Neutropenia Febril: Revisão Da Literatura Em Pacientes Oncológicos

Abstract

Resumo:A neutropenia febril (NF) é uma complicação rotineira em pacientes com câncer submetidos a quimioterapia (QMT), sua apresentação clínica vai desde febre, com intensidades variáveis, sem outros sintomas acompanhados a sepse com grave infecção bacteriana ou fúngica, com grande impacto no prognóstico e mortalidade dos pacientes. Na última década, o prognóstico de muitos pacientes com doenças oncológicas e hematológicas malignas teve significativa melhora devido a novos quimioterápicos, transplantes de medula óssea e indicação de esquemas terapêuticos mais agressivos. As infecções são geralmente assintomáticas, de evolução rápida e muitas vezes fatais sendo essencial o diagnóstico e tratamento antibiótico precoce em pacientes neutropênicos febris. Diante de tal problemática o presente trabalho teve como pressuposto realizar uma revisão atualizada e completa sobre neutropenia febril em pacientes oncológicos, a fim de abordar sua etiologia, epidemiologia, diagnóstico clínico e tratamento. Palavras-chave: neutropenia, neoplasia, febre, infecção, câncerAbstract: Febrile neutropenia (FN) is a common complication in patients with cancer that are under chemotherapy treatment (QMT), its clinical presentation starts since from fever, with variable intensities, without other symptoms accompanied until sepsis with severe bacterial or fungal infection, with great impact on the prognosis and mortality. In the past decade, the prognosis of many patients with oncological and hematological malignancies has been significantly improved due to new chemotherapeutics, bone marrow transplants and indications of more aggressive therapeutic regimens. Infections are generally asymptomatic, of fast evolution and often fatal, and because of that is essential in febrile neutropenic patients, fast diagnosis and antibiotic treatment. In the face of such problematic, the present work had as presupposition to carry out an updated and complete review on febrile neutropenia in cancer patients, in order to address its etiology, epidemiology, clinical diagnosis and treatment.

First Insights into Clinical and Resistance Features of Infections by Klebsiella pneumoniae among Oncological Patients from a Referral Center in Amazon Region, Brazil

“…Several factors are associated with increased risk of infections among cancer patients. Severe and prolonged neutropenia induced by chemotherapy is the main risk factor for the acquisition of serious infections, including those caused by MDR pathogens [10,11]. Moreover, immunocompromised individuals demonstrate few clinical signs in bacterial infections, which are commonly confused with the symptoms of the underlying neoplasm or treatment side effects [7,10,11].…”

“…Severe and prolonged neutropenia induced by chemotherapy is the main risk factor for the acquisition of serious infections, including those caused by MDR pathogens [10,11]. Moreover, immunocompromised individuals demonstrate few clinical signs in bacterial infections, which are commonly confused with the symptoms of the underlying neoplasm or treatment side effects [7,10,11]. Other risk factors that contribute to poor prognosis infections in cancer patients are myeloablative therapy, total body irradiation, high doses of steroids, tissue grafting, prolonged hospitalization, recent surgery, resection of multiple organs, exposed cancer, enteral diet, ostomies, admission to intensive care unit (ICUs), presence of central venous catheter, bladder catheterization, ventilatory assistance, hemodialysis and disease chronic pulmonary disease [12][13][14][15].…”