Neutropenic Enterocolitis: Spectrum of the Disease and Comparison of Definite and Possible Cases

Gómez, Luz Adriana; Martino, Rodrigo; Rolston, Kenneth V. I.

doi:10.1086/514946

Cited by 141 publications

(91 citation statements)

References 17 publications

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“…Neutropen enterocolitis is reported to occur in 0.8% to 26% of neutropenic episodes and the case fatality has been reported to be 50% or higher [61]. The clinical presentation of neutropen enterocolitis is broad with patients with proven imaging findings having more severe disease [62]. The need for radiological confirmation is discussed but recommended by many authors [61].…”

Section: Gastrointestinal Infectionsmentioning

confidence: 99%

Risk of Infections in Adult Patients with Haematological Malignancies

Nørgaard¹

2012

TOIDJ

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Abstract:Patients with haematological malignancies are at increased risk of infections not only because of the malignancy itself but also because of neutropenia induced by intensive chemotherapeutic treatment, and the cytotoxic effect on the cells that line the alimentary tract. In haematological malignancy patients with a compromised inflammatory response, the classic signs and symptoms of infection may be masked. The results of blood cultures therefore play an important diagnostic role. Bacteraemia is a relatively common serious complication occurring in around 15% of patients with haematological malignancies within the first years after diagnosis but the risk varies between different types of haematological malignancies. Other risk factors for bacteraemia are presence of mucositis, neutropenia, and use of central venous catheters. Invasive fungal diseases are also serious infectious complications in this population. Viral infections are particularty often in patients that have received a bone marrow transplant. Future work in this field could focus on potential modifiable risk factors and on how time since haematological diagnosis may influence risk of infection.

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Section: Gastrointestinal Infectionsmentioning

confidence: 99%

Risk of Infections in Adult Patients with Haematological Malignancies

Nørgaard¹

2012

TOIDJ

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“…First, typhlitis occurs after the administration of cytotoxic drugs, particularly high-dose cytarabine, etoposide and anthracyclines at the nadir of neutropenia and thrombocytopenia. Secondly, prolonged exposure to antibiotics results in a marked shift in the gut microflora towards toxin producing bacteria 55 such as Staphylococcus aureus, Pseudomonas aeruginosa and Clostridium septicum. 56,57 In fact, Clostridium species are now more likely to predominate for reasons which are poorly understood so that bacteraemia due to C. tertium or C. septicum is almost pathognomonic for typhlitis.…”

Section: Neutropenic Typhlitis a Paradigm For Gut Mbimentioning

confidence: 99%

Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview

Blijlevens¹,

Donnelly²,

Pauw³

2000

Bone Marrow Transplant

236

153

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Summary:Mucositis is an inevitable side-effect of the conditioning regimens used for haematopoietic stem cell transplantation. The condition is better referred to as mucosal barrier injury (MBI) since it is primarily the result of toxicity and is a complex and dynamic pathobiological process manifested not only in the mouth but also throughout the entire digestive tract. A model has been proposed for oral MBI and consists of four phases, namely inflammatory, epithelial, ulcerative and healing phases. A variety of factors are involved in causing and modulating MBI including the nature of the conditioning regimen, the elaboration of pro-inflammatory and other cytokines, translocation of the resident microflora and their products, for example, endotoxins across the mucosal barrier, exposure to antimicrobial agents and whether or not the haematopoietic stem cell graft is from a donor. Neutropenic typhlitis is the most severe gastrointestinal manifestation of MBI, but it also influences the occurrence of other major transplant-related complications including acute GVHD, veno-occlusive disease and systemic infections. The pathobiology, clinical counterparts and the means of measuring MBI are discussed together with potential approaches for prevention, amelioration and, perhaps, even cure. Bone Marrow Transplantation (2000) 25, 1269-1278. Keywords: mucositis; mucosal barrier injury; diagnosis; risk factors; treatment Mucositis is an inevitable side-effect of the intensive conditioning therapy used for haematopoietic stem cell transplantation 1 and usually refers to the mucosal ulceration of mouth and throat. However, it is generally accepted that oral mucositis is in reality the most obvious manifestation of damage or injury elsewhere particularly that of the gut. Hence, mucosal barrier injury (MBI) may be a more appropriate term for this biological process. There exists no clear definition of MBI which is defined by a constellation of signs and symptoms that vary in their clinical expression. Oral MBI is reported to affect 60% to 100% of transplant recipients 2,3 and is characterised by pain, oedema, erythema, lesions, pseudomembrane formation, excessive mucous production, reduced saliva and bleeding, all of which reduce the patient's ability to eat and drink. In contrast, there are no reliable data on the incidence of gut MBI although intestinal symptoms affect almost every transplant recipient to some extent and include nausea, vomiting, abdominal cramping and watery diarrhoea occasionally accompanied by macroscopic blood loss. The exact course and severity of bowel symptoms of MBI are also difficult to ascertain because many patients are in such pain due to oral MBI that they only gain relief from narcotic analgesia which induces constipation as a result of reduced gut motility. There are also a number of scoring systems for oral MBI 4 although none is universally accepted and all lack standardisation. As yet, there is no system for registering gut MBI although there are published definitions for grading toxicity o...

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“…The clinical hallmarks of ne include fever and abdominal pain, but abdominal distention, bloating, and diarrhea have also been reported as associated signs and symptoms 4,5 . Neutropenic enterocolitis is most commonly reported to affect patients undergoing chemotherapy, but it has also been seen in patients who develop neutropenia in other conditions such as chronic neutropenia and infection with hiv 6,7 .…”

Section: Discussionmentioning

confidence: 99%

Painless Neutropenic Enterocolitis in a Patient Undergoing Chemotherapy

Chow

Bishop

2016

Current Oncology

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Case Description A 60-year-old man developed painless neutropenic enterocolitis after induction chemotherapy for newly diagnosed acute myelogenous leukemia. The patient had recurrent fever while neutropenic, without experiencing abdominal pain or tenderness on physical examination. His diagnosis was delayed by the fact that he had no localizing symptoms.Discussion Neutropenic enterocolitis is a common complication, generally occurring in patients who are severely neutropenic; the condition presents with fever and abdominal pain. No cases of painless neutropenic enterocolitis have yet been reported. Review of the literature shows that patients can develop this condition in the absence of fever and, sometimes, neutropenia. Furthermore, few comprehensive studies or reviews have investigated the utility of computed tomography imaging in identifying a source for abdominal pain in neutropenic patients with fever.Summary Many potential causes of febrile neutropenia should be considered in chemotherapy patients.

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Neutropenic Enterocolitis: Spectrum of the Disease and Comparison of Definite and Possible Cases

Cited by 141 publications

References 17 publications

Risk of Infections in Adult Patients with Haematological Malignancies

Risk of Infections in Adult Patients with Haematological Malignancies

Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview

Painless Neutropenic Enterocolitis in a Patient Undergoing Chemotherapy

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