[The latest developments in control of fungal infections in neutropenic patients]

Abstract

Fever is the main expression of infections in immunocompromised patients and, therefore, an extremely important sign (1). Although none are pathognomonic, the several fever patterns described for infectious and inflammatory pathologies are, unfortunately, not yet proven applicable to immunocompromised patients, making the treatment of this specific group of patients an even greater challenge. Some of these patients, especially the elder and those under treatment with corticosteroids, may present with severe cases of infection and no fever, calling for more careful monitoring. In view of the diagnostic uncertainties, of the few clinical signs and of the potential for quick progression to severe infections, fever in neutropenic patients is considered a medical emergency (2, 3). Patients with a neutrophil count<500/mm3 are those who present a greater number of fever episodes. Before the era of empirical antibiotic therapy, febrile neutropenia was the cause of 70% of chemotherapeutic treatment related deaths (4). With new additions to the antimicrobial arsenal and the introduction of wide-range antibiotics, treatment outcomes for this condition improved significantly, allowing for the use of more toxic and often more efficient chemotherapy regimens.