Skip to main content
Erschienen in: Supportive Care in Cancer 7/2006

01.07.2006 | Original Article

Causes of fever in cancer patients (prospective study over 477 episodes)

verfasst von: E. Toussaint, E. Bahel-Ball, M. Vekemans, A. Georgala, L. Al-Hakak, M. Paesmans, M. Aoun

Erschienen in: Supportive Care in Cancer | Ausgabe 7/2006

Einloggen, um Zugang zu erhalten

Abstract

Goals of work

The aim of this study was to determine the causes of fever among cancer patients.

Methods

All febrile cancer patients were followed up prospectively. Clinical, microbiological and radiological documentations were performed. Aetiologies of fever, type of tumour, site of infection, type of microorganism and outcome were assessed and compared between neutropenics and non-neutropenics.

Results

Four hundred and seventy-seven episodes were evaluated. Infection, non-infectious causes and fever of unknown origin represented 67, 23 and 10%, respectively. The respiratory tract is the most frequently involved site in infection (29%), and in microbiologically documented infections, Gram-negative bacilli were predominant. The tumour itself (27%) or an invasive procedure (17%) were the main causes of non-infectious febrile episodes. Mortality from infection was higher among non-neutropenic (11.1%) than neutropenic patients (4.3%).

Conclusion

Fever in cancer patients remains a challenge, and the differentiation between infectious and non-infectious causes at onset of fever is very difficult. Despite all the prophylactic measures, infection is still the principal cause. However, the infection-related mortality is low either in neutropenic or non-neutropenic patients.
Literatur
1.
Zurück zum Zitat Akova M, Paesmans M, Calandra T et al (2005) A European organization for research and treatment of cancer-international antimicrobial therapy group study of secondary infections in febrile, neutropenic patients with cancer. Clin Infect Dis 40:239–245CrossRefPubMed Akova M, Paesmans M, Calandra T et al (2005) A European organization for research and treatment of cancer-international antimicrobial therapy group study of secondary infections in febrile, neutropenic patients with cancer. Clin Infect Dis 40:239–245CrossRefPubMed
2.
Zurück zum Zitat Circiumaru B, Baldock G, Cohen J (1999) A prospective study of fever in the intensive care unit. Intensive Care Med 25:648–651CrossRefPubMed Circiumaru B, Baldock G, Cohen J (1999) A prospective study of fever in the intensive care unit. Intensive Care Med 25:648–651CrossRefPubMed
3.
Zurück zum Zitat Cometta A, Calandra T, Gaya H et al (1996) Monotherapy with meropenem versus combination therapy with ceftazidime plus amikacin as empiric therapy for fever in granulocytopenic patients with cancer. Antimicrob Agents Chemother 40:1108–1115PubMed Cometta A, Calandra T, Gaya H et al (1996) Monotherapy with meropenem versus combination therapy with ceftazidime plus amikacin as empiric therapy for fever in granulocytopenic patients with cancer. Antimicrob Agents Chemother 40:1108–1115PubMed
4.
Zurück zum Zitat Cometta A, Kern WV, De Bock R et al (2003) Vancomcyin versus placebo for treating persistent fever in patients with neutropenic cancer receiving piperacillin-tazobactam monotherapy. Clin Infect Dis 37:382–389CrossRefPubMed Cometta A, Kern WV, De Bock R et al (2003) Vancomcyin versus placebo for treating persistent fever in patients with neutropenic cancer receiving piperacillin-tazobactam monotherapy. Clin Infect Dis 37:382–389CrossRefPubMed
5.
Zurück zum Zitat Dinarello CA (1996) Thermoregulation and the pathogenesis of fever. Infect Dis Clin North Am 10:433–449CrossRefPubMed Dinarello CA (1996) Thermoregulation and the pathogenesis of fever. Infect Dis Clin North Am 10:433–449CrossRefPubMed
6.
Zurück zum Zitat Dinarello CA, Bunn PA Jr (1997) Fever. Semin Oncol 24:288–298PubMed Dinarello CA, Bunn PA Jr (1997) Fever. Semin Oncol 24:288–298PubMed
7.
Zurück zum Zitat Ezidiegwu CN, Lauenstein KJ, Rosales LG et al (2004) Febrile nonhemolytic transfusion reactions. Management by premedication and cost implications in adult patients. Arch Pathol Lab Med 128:991–995PubMed Ezidiegwu CN, Lauenstein KJ, Rosales LG et al (2004) Febrile nonhemolytic transfusion reactions. Management by premedication and cost implications in adult patients. Arch Pathol Lab Med 128:991–995PubMed
8.
Zurück zum Zitat Fanning J, Neuhoff RA, Brewer JE et al (1998) Frequency and yield of postoperative fever evaluation. Infect Dis Obstet Gynecol 6:252–255CrossRefPubMed Fanning J, Neuhoff RA, Brewer JE et al (1998) Frequency and yield of postoperative fever evaluation. Infect Dis Obstet Gynecol 6:252–255CrossRefPubMed
9.
Zurück zum Zitat Garcia-Suarez J, Krsnik I, Reyes E et al (2003) Elderly haematological patients with chemotherapy-induced febrile neutropenia have similar rates of infection and outcome of younger adults: a prospective study of risk-adapted therapy. Br J Haematol 120:209–216CrossRefPubMed Garcia-Suarez J, Krsnik I, Reyes E et al (2003) Elderly haematological patients with chemotherapy-induced febrile neutropenia have similar rates of infection and outcome of younger adults: a prospective study of risk-adapted therapy. Br J Haematol 120:209–216CrossRefPubMed
10.
Zurück zum Zitat Hann I, Viscoli C, Paesmans M et al (1997) A comparison of outcome from febrile neutropenic episodes in children compared with adults: results from four EORTC studies. International Antimicrobial Therapy Cooperative Group (IATCG) of the European Organization for Research and Treatment of Cancer (EORTC). Br J Haematol 99:580–588CrossRefPubMed Hann I, Viscoli C, Paesmans M et al (1997) A comparison of outcome from febrile neutropenic episodes in children compared with adults: results from four EORTC studies. International Antimicrobial Therapy Cooperative Group (IATCG) of the European Organization for Research and Treatment of Cancer (EORTC). Br J Haematol 99:580–588CrossRefPubMed
11.
Zurück zum Zitat Henderson RA, Pinder L (1990) Acute transfusion reactions. N Z Med J 103:509–511PubMed Henderson RA, Pinder L (1990) Acute transfusion reactions. N Z Med J 103:509–511PubMed
12.
Zurück zum Zitat Hughes W, Armstrong D, Bodey GP et al (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751CrossRefPubMed Hughes W, Armstrong D, Bodey GP et al (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751CrossRefPubMed
13.
Zurück zum Zitat Klastersky J (1994) Non-infectious causes of fever in cancer patients. In: Glauser MP, Calandra T (eds) International practice and research on infections in immunocompromised oncological patients, vol. 1. Baillière Tindall, London, pp 439–454 Klastersky J (1994) Non-infectious causes of fever in cancer patients. In: Glauser MP, Calandra T (eds) International practice and research on infections in immunocompromised oncological patients, vol. 1. Baillière Tindall, London, pp 439–454
14.
Zurück zum Zitat Klastersky J (1998) Science and pragmatism in the treatment and prevention of neutropenic infection. J Antimicrob Chemother 41(suppl. D):13–24CrossRefPubMed Klastersky J (1998) Science and pragmatism in the treatment and prevention of neutropenic infection. J Antimicrob Chemother 41(suppl. D):13–24CrossRefPubMed
15.
Zurück zum Zitat Klastersky J, Weerts D, Hensgens C et al (1973) Fever of unexplained origin in patients with cancer. Eur J Cancer 9:649–656PubMed Klastersky J, Weerts D, Hensgens C et al (1973) Fever of unexplained origin in patients with cancer. Eur J Cancer 9:649–656PubMed
16.
Zurück zum Zitat Le Roux P, de Blic J, Albertini M et al (2004) Flexible bronchoscopy in children. Experience at French centers of pediatric pneumology. Rev Mal Respir 21:1098–1106PubMed Le Roux P, de Blic J, Albertini M et al (2004) Flexible bronchoscopy in children. Experience at French centers of pediatric pneumology. Rev Mal Respir 21:1098–1106PubMed
17.
Zurück zum Zitat Luft FC, Rissing JP, White A et al (1976) Infections of neoplasm as causes of prolonged fever in cancer patients. Am J Med Sci 272:65–74PubMedCrossRef Luft FC, Rissing JP, White A et al (1976) Infections of neoplasm as causes of prolonged fever in cancer patients. Am J Med Sci 272:65–74PubMedCrossRef
18.
Zurück zum Zitat Mackowiak PA, Le Maistre CF (1987) Drug fever: a critical appraisal of conventional concepts. An analysis of 51 episodes in two Dallas hospitals and 97 episodes reported in the English literature. Ann Intern Med 106:728–733PubMed Mackowiak PA, Le Maistre CF (1987) Drug fever: a critical appraisal of conventional concepts. An analysis of 51 episodes in two Dallas hospitals and 97 episodes reported in the English literature. Ann Intern Med 106:728–733PubMed
19.
Zurück zum Zitat McGeer A, Feld R (1994) Epidemiology of infection in immunocompromised oncological patients. In: Glauser MP, Calandra T (eds) International practice and research on infections in immunocompromised oncological patients, vol. 1. Baillière Tindall, London, pp 415–438 McGeer A, Feld R (1994) Epidemiology of infection in immunocompromised oncological patients. In: Glauser MP, Calandra T (eds) International practice and research on infections in immunocompromised oncological patients, vol. 1. Baillière Tindall, London, pp 415–438
20.
Zurück zum Zitat Mulabecirovic A, Gaulhofer P, Auner HW et al (2004) Pulmonary infiltrates in patients with haematological malignancies: transbronchial lung biopsy increases the diagnostic yield with respect to neoplastic infiltrates and toxic pneumonitis. Ann Hematol 83:420–422CrossRefPubMed Mulabecirovic A, Gaulhofer P, Auner HW et al (2004) Pulmonary infiltrates in patients with haematological malignancies: transbronchial lung biopsy increases the diagnostic yield with respect to neoplastic infiltrates and toxic pneumonitis. Ann Hematol 83:420–422CrossRefPubMed
21.
Zurück zum Zitat Pizzo PA, Robichaud KJ, Wesley R et al (1982) Fever and pediatric and young adult patient with cancer. A prospective study of 1,001 episodes. Medicine 61:153–165PubMedCrossRef Pizzo PA, Robichaud KJ, Wesley R et al (1982) Fever and pediatric and young adult patient with cancer. A prospective study of 1,001 episodes. Medicine 61:153–165PubMedCrossRef
22.
Zurück zum Zitat Rossi C, Klastersky J (1996) Initial empirical antibiotic therapy for neutropenic fever analysis of the cause of death. Support Care Cancer 4:207–212CrossRefPubMed Rossi C, Klastersky J (1996) Initial empirical antibiotic therapy for neutropenic fever analysis of the cause of death. Support Care Cancer 4:207–212CrossRefPubMed
23.
Zurück zum Zitat Rubio M, Palau L, Vivas JR et al (1994) Predominance of gram-positive microorganisms as a cause of septicemia in patients with hematological malignancies. Infect Control Hosp Epidemiol 15:101–104PubMedCrossRef Rubio M, Palau L, Vivas JR et al (1994) Predominance of gram-positive microorganisms as a cause of septicemia in patients with hematological malignancies. Infect Control Hosp Epidemiol 15:101–104PubMedCrossRef
24.
Zurück zum Zitat Scharfe T, Alken P, Muller ST et al (1990) Percutaneous litholapaxy. Indications and limitations of the technique in complex nephrolithiasis. Arch Esp Urol 43:311–318PubMed Scharfe T, Alken P, Muller ST et al (1990) Percutaneous litholapaxy. Indications and limitations of the technique in complex nephrolithiasis. Arch Esp Urol 43:311–318PubMed
25.
Zurück zum Zitat Velasco E, Byington R, Martins CS et al (2004) Bloodstream infection surveillance in a cancer centre: a prospective look at clinical microbiology aspects. Clin Microbiol Infect 10:542–549CrossRefPubMed Velasco E, Byington R, Martins CS et al (2004) Bloodstream infection surveillance in a cancer centre: a prospective look at clinical microbiology aspects. Clin Microbiol Infect 10:542–549CrossRefPubMed
26.
Zurück zum Zitat Viscoli C (1998) The evolution of the empirical management of fever and neutropenia in cancer patients. J Antimicrob Chemother 41 (suppl. D.):65–80CrossRefPubMed Viscoli C (1998) The evolution of the empirical management of fever and neutropenia in cancer patients. J Antimicrob Chemother 41 (suppl. D.):65–80CrossRefPubMed
27.
Zurück zum Zitat Viscoli C, Bruzzi P, Castagnola E et al (1994) Factors associated with bacteraemia in febrile, granulocytopenic cancer patients. The International Antimicrobial Therapy Cooperative Group (IATCG) of the European Organization for Research and Treatment of Cancer (EORTC). Eur J Cancer 30A:430–437CrossRefPubMed Viscoli C, Bruzzi P, Castagnola E et al (1994) Factors associated with bacteraemia in febrile, granulocytopenic cancer patients. The International Antimicrobial Therapy Cooperative Group (IATCG) of the European Organization for Research and Treatment of Cancer (EORTC). Eur J Cancer 30A:430–437CrossRefPubMed
28.
Zurück zum Zitat Zihlif M, Khanchandani G, Ahmed HP et al (2005) Surgical lung biopsy in patient with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: improved outcome with specific diagnosis. Am J Hematol 78:94–99CrossRefPubMed Zihlif M, Khanchandani G, Ahmed HP et al (2005) Surgical lung biopsy in patient with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: improved outcome with specific diagnosis. Am J Hematol 78:94–99CrossRefPubMed
Metadaten
Titel
Causes of fever in cancer patients (prospective study over 477 episodes)
verfasst von
E. Toussaint
E. Bahel-Ball
M. Vekemans
A. Georgala
L. Al-Hakak
M. Paesmans
M. Aoun
Publikationsdatum
01.07.2006
Verlag
Springer-Verlag
Erschienen in
Supportive Care in Cancer / Ausgabe 7/2006
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-005-0898-0

Weitere Artikel der Ausgabe 7/2006

Supportive Care in Cancer 7/2006 Zur Ausgabe

Forthcoming Meetings

Forthcoming Meetings

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

CUP-Syndrom: Künstliche Intelligenz kann Primärtumor finden

30.04.2024 Künstliche Intelligenz Nachrichten

Krebserkrankungen unbekannten Ursprungs (CUP) sind eine diagnostische Herausforderung. KI-Systeme können Pathologen dabei unterstützen, zytologische Bilder zu interpretieren, um den Primärtumor zu lokalisieren.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Adjuvante Immuntherapie verlängert Leben bei RCC

25.04.2024 Nierenkarzinom Nachrichten

Nun gibt es auch Resultate zum Gesamtüberleben: Eine adjuvante Pembrolizumab-Therapie konnte in einer Phase-3-Studie das Leben von Menschen mit Nierenzellkarzinom deutlich verlängern. Die Sterberate war im Vergleich zu Placebo um 38% geringer.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.