Soluble tumor necrosis factor receptor type II in the early diagnosis of fever in neutropenia.

Sepsis in chemotherapy-associated neutropenia is a major cause of mortality in the treatment of acute myeloid leukemia (AML). Early diagnosis of sepsis is crucial for patient survival. We analyzed the value of prospectively measuring serum concentrations of soluble tumor necrosis factor receptor type II (sTNF-RII) in patients with AML for early diagnosis of sepsis in neutropenia. Therefore, 54 adult patients with AML and neutropenia were followed around the onset of fever. A total of 59 febrile episodes were documented. We could not demonstrate a significant increase in sTNF-RII levels prior to fever. sTNF-RII concentrations were not predictive of the severity of a febrile episode. Based on…

Early detection of pneumonia in febrile neutropenic patients: use of thin-section CT.

The purpose of this study was to evaluate the usefulness of thin-section CT for early detection of pneumonia in neutropenic patients with an unknown site of infection and normal or nonspecific findings on chest radiographs.Eighty-seven patients with febrile neutropenia that persisted for more than 2 days despite empiric antibiotic treatment underwent 146 prospective examinations. If findings on chest radiographs were normal (n = 126) or nonspecific (n = 20), thin-section CT (1-mm collimation, 10-mm increment) was done. If thin-section CT scans showed opacities, bronchoalveolar lavage was recommended.Findings on chest radiographs were nonspecific for pneumonia in 20 (14%) of 146 cases, and C…

Multiple renal aspergillus abscesses in an AIDS patient: contrast-enhanced helical CT and MRI findings.

Renal insufficiency or allergic reactions for X-ray contrast agents are frequent limitations in immunocompromised hosts such as neutropenic or AIDS patients. Due to a better tolerance of contrast agents in MRI, this technique is well suited for investigation of parenchymal organs. We demonstrate an allergic AIDS patient who presented with fever and flank pain. At sonography, anechoic renal lesions were supposed to be non-complicated cysts; however, on T2-weighted MRI, the center was of high signal. Dynamic contrast-enhanced MRI of the kidneys demonstrated an enhancing rim with ill-defined margins. The lesions were supposed to be multiple bilateral abscesses. Due to the multiple dynamic cont…

Fokussuche bei neutro- penischem Fieber

Magnetresonanztomographie (MRT) der Leber und des Gehirns bei hämatologisch-onkologischen Patienten mit Fieber unbekannter Ursache

PURPOSE To examine the advantage of liver and brain MRI in clinically anomalous haematological patients with fever of unknown origin. MATERIAL AND METHODS Twenty liver MRI (T2-TSE, T2-HASTE, T1-FLASH +/- Gd dynamic) and 16 brain MRI (T2-TSE, FLAIR, T1-TSE +/- Gd) were performed searching for a focus of fever with a suspected organ system. Comparison with clinical follow-up. RESULTS A focus was detected in 11/20 liver MRI. Candidiasis (n = 3), mycobacteriosis (n = 2), relapse of haematological disease (n = 3), graft versus host disease (n = 1), non-clarified (n02). The remaining 9 cases with normal MRI were not suspicious of infectious hepatic disease during follow-up. In brain MRI, 3/16 sho…

Liposomal Amphotericin B for Fever and Neutropenia

Pneumonia in Febrile Neutropenic Patients and in Bone Marrow and Blood Stem-Cell Transplant Recipients: Use of High-Resolution Computed Tomography

PURPOSE: To obtain statistical data on the use of high-resolution computed tomography (HRCT) for early detection of pneumonia in febrile neutropenic patients with unknown focus of infection. MATERIALS AND METHODS: One hundred eighty-eight HRCT studies were performed prospectively in 112 neutropenic patients with fever of unknown origin persisting for more than 48 hours despite empiric antibiotic treatment. Fifty-four of these studies were performed in transplant recipients. All patients had normal chest roentgenograms. If pneumonia was detected by HRCT, guided bronchoalveolar lavage was recommended. Evidence of pneumonia on chest roentgenograms during follow-up and micro-organisms detected…