Febrile neutropenia

Question 1

Good broad spectrum regimen for new onset febrile neutropenia

Answer 1

• Piperacillin-tazobactam (Zosyn)
• Vancomycin
• Voriconazole (fungal, Aspergillus, and PJP coverage)
• +/- Acyclovir

Question 2

About 10% of BMT patients will develop opportunistic fungal infection with. . .

Answer 2

. . . Aspergillus or non-albicans Candida

Question 3

Fusarium

Answer 3

Ubiquitous fungus that can cause opportunistic fungal infections similar to Aspergillus and non-albicans Candida

Under the microscope it has septated hyphae in addition to oblong single cells.

Question 4

1-3-beta-D-glucan vs galactomannan tests

Answer 4

1-3-beta-D-glucan: Suggests some fungal infection, but is nonspecific as to which pathogen.

Galactomannan: Primarily to identify Aspergillus.

Both should be performed in patients with febrile neutropenia.

Question 5

What’s going on in the CT scan of this patient with febrile neutropenia?

Answer 5

This CT shows the halo sign – a focus of pulmonary infarction surrounded by a halo of hemorrhage.

This is highly suggestive of angioinvasive Aspergillus pneumonia in this context.

A similar halo sign may be seen in lung cancer, where it indicates peritumorial hemorrhage.

Question 6

Treatment options for invasive Aspergillus pneumonia

Answer 6

Voriconazole

Isavuconazole

Question 7

Neutropenia definition by Absolute Neutrophil Count

Answer 7

ANC < 100/mm³

High risk for infection by various pathogens, especially Aspergillus

Question 8

VISA

Answer 8

Vancomycin Intermediate Staph. Aureus

Staph that is partially resistant to Vancomycin due to decreased Vancomycin penetration across the cell wall.

Question 9

Infectious risks of early vs late complement deficiencies

Answer 9

Early: Encapsulated bacteria (S pneumoniae, H influenzae)

Late: Neisseria species

Question 10

Neutropenic patients should not be allowed to eat. . .

Answer 10

. . . raw vegetables

Unless they are irradiated

Question 11

Meningitis following solid organ transplant

Answer 11

Very likely to be Listeria

Question 12

New fever in a patient on TPN

Answer 12

You need to be highly suspicious of fungal septicemia

Fungi love TPN. The looove it.

Question 13

When a fever persists for >4 days despite broad spectrum empiric antibiotic therapy, you should consider. . .

Answer 13

. . . adding coverage for Candida/yeast and Aspergillus/mold