinical features, diagnosis, severity assessment, management, and treatment guidelines. It discusses community-acquired pneumonia and outlines 4 patient categories based on risk factors and symptoms. Key points include that pneumonia has many potential causes, symptoms often include cough and fever, and treatment involves antibiotics with consideration of atypical pathogens and severity of illness. Hospitalization is recommended for higher-risk patients or those not improving after 2 days.
The hypothalamus controls body temperature through neurons that receive signals from temperature receptors in the skin and blood. These signals are integrated in the hypothalamus' temperature regulation center to maintain a normal temperature of around 37°C. Fever is defined as a temperature greater than 37.2°C in the morning or 37.7°C in the afternoon. Common causes of fever in the ICU include infections like ventilator-associated pneumonia as well as non-infectious causes like drug reactions. Blood cultures, sputum cultures, urine cultures and imaging tests may help diagnose the cause, and treatment is aimed at the underlying condition.
This document discusses pyrexia of unknown origin (PUO). It defines PUO as a fever over 38°C lasting more than 3 weeks without an obvious cause despite evaluations. Common causes include infections (40%), malignancies (25%), and autoimmune diseases (15%). The document outlines the pathogenesis of fever and classifications of PUO. It describes the approach to evaluating a PUO patient through history, exam, and staged laboratory/imaging investigations. Empirical treatment trials are generally not recommended until a cause is found due to risks of misleading outcomes. The prognosis is determined by the underlying disease, with neoplasms having the worst outcomes.
19. presenting problems in infectious diseasesAhmad Hamadi
This document discusses the evaluation and management of fever. It notes that the differential diagnosis for fever is broad and initial screening investigations should include blood tests, imaging, and cultures of potential sites of infection depending on symptoms. For patients where the cause is not obvious, further targeted investigations are needed. The document also discusses considerations for evaluating fever in people who inject drugs, including risks related to injection practices and common infections in this population.
1. The IDSA guidelines provide recommendations for managing neutropenic patients with cancer who develop fever, focusing on antimicrobial treatment.
2. It distinguishes between high-risk and low-risk patients based on factors like anticipated duration of neutropenia, severity of neutropenia, and comorbidities. High-risk patients require initial IV antibiotics in the hospital, while low-risk patients may be candidates for oral or outpatient treatment.
3. The guidelines make recommendations on appropriate empiric antibiotic therapy, modifying treatment, treatment duration, and use of prophylaxis for both high-risk and low-risk neutropenic fever patients. It also provides guidance on use of empirical and preempt
Febrile Neutropenia.pptx , low neutrophil with feversengsong07072000
Febrile neutropenia is a medical emergency defined as fever in a patient with abnormally low circulating neutrophils commonly associated with chemotherapy. It carries a risk of severe, life-threatening infections. Initial management involves assessing infection risk, obtaining blood cultures and imaging, and empirically starting antibacterial therapy with an escalation strategy. For high risk or persistent cases, antifungal therapy or diagnostic testing for fungi should be considered. Management aims to treat any infection while narrowing antibacterial coverage.
This document summarizes guidelines for the management of febrile neutropenia. It describes definitions of fever and neutropenia and risk factors. Initial evaluation involves blood cultures, site-specific cultures as indicated, and monitoring. Risk is stratified using tools like the MASCC index. Prophylaxis includes hand hygiene, oral care, and sometimes antibiotics or antifungals. Empiric antibiotic therapy is recommended, with modifications based on risk and response. Therapy typically continues until resolution of fever and recovery of neutrophils. Empiric antifungals may be considered for persistent fever.
The document discusses fever of unknown origin (FUO). It defines FUO as a fever over 38.3°C on two occasions that lasts longer than 3 weeks and where the cause is not determined after a week of testing. Common causes include infections like tuberculosis, inflammatory diseases, and cancers. The document outlines different categories of FUO and discusses approaches to evaluating potential causes based on factors like location of fever onset and patient immune status. It also lists specific conditions that commonly underlie FUO and notes their distinguishing features.
Febrile neutropenia approach and treatmentahmed mjali
Neutropenia is a common complication of chemotherapy that can lead to life-threatening infections. The document outlines guidelines for managing febrile neutropenia, including initial evaluation, antibiotic selection based on risk level, duration of treatment, use of prophylaxis and growth factors, and recommended environmental precautions.
This document discusses pyrexia of unknown origin (PUO), defined as a fever that lasts for more than 3 weeks or occurs frequently without explanation after a physician's efforts to find the cause. Common causes of PUO include infections, neoplasms, and collagen vascular diseases. PUO can be classified as classical, nosocomial, neutropenic, HIV-associated, or transplant-associated. A thorough history, examination, and baseline investigations should be performed to evaluate for potential causes, while avoiding unnecessary tests or therapeutic trials that could mask the underlying condition.
Community aquired pneumonia : Dr. Devawrat Buche MD (FNB )Renuka Buche
Community acquired pneumonia is an acute lung infection that develops outside of a hospital setting. It is defined as an infiltrate seen on chest imaging along with symptoms of fever, cough, sputum production and shortness of breath. In India, the most common causes are Streptococcus pneumoniae, Staphylococcus aureus, and Klebsiella pneumoniae. Treatment involves initial empirical antibiotic therapy guided by risk stratification scores and local antibiotic resistance patterns, with options including respiratory fluoroquinolones, beta-lactams plus macrolides, or monotherapy in lower risk patients. Outcomes include 30-day mortality rates of 10-12% in hospitalized patients and increased long-term mortality risk.
Community-acquired pneumonia (CAP) is a common infectious disease worldwide and a major cause of mortality and morbidity. The document discusses definitions, etiology, risk factors, diagnosis, and treatment recommendations for CAP according to guidelines from IDSA/ATS. Key points include common bacterial and atypical pathogens causing typical and atypical CAP; use of severity assessment scores to determine hospitalization and ICU needs; recommendations for empirical antibiotic therapy based on patient factors; and considerations for MRSA coverage and broad-spectrum therapy.
Ventilator-associated pneumonia (VAP) is a common infection in mechanically ventilated patients. The risk of developing VAP increases the longer a patient requires ventilation. Early-onset VAP is usually caused by bacteria that normally inhabit the mouth and throat, while late-onset VAP is often caused by more resistant bacteria. Diagnosis of VAP requires evaluating clinical signs along with testing lower respiratory tract secretions. Prevention strategies aim to reduce bacterial contamination and aspiration, including oral care, elevation of the head, and careful management of tubes.
This document discusses infections in immunocompromised patients. It begins by describing the various microbes that can cause infection, including bacteria, parasites, fungi and viruses. It then discusses the different types of underlying immune defects that determine infection risk, such as humoral versus cell-mediated defects. The document outlines various factors that influence the risk of infection, including the level of immunosuppression, transplant organ, graft-versus-host disease, exposures, and immune-modulating medications. It presents several case examples of infections in immunocompromised patients.
This document provides information on febrile neutropenia, including:
- It is a common and serious complication of cancer chemotherapy, especially in those with hematologic malignancies.
- Initial evaluation of febrile neutropenic patients includes assessing infection risk factors and sites, as well as collecting blood and other cultures.
- High-risk patients require intravenous empirical antibiotic therapy in the hospital, while low-risk patients may be treated orally or as outpatients.
- Empirical therapy typically involves a broad-spectrum beta-lactam with coverage against pseudomonas, with vancomycin or other anti-gram positive coverage only added if clinically indicated. Therapy is continued until marrow recovery from neutropenia
This document discusses neutropenia and febrile neutropenia in children. It defines neutropenia as a decrease in absolute neutrophil count and describes different levels of severity from mild to profound. It outlines common causes of infection in febrile neutropenic children including bacteria, fungi, and viruses. Risk factors for serious infection are described. Guidelines are provided for evaluation, treatment including antibiotic and antifungal selection, and risk stratification of febrile neutropenic children.
This document discusses community-acquired pneumonia (CAP). It defines CAP and outlines its epidemiology, noting risk factors like increasing age and winter season. Diagnosis involves clinical evaluation, chest imaging, and ruling out other causes if imaging is abnormal but symptoms aren't. Severity is assessed using scores like CURB-65 to determine appropriate treatment setting. Most ambulatory patients receive 5 days of antibiotics while hospitalized patients get broader empiric coverage. Adjunctive steroids may benefit severe cases. Proper follow up and prevention through vaccination and smoking cessation are also discussed.
PATTERN OF HOSPITAL-ACQUIRED PNEUMONIA IN INTENSIVE CARE UNIT OF SUEZ CANAL U...Khaled Mohamed
Hospital-acquired pneumonia occurs more than 48 h after hospital admission and was not present at the time of admission, while ventilator-associated pneumonia occurs
after 48–72 h of endotracheal intubation or within 48 h of extubation. HAP is the second most common nosocomial infection and accounts for approximately 25% of all infections in the Intensive
Care Unit worldwide.
Sepsis is a life-threatening condition caused by a dysregulated immune response to infection that can lead to organ dysfunction. It is a major public health challenge worldwide with high mortality rates. The pathophysiology of sepsis involves an initial hyperinflammatory state followed by immune suppression that increases susceptibility to secondary infections. Biomarkers such as C-reactive protein and procalcitonin can help diagnose sepsis and evaluate severity, but an ideal biomarker has yet to be identified. Treatment of sepsis involves both resuscitative strategies and infection control according to surviving sepsis guidelines, and focuses on the complex pathophysiology of the condition.
This document provides definitions and guidelines for the management of septic shock. It begins with definitions of terms like SIRS, sepsis, septic shock, and qSOFA. It then discusses the pathophysiology of sepsis, including the host immune response and organ dysfunction. Manifestations across organ systems are outlined. Recommended markers for sepsis diagnosis are described. Treatment protocols emphasize early fluid resuscitation, screening programs, appropriate cultures before antibiotics, initiating broad-spectrum antibiotics within 1 hour, and optimizing antibiotic dosing and duration. Combination empiric therapy for septic shock may be considered but should be de-escalated once infection is controlled.
This document defines non-resolving pneumonia and discusses its causes and diagnostic evaluation. Non-resolving pneumonia is defined as persistence of clinical symptoms and radiographic abnormalities for longer than expected despite adequate antibiotic therapy. Common causes include inappropriate antibiotic therapy, complications of the initial infection, host factors, and presence of resistant or unusual pathogens. A thorough diagnostic evaluation includes assessing treatment response, looking for complications or superinfections, evaluating for unusual organisms, and examining host immune function. Radiological imaging, bronchoscopy with protected specimen brushing or biopsy, and CT-guided biopsies can help identify causative organisms or underlying conditions.
Approach to acute febrile illness in Tropical regions YMC Medicine
1. Acute undifferentiated febrile illness (AUFI) refers to fever without localizing signs for less than 14 days, which is common in tropical regions and can be caused by various infections.
2. A rational approach to evaluating AUFI involves collecting epidemiological information, clinical examination, and sequential laboratory testing to identify the cause.
3. Common etiologies of AUFI in tropical regions include malaria, dengue, enteric fever, leptospirosis, scrub typhus, and rickettsioses. Clinical features and complications can overlap between these illnesses.
Neutropenia is defined as an absolute neutrophil count (ANC) below specific thresholds, with severe neutropenia being an ANC below 500/microL. The risks of infection are related to the duration and degree of neutropenia as well as other factors that compromise immunity. Febrile neutropenia is diagnosed based on temperature thresholds and requires prompt evaluation and treatment with broad-spectrum intravenous antibiotics to cover common bacterial and fungal pathogens. Fluid resuscitation is the initial treatment for shock in febrile neutropenic patients, while vasopressors may be needed if the patient does not respond to fluids alone.
Community acquired pneumonia by dr md abdullah saleemsaleem051
This document provides information on community-acquired pneumonia (CAP), including epidemiology, risk factors, presentation, diagnosis, treatment recommendations, and prevention strategies. It notes that CAP is one of the most common infectious diseases worldwide, with higher rates among the elderly. Common bacterial causes are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Clinical assessment and chest imaging are important for diagnosis and management. Antibiotic treatment should be based on likely pathogens and severity of illness. Immunization can help prevent CAP in high-risk groups.
1. The IDSA guidelines provide recommendations for managing neutropenic patients with cancer who develop fever, focusing on antimicrobial treatment.
2. It distinguishes between high-risk and low-risk patients based on factors like anticipated duration of neutropenia, severity of neutropenia, and comorbidities. High-risk patients require initial IV antibiotics in the hospital, while low-risk patients may be candidates for oral or outpatient treatment.
3. The guidelines make recommendations on appropriate empiric antibiotic therapy, modifying treatment, treatment duration, and use of prophylaxis for both high-risk and low-risk neutropenic fever patients. It also provides guidance on use of empirical and preempt
Febrile Neutropenia.pptx , low neutrophil with feversengsong07072000
Febrile neutropenia is a medical emergency defined as fever in a patient with abnormally low circulating neutrophils commonly associated with chemotherapy. It carries a risk of severe, life-threatening infections. Initial management involves assessing infection risk, obtaining blood cultures and imaging, and empirically starting antibacterial therapy with an escalation strategy. For high risk or persistent cases, antifungal therapy or diagnostic testing for fungi should be considered. Management aims to treat any infection while narrowing antibacterial coverage.
This document summarizes guidelines for the management of febrile neutropenia. It describes definitions of fever and neutropenia and risk factors. Initial evaluation involves blood cultures, site-specific cultures as indicated, and monitoring. Risk is stratified using tools like the MASCC index. Prophylaxis includes hand hygiene, oral care, and sometimes antibiotics or antifungals. Empiric antibiotic therapy is recommended, with modifications based on risk and response. Therapy typically continues until resolution of fever and recovery of neutrophils. Empiric antifungals may be considered for persistent fever.
The document discusses fever of unknown origin (FUO). It defines FUO as a fever over 38.3°C on two occasions that lasts longer than 3 weeks and where the cause is not determined after a week of testing. Common causes include infections like tuberculosis, inflammatory diseases, and cancers. The document outlines different categories of FUO and discusses approaches to evaluating potential causes based on factors like location of fever onset and patient immune status. It also lists specific conditions that commonly underlie FUO and notes their distinguishing features.
Febrile neutropenia approach and treatmentahmed mjali
Neutropenia is a common complication of chemotherapy that can lead to life-threatening infections. The document outlines guidelines for managing febrile neutropenia, including initial evaluation, antibiotic selection based on risk level, duration of treatment, use of prophylaxis and growth factors, and recommended environmental precautions.
This document discusses pyrexia of unknown origin (PUO), defined as a fever that lasts for more than 3 weeks or occurs frequently without explanation after a physician's efforts to find the cause. Common causes of PUO include infections, neoplasms, and collagen vascular diseases. PUO can be classified as classical, nosocomial, neutropenic, HIV-associated, or transplant-associated. A thorough history, examination, and baseline investigations should be performed to evaluate for potential causes, while avoiding unnecessary tests or therapeutic trials that could mask the underlying condition.
Community aquired pneumonia : Dr. Devawrat Buche MD (FNB )Renuka Buche
Community acquired pneumonia is an acute lung infection that develops outside of a hospital setting. It is defined as an infiltrate seen on chest imaging along with symptoms of fever, cough, sputum production and shortness of breath. In India, the most common causes are Streptococcus pneumoniae, Staphylococcus aureus, and Klebsiella pneumoniae. Treatment involves initial empirical antibiotic therapy guided by risk stratification scores and local antibiotic resistance patterns, with options including respiratory fluoroquinolones, beta-lactams plus macrolides, or monotherapy in lower risk patients. Outcomes include 30-day mortality rates of 10-12% in hospitalized patients and increased long-term mortality risk.
Community-acquired pneumonia (CAP) is a common infectious disease worldwide and a major cause of mortality and morbidity. The document discusses definitions, etiology, risk factors, diagnosis, and treatment recommendations for CAP according to guidelines from IDSA/ATS. Key points include common bacterial and atypical pathogens causing typical and atypical CAP; use of severity assessment scores to determine hospitalization and ICU needs; recommendations for empirical antibiotic therapy based on patient factors; and considerations for MRSA coverage and broad-spectrum therapy.
Ventilator-associated pneumonia (VAP) is a common infection in mechanically ventilated patients. The risk of developing VAP increases the longer a patient requires ventilation. Early-onset VAP is usually caused by bacteria that normally inhabit the mouth and throat, while late-onset VAP is often caused by more resistant bacteria. Diagnosis of VAP requires evaluating clinical signs along with testing lower respiratory tract secretions. Prevention strategies aim to reduce bacterial contamination and aspiration, including oral care, elevation of the head, and careful management of tubes.
This document discusses infections in immunocompromised patients. It begins by describing the various microbes that can cause infection, including bacteria, parasites, fungi and viruses. It then discusses the different types of underlying immune defects that determine infection risk, such as humoral versus cell-mediated defects. The document outlines various factors that influence the risk of infection, including the level of immunosuppression, transplant organ, graft-versus-host disease, exposures, and immune-modulating medications. It presents several case examples of infections in immunocompromised patients.
This document provides information on febrile neutropenia, including:
- It is a common and serious complication of cancer chemotherapy, especially in those with hematologic malignancies.
- Initial evaluation of febrile neutropenic patients includes assessing infection risk factors and sites, as well as collecting blood and other cultures.
- High-risk patients require intravenous empirical antibiotic therapy in the hospital, while low-risk patients may be treated orally or as outpatients.
- Empirical therapy typically involves a broad-spectrum beta-lactam with coverage against pseudomonas, with vancomycin or other anti-gram positive coverage only added if clinically indicated. Therapy is continued until marrow recovery from neutropenia
This document discusses neutropenia and febrile neutropenia in children. It defines neutropenia as a decrease in absolute neutrophil count and describes different levels of severity from mild to profound. It outlines common causes of infection in febrile neutropenic children including bacteria, fungi, and viruses. Risk factors for serious infection are described. Guidelines are provided for evaluation, treatment including antibiotic and antifungal selection, and risk stratification of febrile neutropenic children.
This document discusses community-acquired pneumonia (CAP). It defines CAP and outlines its epidemiology, noting risk factors like increasing age and winter season. Diagnosis involves clinical evaluation, chest imaging, and ruling out other causes if imaging is abnormal but symptoms aren't. Severity is assessed using scores like CURB-65 to determine appropriate treatment setting. Most ambulatory patients receive 5 days of antibiotics while hospitalized patients get broader empiric coverage. Adjunctive steroids may benefit severe cases. Proper follow up and prevention through vaccination and smoking cessation are also discussed.
PATTERN OF HOSPITAL-ACQUIRED PNEUMONIA IN INTENSIVE CARE UNIT OF SUEZ CANAL U...Khaled Mohamed
Hospital-acquired pneumonia occurs more than 48 h after hospital admission and was not present at the time of admission, while ventilator-associated pneumonia occurs
after 48–72 h of endotracheal intubation or within 48 h of extubation. HAP is the second most common nosocomial infection and accounts for approximately 25% of all infections in the Intensive
Care Unit worldwide.
Sepsis is a life-threatening condition caused by a dysregulated immune response to infection that can lead to organ dysfunction. It is a major public health challenge worldwide with high mortality rates. The pathophysiology of sepsis involves an initial hyperinflammatory state followed by immune suppression that increases susceptibility to secondary infections. Biomarkers such as C-reactive protein and procalcitonin can help diagnose sepsis and evaluate severity, but an ideal biomarker has yet to be identified. Treatment of sepsis involves both resuscitative strategies and infection control according to surviving sepsis guidelines, and focuses on the complex pathophysiology of the condition.
This document provides definitions and guidelines for the management of septic shock. It begins with definitions of terms like SIRS, sepsis, septic shock, and qSOFA. It then discusses the pathophysiology of sepsis, including the host immune response and organ dysfunction. Manifestations across organ systems are outlined. Recommended markers for sepsis diagnosis are described. Treatment protocols emphasize early fluid resuscitation, screening programs, appropriate cultures before antibiotics, initiating broad-spectrum antibiotics within 1 hour, and optimizing antibiotic dosing and duration. Combination empiric therapy for septic shock may be considered but should be de-escalated once infection is controlled.
This document defines non-resolving pneumonia and discusses its causes and diagnostic evaluation. Non-resolving pneumonia is defined as persistence of clinical symptoms and radiographic abnormalities for longer than expected despite adequate antibiotic therapy. Common causes include inappropriate antibiotic therapy, complications of the initial infection, host factors, and presence of resistant or unusual pathogens. A thorough diagnostic evaluation includes assessing treatment response, looking for complications or superinfections, evaluating for unusual organisms, and examining host immune function. Radiological imaging, bronchoscopy with protected specimen brushing or biopsy, and CT-guided biopsies can help identify causative organisms or underlying conditions.
Approach to acute febrile illness in Tropical regions YMC Medicine
1. Acute undifferentiated febrile illness (AUFI) refers to fever without localizing signs for less than 14 days, which is common in tropical regions and can be caused by various infections.
2. A rational approach to evaluating AUFI involves collecting epidemiological information, clinical examination, and sequential laboratory testing to identify the cause.
3. Common etiologies of AUFI in tropical regions include malaria, dengue, enteric fever, leptospirosis, scrub typhus, and rickettsioses. Clinical features and complications can overlap between these illnesses.
Neutropenia is defined as an absolute neutrophil count (ANC) below specific thresholds, with severe neutropenia being an ANC below 500/microL. The risks of infection are related to the duration and degree of neutropenia as well as other factors that compromise immunity. Febrile neutropenia is diagnosed based on temperature thresholds and requires prompt evaluation and treatment with broad-spectrum intravenous antibiotics to cover common bacterial and fungal pathogens. Fluid resuscitation is the initial treatment for shock in febrile neutropenic patients, while vasopressors may be needed if the patient does not respond to fluids alone.
Community acquired pneumonia by dr md abdullah saleemsaleem051
This document provides information on community-acquired pneumonia (CAP), including epidemiology, risk factors, presentation, diagnosis, treatment recommendations, and prevention strategies. It notes that CAP is one of the most common infectious diseases worldwide, with higher rates among the elderly. Common bacterial causes are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Clinical assessment and chest imaging are important for diagnosis and management. Antibiotic treatment should be based on likely pathogens and severity of illness. Immunization can help prevent CAP in high-risk groups.
Similar to FEBRILE NEUTROPAENIA IN PAEDIATRICS (20)
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
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rapid turnover such as in the bone marrow.
Despite major advances in prevention and treatment, FN
remains one of the most frequent and serious complications
of cancer chemotherapy.
Physicians must be keenly aware of the infection risks,
diagnostic methods, and antimicrobial therapies required for
management of febrile patients through the neutropaenic
period.
4. DEFINITION
Defined as:
FEBRILE
*Single temperature of > 38.30c
OR
sustained temperature of > 38.0 for at least one hour.
• NEUTROPAENIA
*Absolute Neutrophil Count (ANC) of less than 0.5 X 109/L (
<500cells/mm3)
OR
1.0 x 109/L with a predicted decrease to < 0.5 X 109/L
within the next 48hrs
• FEBRILE NEUTROPENIA (FN) is an oral temperature of ≥ 38.3 °C
or two consecutive readings of ≥38.0 °C for 2 hr and an absolute
neutrophil count (ANC) of < 0.5 × 109/l, or expected to fall below
0.5 × 109/l .
ANC= Total white blood cell count(cells/mm3) x (percent neutrophils
+ percent Bands) ÷ 100
5. EPIDEMIOLOGY
Most Chemotherapy regimens are associated with 6-8 days of
neutropaenia.
Mortality from untreated FN ranges from 2 -21%
FN is observed in approximately 8 cases per 1000.
10 – 50% of patients with solid tumours and 80% of those with
hematological malignancies will develop fever during >1
chemotherapy cycle associated with neutropaenia
A study done in Pakistan showed that ALL was the most frequent
underlying malignancy (84.3%) and the highest FN episodes
(72.1%) occurred during the induction phase treatment
A study in East Africa revealed that Acute lymphocytic leukemia
(ALL) was the most frequent diagnosed cancer type among
febrile neutropenic patients in more than half of the participants.
Clinically documented infections occur in 20 – 30% of febrile
episodes ; common sites of tissue based infection include the
intestinal tract,lungs and Skin.
6. EPIDEMIOLOGY CONT…
Substantial fluctuation in the epidemiological
spectrum of bloodstream isolates obtained from
febrile neutropaenic patients has occurred over the
past 40 years
During the 1960’s and 1970’s,gram negative
pathogens predominated.
During the 1980’s – 1990’s,gram positive organisms
became more common because of increased use of
indwelling plastic venous catheters which allow for
colonization by and entry of gram positive skin flora.
The majority of patients who develop fever during
neutropaenia have no identifiable site of infection and
no positive culture results.
7. ETIOLOGY
Most infections are bacterial, but viral or fungal
etiology are possible.
Coagulase Negative Staphylococci (CONS)is the
most common blood isolate.
Recent trends have shown gram positives
organisms accounting for more than 50% of blood
cultures in children undergoing chemotherapy.
Drug – resistant gram negative bacteria species are
causing an increasing number of infections.
Fungi are rarely identified early in the course of
neutropaenia; can be seen in cases of prolonged
neutropaenia.
9. PATHOPHYSIOLOGY - FEVER
Fever is defined as a single oral temperature
measurement of >38.30c or a temperature of >38.0
sustained over a 1 hour period.
Site of measurement, age of patient, time of day e.t.c
affect the value obtained.
Fever occurs when either endogenous or exogenous
pyrogens cause an elevation in the body's
thermoregulatory set-point.
Fever during chemotherapy induced neutropaenia may be
the only indication of a severe underlying infection
because signs and symptoms of inflammation typically are
attenuated.
NB: Oral temperatures are usually 0.3 – 0.6oc higher than
axillary temperatures.
16. PATHOPHYSIOLOGY -
NEUTROPAENIA
Profouned Neutropaenia : ANC < 100
Severe Neutropaenia : ANC < 500
Prolonged Neutropaenia : > 7 days
Chronic neutropenia : Neutropenia for > three
months:
Isolated Neutropenia : Neutropenia without
associated anemia and/or thrombocytopenia:
Granulocytopenia : Reduced number of
neutrophils, eosinophils, and basophils:
17. Pathophysiology OF FN
Bone marrow infiltration by malignancy
Chemotherapy induced pancytopaenia
Defective humoral and cellular defects
Mucositis
Central Venous catheter infections
Anorexia
18.
19. CLINICAL FEATURES
Detailed history & physical examination with special
attention to clues suggesting etiology or focus of
infection,and also try to identify any features that
may help risk stratify the patient.
Factors which contribute to occurrence of FN in
pediatric cancer patients include age of child,
duration of neutropenia, ANC value, co-morbidities,
type of cancer and its stage, complication of
chemotherapy, identified pathogens, the severity of
vital signs.
Fever is typically the first manifestation of a severe
infection, especially in a neutropaenic patient.
Attention to signs of shock, hypoxia or deep organ
infections is essential.
20. HISTORY
Presenting illness
Specific type of cancer
Chemotherapy treatment (type and number)
Medication use (including prior broad spectrum
antibiotics)
Previous history of infections, especially with
bacterial-resistant organisms,
Allergies, should be noted to guide your therapy
Co-morbidities
21. EXAMINATION
Seek for subtle signs
Pain and tenderness may be the only indicators of
infection.
Periodontium,pharynx,perineum,eyes,lungs,esopha
gus
Rectal temperature measurements (and rectal
examinations) are avoided during neutropaenia to
prevent colonizing gut organisms from entering the
surrounding mucosa and soft tissues.
Use of axillary temperatures is discouraged
because they may not accurately reflect core body
temperature.
22. INVESTIGATIONS
Blood cultures - Qualitative vs quantitative
*Lumens of central venous catheters
*Peripheral blood culture from two different sites
Imaging
*CXR only in symptomatic patients
* CT in prolonged neutropaenia
• Additional diagnostic and supportive tests
*Urinalysis
*CBC
*LFT
*Serum E/U/Cr
*CSF Analysis
23. DIFFERENTIAL DIAGNOSIS
Transfusion reaction
Medication allergies and toxicities
Tumor-related fever
Thrombophlebitis
Resorption of blood from large hematoma
Viral infections
Invasive fungal infections
24. MANAGEMENT
Guidelines
*2017 International paediatric fever and Neutropaenia Guidelines Panel
*2011 Interntional Diseases Society of America(IDSA)
Risk stratification
*MASCC (Multinational Association for supportive Care in cancer Risk –
index score)
*The Clinical Index of Stable Febrile Neutropenia Score
* Clinical assesment
This is a means to determine which patients require prolonged
hospitalization and which may be candidiates for oral or once daily IV
reimens and/or for early discharge from the hospital to complete the
antibiotic course as outpatients.
The classification of FN in terms of the risk of infection helps to choose
antimicrobial therapy, in defining the route of administration, the possibility
of outpatient treatment and the probable etiology
25. MASCC Scoring Index
Characteristic/Score
The burden of illness: no or mild symptoms: 5
The burden of illness: none or mild: 5
The burden of illness: moderate symptoms: 3
The burden of illness: severe symptoms: 0
No hypotension (systolic BP greater than 90 mmHg): 5
No chronic obstructive pulmonary disease: 4
Type of Cancer
Solid tumor: 4
Lymphoma with previous fungal infection: 4
Hematologic with previous fungal infection: 4
No dehydration: 4
Outpatient status (at the onset of fever): 3
Age less than 60 years: 2*
According to the MASCC scores, a patient with a score < 26 is to be
considered at low risk and treated as an outpatient, whereas a patient
with a score > 21 is at high risk and should be hospitalized
26. The Clinical Index of Stable Febrile
Neutropaenia Score
Characteristics/Score
ECOG performance status (greater than 2): 2
Chronic obstructive pulmonary disease (COPD): 1
Stress-induced hyperglycemia: 2
Chronic cardiovascular disease: 1
Monocytes less than 200 per mcL: 1
mucositis: 1
Interpretation
0-2: Consider outpatient management with oral
antibiotics
≥ 3: Inpatient management
27. CLINICAL ASSESMENT
*HIGH RISK
Prolonged (> 7 days duration) and Profound neutropaenia (ANC
<100cells/mm3) OR
Type of malignancy : AML,pre-B ALL,Burkitts
Lymphoma,progressive malignancy, relapse with Bone marrow
involvement
Type of chemotherapy : HSCT, ALL Induction, Any chemo more
intensive than ALL maintenance therapy
Presence of central venous catheter
Age ≤ 5years
Presence of hypotension,pneumonia,new-onset abdominal pain,or
neurological changes
Laboratory : Hb : 7g/dl, Plt : 50,000/ul
Imaging : New CXR changes
*LOW RISK
Neutropaenia expected to last < 7 days
No other abnormalities present
28. Principles of Treatment
Treat as an EMERGENCY!
Empiric broad-spectrum antibiotic therapy is the main
management initiated for the treatment of FN in patients
with cancer.
Regimen MUST provide coverage against Pseudomonas
and at least some coverage for gram negative organisms.
Inpatient vs Outpatient
Oral vs Parenteral
High risk vs Low risk
Monotherapy vs Duotherapy
Vancomycin ?
Antifungal therapy?
29. INPATIENT vs OUTPATIENT
Inpatient treatment recommended for;
1. All high risk patients
2. Low risk patients with the following conditions
*Presence of clear anatomic site of infection
*Cardiovascular comorbidities
*Severe thrombocytopenia(platelets < 10,000/mcl)
*Unable to swallow oral medications
*Concern for poor adherence to outpatient treatment
Outpatient treatment recommended for;
* Low risk patients able to take oral medications
* Absence of above complications
* Ease of monitoring and follow up
30. ORAL VS PARENTERAL
Flouroquinolones +/- Amoxicillin-clavulanate
Consider oral if child is able to reliably tolerate
oral antibiotics
Presents a challenge in the presence of mucositis
and/or impaired G.I absorption.
Some centres allow outpatient mgt of selected
low risk children after a single dose of Parenteral
antibiotics such as Ceftazidime and then
discharged on oral antibiotic such as ciprofloxacin
31. HIGH RISK VS LOW RISK
• HIGH RISK
Monotherapy with an antipseudomonal beta lactam:
*IV Cefepime 50mg/kg/dose 8hrly(Max dose 2g/dose)
*IV Meropenem 20mg/kg/dose 8hrly(Max 1g/dose)
Addition of a second gram negative agent or glycopeptides:
*patients who are clinically unstable
*Suspicion of a resistant infection
*Centers with a high rate of resistant pathogens
LOW RISK
Oral antibiotics can be considered if :
* the child is able to tolerate the route of administration reliably
* infrastructure is in place to ensure careful monitoring and
follow up
32. MONOTHERAPY VS
DUOTHERAPY
MONOTHERAPY
• Antipseudomonal penicillin monotherapy is non-inferior to
aminoglycoside containing regimens for initial management,and has
less toxicity.
DUOTHERAPY
AMINOGLYCOSIDES + Antipseudomonal
penicillin,cefepime,ceftazidime or
carbapenems.
Advantages:
*Synergestic effect
*Decrease in emergence of drug resistance
Disadvantages:
*Ototoxicity
*Nephrotoxicity
33. VANCOMYCIN?
IDSA recommendation is that Vancomycin should only be
added to the initial regimen if:
* Catheter related infections
* Severe mucositis
* ß – lactam resistant streptococcus pneumoniae
* hypotension or other signs of sepsis
* Known colonization with MRSA
Empiric duotherapy with Vancomycin + Ceftazidime has been
extensively studied in neutropaenic patients and found to be
safe and efficacious
Unwarranted overuse increases the risk of Vancomycin
resistant enterococcus.
Discontinued after 48hrs if clinical course is stable and gram-
positive organisms are not isolated
34. ANTIFUNGAL THERAPY
• Fungal superinfection may affect 9 – 31% of
patients with prolonged Neutropaenia
• Caspofungin,Voriconazole or liposomal
amphotericin B
• Consider antifungal therapy if:
*Prolonged febrile neutropaenia
*AML,Relapsed acute Leukemia
* Allogeneic HSCT
* Receiving high dose corticosteroids
35. Fever(temperature >38.3oc) + Neutropaenia
(<500neutrophils/mm3)
Obvious catheter – related infection
Known colonization with MRSA or B-lactam resistant
pneumococcus
Severe Mucositis
Hypotension or sepsis syndrome
Positive blood culture for gram positive organism (pending
susceptibility testing)
Vancomycin not
needed
Duotherapy
Cefepime,
Ceftazidime
Or
Carbapenem
Aminoglycoside
+
Antipseudomonal
penicillin,
cefepime,ceftazidime,or
carbapenem
Vancomycin needed
Vancomycin
+
Cefepime,ceftazidime.or
carbapenem
+/-
aminoglycoside
NO YES
Monotherapy Vancomycin +
36. Treatment Monitoring
3 – 5 days,
The condition of the patient is the primary determinant of
further therapy:
*Absence of presenting signs & symptoms of sepsis
*No evident source of infection
*Clinical improvement
*negative cultures after 48hours
*ANC > 100/mm3
Consideration
Change to an appropriate oral antibiotics i.e Cefixime.
Discharge to continue parental medications at home.
37. Afebrile within 1st 3 days of
treatment
No etiology
identified
Low
risk
High risk
Consider
discharge
Continue antibiotic
therapy
Etiology identified
Adjust to most
appropriate treatment
38. MONITORING CONT…
After the 5th day
Antibiotics may be discontinued after the 7th day if :
*Patient remains afebrile
*If ANC > 500/mm3
*Evidence of bone marrow recovery
Continue parenteral Antibiotics if:
* ANC remains < 100/mm3
*Ongoing mucositis
* factors predisposing to recurrent
infections(even if afebrile)
39. After the 5th day
If fever continues beyond 5 days, actively consider:
*Non bacterial infection
*A drug resistance organism
*Poorly accesible focus of infection(e.g Abscess)
*Inadequate dosing of antimicrobials
*non-infectious cause of fever
Considerations
Re-examine thoroughly
Repeat blood cultures + fungal cultures
Imaging studies
Continue antibiotics for at least 2 weeks
Commence antifungal therapy
40. Persistent fever during
treatment
No etiology identified
Reassess patient on Day 4 to
5
Clinically stable:
Continue initial
antibiotics
Unstable or toxic :
Change antibiotics
If no change in patient,
consider stopping
Vancomycin(if used
initially)
If progressive disease, add
vancomycin and consider
other
changes(anaerobes,entero
cocci)
Febrile through day 5 –
7
Resolution of
neutropaenia not
imminent
Add Antifungal therapy
with or without change
in Antibiotics
41. DURATION OF TREATMENT
Traditionally,broad spectrum antibiotic therapy is
continued until the ANC has returned to >0.5 x
109/L .
Antibiotics may be discontinued after 7 days(as
earlier explained)
Persistent fever in patients with ongoing
neutropaenia requires treatment for a minimum of
2 weeks.
42. OTHER CONSIDERATIONS
The use of Colony GSF
*Not recommended routinely
*Can shorten the duration of neutropaenia
*Does not decrease mortality
Granulocyte Infusions
Use of probiotics/prebiotics
Prophylactic antimicrobial therapy
43. CONCLUSION
Currently,appropriate administeration of
antibacterial and antifungal antibiotics remain
standard of care.
Each institution must develop a plan of care,
based on local epidemiology and resistance
pattern of infection.
Definitive guidelines for risk stratification in the
paediatric population as compared to adults are
not available.
44. REFERENCES
Andrew YK. Prolonged febrile neutropaenia in the paediatric
patient with Cancer. ASCO Educational book 2012; Vol 32:
565 – 569
Alia Z. Febrile Neutropaenia current guidelines for Children,
January,2016. SIOP PODC Supportive care Education.
Davis K,Wilson S. Febrile Neutropaenia in paediatric
oncology. Paediatr Child Health (Oxford). 2020 Mar;30(3):93
– 97.
Rudolph M., Rudolph CD, Paller,Hostettter MK,Lister G. &
Siegel Nj (2011)Rudolphs Textbook of Paediatrics 22nd Ed.
McGraw Hill