Neutropaenic sepsis

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What is Neutropaenic sepsis?

Neutropaenic sepsis is a systemic infection that occurs in the setting of decreased blood neutrophils (granulocytes).

A decrease in neutrophils increases the risk of infection, and once microorganisms have entered the body, reduces the body's ability to fight the infection.

Many microorganisms, including some that don't usually cause infections, may proliferate in these patients and cause disseminated infection.

Who gets Neutropaenic sepsis?

Up to 48.3% of neutropaenic cancer patients suffer infections and 21% of patients with cancer who experience neutropaenic fever will suffer serious complications. Neutropaenic sepsis carries an overall 4-30% mortality rate in cancer patients.

Predisposing Factors

Cancer patients may suffer neutropaenia as a result of their disease, for example leukaemia, but the most common causes are chemotherapy and radiotherapy. Most chemotherapy agents are myelosuppressive, meaning they suppress bone marrow function and thus production of white blood cells including neutrophils.

Progression

Neutropaenia increases the susceptibility of the body to bacterial infection. Patients with neutropaenia alone (i.e. no other white blood cell deficits) are not at increased risk of parasitic or viral infections. Prolonged neutropenia also increases the risk of systemic fungal infection.

The most common infections seen in neutropaenic patients are skin infections, including ulcers, abscesses and rashes that are slow to heal. Signs of infection such as warmth and swelling may be absent, as these are usually mediated by neutrophils.

Neutropaenic sepsis is when an infection enters the blood, often from a skin or gastrointestinal source, and becomes systemic. This is dangerous as many organ systems may be affected and the infection can worsen quickly.

Neutropaenic patients are susceptible to infections with the following bacteria: Staphylococci, Streptococci, Enterococci, Pseudomonas aeruginosa, Aeromonas hydrophila, Bacillus species, Corynebacteria and Enterobacteriaciae. Fungi from the species Candida, Aspergillus and Fusarium can also cause infection.

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