Clinical Analysis Of Febrile Neutropenia With Abdominal Symptoms

Backgrounds and Objective:Recently, due to the improvement of chemotherapy regimens, the application ofmulti-drug combination regimens, the strong supportive care, and the development ofhematopoietic stem cell transplantation, the prognosis of hematological malignancieshad been significantly improved with a results of some patients to be long-termsurvivors. But morbidity and mortality of compilations caused by the disease itselfand the related treatment are still high. Neutropenic fever complicated by abdominalsymptoms is a life-threatening complication occurring most frequently after intensivechemotherapy in hematological malignancies with high mortality. Due to thediversity of clinical manifestation of abdominal symptoms, it is lack of unifiedinternational diagnostic criteria. There has been a debate on the treatment strategy.Recent researches shown that good clinical response can be expected by fast,broad-spectrum antibiotics, extra-GI nutrition and so on. This study retrospectivelyanalyzes the clinical manifestations and treatment of neutropenic fever withabdominal symptoms, so as to provide clinical data for the treatment of neutropenicfever with abdominal symptoms. Methods:Twenty-seven patients with neutropenic fever complicated by abdominalsymptoms treated in the department of hematology, The First Affiliated Hospital OfZhengzhou University during March,2012to December,2013were retrospectivelyanalysed. Patients’ clinical data such as clinical signs, laboratory tests, imagingfindings, relations with chemotherapy, treatment and the outcome were collected andrecorded.Results:ALL of twenty-seven cases of febrile neutropenia were complicated withabdominal symptoms, including bowel sounds decreased to disappeared/increased todisappeared, abdominal pain, abdominal tenderness, watery or bloody diarrhea,abdominal distension, nausea/vomiting (nothing to do with chemotherapy), andincreased abdominal muscle tone in some patients.Twenty-seven patients (100%) were in neutropenic period when fever occurred,and the fever (39.1℃~41.5℃) might present before or after abdominal symptoms.The above data indicated that all the patients experienced infection (T≥38.5℃,sustaining more than1h).The mean neutrophil count was0.11×109/L(0~0.5×109/L) at the onset ofsymptoms or during the acute illness. Blood electrolyte showed hypokalemia,hyponatremia, and hypocalcemia. PCT levels were elevated in all cases who receivedthe test. Blood cultures for pathogens were positive in three cases, while stoolcultures for pathogens were positive in five cases. Plain X-rays of the abdomen infour patients showed pneumatosis intestinalis. One patient showed signs of increasedintestinal wall thickness＞7.3mm by ultra-sonic examination.Of twenty-seven cases, seventeen cases received remission inductionchemotherapy, two cases received induction remission chemotherapy after relapse.And the other eight cases received post-remission chemotherapy. Twenty-one caseswith abdominal symptoms occured after the course of chemotherapy, with fourteencases within7days and seven cases in7days. In six cases with abdominal symptoms occurred during chemotherapy, who were all remission induction chemotherapypatients.All patients received promptly broad spectrum antibiotics as soon as abdominalsymptoms presented. After treatment for3to5days, if patient had fever persistent, orhistory of fungal infection, or positive G/GM, antifungal agents will be administrated.Supportive cares included: parenteral nutrition, gastrointestinal decompression,somatostatin application, and maintaining electrolyte balance, etc.After the treatment, twenty-five out of twenty-seven cases（92.59%）restoredneutrophils with normal body temperature. The symptoms and signs of abdomenwere disappeared. Six out of twenty-seven cases experienced severe complicationwith four cases saved and two cases dead.Conclusion:The abdominal symptoms in patients with neutropenic fever include bowelsounds decreased to disappeared/increased to disappeared, abdominal pain andtenderness, watery or bloody diarrhea, etc. Predisposing factors for developingintestinal infection were hematological malignancy treatment with chemotherapy andthe previous infection. Radiological imaging examination is helpful in diagnosis.Proper conservative management such as broad spectrum antibiotics, bowel rest,parenteral nutrition, and maintaining electrolyte balance can improve the outcomes ofpatients of febrile neutropenia with GI infections.