Neutropenic Sepsis - Symptoms, Diagnosis, and Treatment

Introduction

A body response to an infection is called neutropenic sepsis. It is a severe ailment that may be fatal. It may occur if persons are simultaneously infected and have a low neutrophil count. It is also known as febrile neutropenia. Neutropenic Sepsis usually affects a person who has received any anti-cancer treatment during the previous four weeks or a patient with a low level of neutrophils. It is also seen in patients having temperatures of 37.5 degrees Celsius or higher or with a temperature below 36 degrees Celsius.

What Is Sepsis?

Septicemia, an infection of the blood, can lead to sepsis, a systemic reaction. When an infection is so bad that it overwhelms the body's organs, it can lead to sepsis. Sepsis can have any of the following effects:

• Fever exceeding 103 degrees Fahrenheit.

• Cold and sweating.

• Changes in consciousness, disorientation, and sluggishness.

• Tachycardia (rapid heart rate).

• Tachypnea (rapid breathing).

• Dyspnea (difficulty breathing).

• Low blood pressure or blood pressure swings.

• Lower urination.

• Glucose levels change.

• An increase in the risk of blood clots, such as heart attacks, strokes, pulmonary embolism, deep vein thrombosis (a clot in a vein), and heart attacks (a clot blocking a blood vessel in the brain).

• The infection can also cause discomfort, swelling, pelvic or abdominal pain, breathing difficulties, and other symptoms.

• A medical emergency called sepsis can get much more severe very quickly. Medical attention is urgently needed for this situation.

What Is Neutropenia?

There are various types of immune cells, including white blood cells. The most prevalent kind of white blood cell is the neutrophil. They support healing and recovery from illnesses and the fight against bacterial and other infections. A low white blood cell count is known as neutropenia. This condition can be brought on by cancer, cancer treatment, illnesses or infections, or as a side effect of the medicine. The most frequent cause of severe neutropenia is cancer treatment, which raises the risk of infections. Neutropenia can make infections worse and result in neutropenic sepsis.

What Is the Incidence of Neutropenic Sepsis?

70 to 100 percent of persons with a low neutrophil count as a result of treatment can develop neutropenic sepsis. Neutropenic sepsis is regarded as a medical emergency since it can be fatal. Neutropenia puts a person at risk for neutropenic sepsis. The risk is higher when the neutrophil count is extremely low, stays low for a long time, and other white blood cells are also low.

What Distinguishes Neutropenic Sepsis From Non-Neutropenic Sepsis?

Cancer itself predisposes a person to neutropenia, as does chemotherapy. Sepsis typically happens when a localized fungal or bacterial infection spreads across the body. It can occur anywhere in the body. The earliest signs and symptoms that appear before sepsis takes hold usually correspond to the infection's original location of origin.

Initial signs of infection examples include:

• Pulmonary Infection - Chest tightness, coughing, and wheezing are symptoms of a respiratory illness.

• Digestive Tract Infection - Infection of the digestive tract, which results in nausea, vomiting, and diarrhea

• Urinary Tract Infection - Blood in the urine and dysuria (painful urination) are symptoms of urinary tract infections.

• Skin Infection - An infection of the skin that may result in redness, pus, or discomfort

However, the signs and symptoms may manifest differently in someone with neutropenic sepsis. Neutropenic sepsis shows symptoms like confusion or stomach discomfort but no fever. As a result, the course of treatment for neutropenic sepsis may vary from that of non-neutropenic sepsis.

What Are the Symptoms of Neutropenic Sepsis?

• A fever may be present in a patient with sepsis who is not neutropenic, but it may not be present in a neutropenic patient.

• The neutropenic patient with sepsis may also experience disorientation or gastrointestinal distress.

• Additional sepsis warning indicators include erratic blood pressure, changed glucose levels, breathing difficulties, a rapid heartbeat, and altered mental status.

How to Diagnose Neutropenic Sepsis?

• A complete blood count (CBC), kidney function tests, liver function tests, additional specialized testing for C-reactive protein, and venous lactate are all components of the diagnostic process for neutropenic sepsis.

• The diagnosis process includes locating the infection source.

• Blood cultures should be taken from a vein or from the central venous line. A thin, flexible tube is put in a vein in the neck, chest, or arm. Blood cultures may yield false-positive results, showing the absence of a condition when it exists.

What Is the Treatment of Neutropenic Sepsis?

• Treatment for neutropenic sepsis must be aggressive. The treatment entails careful monitoring and regulation of vital signs (pulse, breathing rate, blood pressure, and temperature) to avoid consequences such as organ failure.

• The infection must be treated immediately.

• Antibiotics that are directed at particular pathogenic bacteria can be used to treat neutropenia and prevent issues with antibiotic resistance.

• A systemic fungal infection may occasionally require antifungal treatment. Candida and Aspergillus are the two most prevalent fungi that cause infections in neutropenic sepsis.

• Some examples of systemic therapy include intravenous fluids, electrolytes, nutrition supplementation, blood pressure, heart rate drugs, glycemic control, oxygen supplementation, mechanical breathing aid, or dialysis (mechanical blood filtering).

• Other crucial actions include safeguards against blood clots and preventative measures against sores and further infections.

How to Prevent Neutropenic Sepsis?

A medical team will advise about neutropenic safety measures to reduce the risk of infections if a person has neutropenia. Precautions can consist of:

• Ensure all meat, poultry, and fish are properly cooked before consumption.

• Washing carefully before eating raw fruit and vegetables.

• After using the restroom and touching anything contaminated, a person should wash their hands thoroughly.

• Keeping a distance from anybody infected with a contagious disease.

• Preventing crowds.

• Having a balanced diet, getting adequate sleep, and drinking plenty of water.

• Continuing activity.

• It is crucial to stay up to date with advised immunizations, even when the timing can be challenging. Occasionally, a low white blood cell count can reduce the efficacy of immunizations.

• To prevent the development of neutropenic sepsis, a person needs treatment for minor infections.

• Suppose the patient has any alarming symptoms, such as a fever, a wound with redness or pus, vomiting, diarrhea, a cough or sore throat, discomfort or burning when urinating, or any other symptom. In that case, the patient should immediately go to the doctor.

• Adopting neutropenic precautions is crucial as they are a significant risk factor for sepsis. The infection must be treated, and the systemic effects must be monitored and managed in the case of neutropenic sepsis.

Conclusion

Sepsis with neutropenia is a dangerous disorder. It is crucial to take care if a person is neutropenic due to a medical condition or medical therapy to prevent infections that may become serious and lead to sepsis. The treatment includes ensuring that the white blood count, which includes neutrophil count, eventually returns to normal. The chance of developing neutropenic sepsis will decrease when the immune system strengthens.