The doctor will take a thorough history and do a complete physical exam to find out what is causing the fever and where the infection comes from. Common areas that infections may arise from are:
- 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)
The following laboratory tests and diagnostic imaging may be performed for a child with neutropenic fever:
- Full blood count
- Tests to look at degree of inflammation in the body that may indicate a serious bacterial infection
- Blood cultures from central venous lines, if any
- Samples from other sites (urine, sputum, wound, stool and others) will be collected and sent for testing if we suspect that there may be an infection from these sites
- Chest X-ray if symptomatic (displaying symptoms of a disease i.e. cough, breathlessness or low oxygen saturations)
- Respiratory Viral Immunofluorescence or Multiplex Polymerase Chain Reaction, if there are symptoms of upper respiratory tract infection
- Imaging studies (CT scan, ultrasound, 2D-echo etc.) will be considered as guided by the doctors' physical findings
Education of patients and their caregivers is crucial to the outcome of treatment as they need to be aware of the possible signs, symptoms and dangers of neutropenic fever. This will empower them to seek necessary treatment early and also to be prepared for the possible complications.
Broad spectrum antibiotics will be quickly initiated once the appropriate investigations are obtained. If there is evidence of a specific viral infection such as Herpes Simplex Virus or Cytomegalovirus, we may choose to initiate antiviral drugs as well. For children with prolonged neutropenic fever, we may initiate antifungal treatment if we think the child is at risk.
How fast a child can be discharged is dependent on the type of bacteria, fungus or virus, source of infection and how well the child recovers.
The child needs to fulfil all these criteria before he or she is allowed to be discharged:
- Evidence of marrow recovery - ANC more than 500/mm3 and rising
- No fever for at least 24 hours
- Low probability of having a blood infection caused by bacteria or fungi after 48 hours
- Clinically well i.e. haemodynamically stable (blood pressure, heart rate, oxygen saturation and respiratory rate within normal ranges)
- Adequate care and monitoring can be provided at home
- Able to eat and drink adequately