Risk and types of infections in, and initial management of, children with non-chemotherapy-induced neutropenia and fever

Category	Condition	Predominant causes of fever	Initial management
Low risk	Transient isolated neutropenia in otherwise healthy child	Viral infection	Appropriate treatment for age or site of localized infection Careful follow-up Serial blood counts to ensure that neutropenia resolves
	Chronic autoimmune neutropenia/chronic idiopathic neutropenia	Common: Upper respiratory tract infections Acute otitis media Skin infections Gingivitis Mouth ulcers	Oral antibiotics as indicated for suspected bacterial infections and close outpatient follow-up for patients with adequate bone marrow reserves for most common infections Skin and soft tissue infections generally warrant hospitalization and parenteral antibiotics
		Less common: Pneumonia Periorbital cellulitis Labial cellulitis or abscess in females Meningitis Sepsis	Hospitalization and parenteral antibiotics for complicated febrile illnesses* Individualized management for children with history of complicated febrile illness*
Low-moderate risk	Cyclic neutropenia	Common: Oral ulcers Gingivitis Periodontitis Pharyngitis Adenopathy	Generally do not require antibiotics for fevers or mucocutaneous inflammatory lesions that are typical during neutrophil nadirs
		Less common: Bacteremia Cellulitis Acute otitis media Sinusitis Pneumonia Peritonitis	Individualized management for: Atypical fevers or lesions Less common localized infections (eg, cellulitis, acute otitis media, sinusitis, pneumonia, peritonitis) Children with a history of complicated febrile illness*
		Uncommon: Clostridium-associated necrotizing enterocolitis	Hospitalization and broad-spectrum parenteral antibiotics for: Abdominal pain Significant localized infection Signs of sepsis
High risk	Severe congenital neutropenia	Omphalitis Cellulitis Perirectal abscess Sepsis	Hospitalization and initiation of broad-spectrum antibiotics
	Aplastic anemia, including inherited forms: Shwachman-Diamond syndrome Fanconi anemia Dyskeratosis congenita	Dyskeratosis congenita Soft tissue infections Bacteremia Invasive fungal disease, especially due to Aspergillus spp	Hospitalization and initiation of broad-spectrum antibiotics Antifungal agents may be warranted for persistent unexplained fever
	Ill-appearing child with neutropenia	Cellulitis Perirectal abscess Sepsis Respiratory tract infections Bacteremia Invasive fungal disease, especially due to Aspergillus spp	Hospitalization and initiation of broad-spectrum antibiotics Antifungal agents may be warranted for persistent unexplained fever

This table is meant for use with UpToDate content on non-chemotherapy-induced neutropenia in children. Refer to UpToDate content for details, including antimicrobial management.

* Hemodynamic instability, gastrointestinal symptoms, new-onset neurologic signs or mental status changes, intravascular catheter infection (especially catheter tunnel infection), underlying chronic lung disease, new pulmonary infiltrate, hypoxemia, skin or soft tissue infection, or sinus tenderness or other findings of upper respiratory tract infection.

Graphic 65091 Version 15.0

خرید پکیج

Risk and types of infections in, and initial management of, children with non-chemotherapy-induced neutropenia and fever