Infectious Diseases Management of Febrile Neutropenia: Review Questions George J. Alangaden, MD Dr. Alangaden is an associate professor of internal medicine, Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI. Choose the single best answer for each question.
	1. A 38-year-old man with relapsed acute myelogenous leukemia (AML) recently received induction chemotherapy that included high-dose cytosine arabinoside. He is receiving antimicrobial prophylaxis with ciprofloxacin and fluconazole. On hospitalization, he has high fever, oral mucositis, and profound neutropenia. Soon after, he develops hypotension, rash, and acute respiratory distress syndrome. Which of the following is the most likely pathogen responsible for this patientıs clinical condition? Viridans streptococci Pseudomonas aeruginosa Candida albicans Staphylococcus aureus Herpes simplex virus (HSV) Click here to compare your answer. 2. A 54-year-old woman who is undergoing chemotherapy for multiple myeloma is hospitalized with a temperature of 101°F (38.3°C) and neutropenia. Clinical examination reveals pallor. Her tunneled Hickman catheter site appears normal. The rest of her examination is unremarkable. Blood cultures are obtained, and empiric therapy is started with intravenous cefepime and vancomycin. She remains febrile over the next 3 days with no change in her clinical status. Her blood cultures remain negative, and she remains neutropenic. What is the most appropriate management at this time? Stop all antibiotics Stop vancomycin Stop cefepime Continue current therapy Add amphotericin B Click here to compare your answer.		3. A 36-year-old man with AML receives an allogeneic stem cell transplantation. His post-transplantation course is complicated by prolonged neutropenia and fevers. He is started on empiric cefepime, and his fever slowly resolves over the next 6 days. All blood cultures remain negative. Engraftment occurs on day 21 post-transplant. Upon resolution of neutropenia, he develops sudden pain and diminished vision in his left eye. Ophthalmologic examination reveals chorioretinitis of the left eye. What is the most likely pathogen responsible for this patient’s symptoms? Cytomegalovirus HSV Methicillin-resistant Staphylococcus aureus Candida species Toxoplasma gondii Click here to compare your answer. 4. A 42-year-old man undergoing chemotherapy for non-Hodgkin’s lymphoma is hospitalized with fever and chills. He appears clinically stable. Examination reveals no signs of mucositis or infection. His absolute neutrophil count (ANC) is 200 cells/mm3. Blood cultures are obtained, and empiric therapy with imipenem is begun. His fevers subside over the next 2 days. He remains clinically stable, his chest radiograph is normal, and all cultures remain negative. A week after admission, his ANC is 300 cells/mm3and he is afebrile. What is the next most appropriate course of management? Stop imipenem Continue imipenem until ANC > 500 cells/mm3 Add amphotericin B Add granulocyte colony stimulating factor Click here to compare your answer.
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