The doctor will conduct a detailed history and complete physical examination to identify the cause of the fever and its source. Common sites of infections include:
- Upper respiratory tract (Otitis Media or Sinusitis)
- Oropharynx (Dental Abscess or Mucositis)
- Lower respiratory tract (Pneumonia, including Pneumocystis Jirovecii Pneumonia)
- Gastrointestinal tract (Clostridium Difficile Colitis or Typhlitis)
- Skin (Cellulitis, Chicken Pox or Herpes Virus Infection)
- Perineum and perianal area (Anal Fissure or Abscess)
- Central catheter sites (Tunnel or Exit Site Infection)
For a child with neutropenic fever, the following tests and imaging studies may be performed:
- Full blood count
- Tests to assess the degree of inflammation indicating a serious bacterial infection
- Blood cultures from central venous lines, if present
- Samples from potential infection sites (urine, sputum, wound, stool and others) for testing
- Chest X-ray for symptomatic cases (e.g., cough, breathlessness, low oxygen saturations)
- Respiratory viral immunofluorescence or multiplex polymerase chain reaction for upper respiratory tract infection symptoms
- Imaging studies (CT scan, ultrasound, 2D-echo, etc.) as indicated by physical findings
Educating patients and caregivers about signs, symptoms and risks of neutropenic fever is crucial for successful treatment outcomes. This empowers them to seek timely treatment and prepare for potential complications.
Broad-spectrum antibiotics are promptly initiated after appropriate investigations. If a specific viral infection ,such as Herpes Simplex Virus or Cytomegalovirus, is evident, antiviral drugs may also be started. In cases of prolonged neutropenic fever, antifungal treatment may be considered for children at risk.
A child's discharge depends on the type of infecting organism, the source of infection and the child's recovery status. Discharge criteria include:
- Evidence of marrow recovery (ANC over 500/mm3 and rising)
- Absence of fever for at least 24 hours
- Low probability of bacterial or fungal blood infection after 48 hours
- Clinical well-being (haemodynamically stability with normal blood pressure, heart rate, oxygen saturation and respiratory rate)
- Provision of adequate care and monitoring at home
- Sufficient oral intake