Sun10October1036AM 6

You are asked to review a 35-year-old man with acute myeloid leukaemia (AML) with pyrexia and tachycardia.

A review of his notes reveals that he has been on intravenous Tazocin for neutropenic sepsis for four days.

His temperature is 39.5°C, BP 100/62 mmHg, HR 105, sats 90% on air.

A chest x ray is performed:

Which treatment should be commenced?

(Please select 1 option)

Meropenem

Clarithromycin

Fluconazole Incorrect answer selected

Aciclovir

AmBisome This is the correct answer

Explanation

Invasive fungal infection should be considered in patients with neutropenic sepsis who do not respond to broad spectrum antibiotics.

IN this case the CXR shows a well defined opacity in the right middle lobe which is due to aspergillus infection. High resolution CT scan (HRCT) can provide further evidence to support the diagnosis but ideally the diagnosis should be confirmed with a tissue sample, for example sputum or BAL washings.

Ambisome/amphotericin B, voriconazole and echinocandin (caspofungin, micafungin, and anidulafungin) have activity against Aspergillus. Fluconazole does not have good activity.

Further Reading:

Gea-Banacloche J. Evidence-based approach to treatment of febrile neutropenia in hematologic malignancies. Hematology Am Soc Hematol Educ Program. 2013;2013:414-22.

Answer Statistics

1

8%

2

5%

3

29%

4

2%

5

59%

Times answered: 272