Febrile Neutropenia in Cancer Patient: Epidemiology, Microbiology, Pathophysiology and Management

Abstract

Febrile neutropenia (FN) is characterized by a decrease in neutrophils number to values below 500 cells/ mm3 and an occurrence of fever higher or similar to38.3oC. It commonly occurs in cancer patients as a result of chemotherapy regimens. Chemotherapy destroys carcinogenic cells but also attacks in many cases some normal cells including essential elements of the immune system. Fever is one of the characteristic symptoms of FN and is usually associated with the presence of an infection caused by various microorganisms. Bacteria, including Gram-positive isolates (currently dominating) and Gram-negative species (Dominant in the 1970s), are usually reported as the main microorganisms responsible for FN and cause complicated infections leading to death. Other types of microorganisms such as fungi and viruses are also associated with the condition. The incidence and epidemiology of FN are variable according to a multitude of factors such as the type of cancer, the age, and sex of the patient, the type and cycle of treatment. The morbidity and mortality rates of FN have decreased over the years as a result of the use of appropriate antibiotic treatment, preventive measures, risk assessment procedures and adequate patient management plans. However, FN, mainly associated with complicated infections remains a significant threat and an oncological emergency. The threat is amplified with the continuing occurrence of antibiotic resistant microorganisms, which causes infections that are difficult to treat, leading to the death of millions of people worldwide. Due the oncological significance of FN, the development of new technologies and medications for cancer treatment for use in modern medicine should take into account the risks associated with the occurrence of FN.