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Fever - non neutropenic

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Children with cancer may present with fever when not neutropenic. If a diagnosis is not apparent then it is often safer to treat as for febrile neutropenia initially. If there are any concerns, discuss with the paediatric oncologist on call. Otherwise, contact the oncology unit during normal hours.

Non-neutropenic fever

Children with cancer may also present with fevers when they are not neutropenic. This can be divided into:

  • children who have just received chemotherapy where the counts are expected to fall soon - consider treating as febrile neutropenia (see antibiotic protocol).
  • Newly diagnosed patients - consider treating as febrile neutropenia (see  antibiotic protocol).
  • Children on chemotherapy that is not myelo-suppressive where the counts are not expected to fall significantly.
  • Childen who have finished treatment.
  • Children whose counts are recovering after a neutropenic episode.

Management

Management of these patients is more difficult to determine and should be decided on an individual basis by the paediatric oncologist.

Some studies have shown rates of mortality from infection to be higher in non-neutropenic patients with cancer which may be due to delay in appropriate antibiotic therapy1.

Some of the factors used to guide decisions are:

  • Presence of a CVL - this increases the risk of infection in any child. The child should have blood cultures taken from all lumens of the CVL. Children without CVL should have peripheral cultures when bloods are being taken to check neutrophil count.
  • The child is clinically unwell with no obvious source - treat as for neutropenic fever (see antibiotic protocol).
  • The child has obvious signs of a respiratory viral infection - take appropriate swabs and blood cultures and consider treating conservatively and observe. During influenza season, start Tamiflu treatment for "flu-like illness" or discuss with infectious diseases.
  • The child has obvious site of infection - treat as appropriate after taking blood cultures - the child may not need "febrile neutropenia" antibiotic cover.

References

  1. Toussaint E et al. Causes of fever in cancer patients. Supportive care in cancer. 2006;14(7):763-9

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  • Date last published: 03 March 2014
  • Document type: Clinical Guideline
  • Services responsible: National Child Cancer Network