Causes of fever in adult patients with acute leukemia
Kanakura, Y.; Teshima, H.; Hirayama, F.; Tani, Y.; Kubota, Y.; Oguma, S.; Ueda, T.; Nakamura, H.; Shibata, H.; Masaoka, T.
Nihon Ketsueki Gakkai Zasshi Journal of Japan Haematological Society 48(7): 1514-1521
1985
ISSN/ISBN: 0001-5806 PMID: 4090930 Document Number: 258166
Two hundred and ninety febrile episodes were analyzed in 163 adult patients undergoing remission induction therapy for acute leukemia and blastic crisis (BC) of chronic myelocytic leukemia (CML). The incidence of probable and documented infections was 45.5% of febrile episodes in the patients with acute leukemia. The most common types of infection were sepsis and pneumonia, which accounted for 52.0% of the probable and documented infections. Antibiotic or antifungal therapy was effective in over 80% of the episodes in which the cause could not be determined. In patients with BC of CML, the cause of fever could not be identified in 75% of episodes; Antileukemic therapy was effective in 8 of 21 (38.1%) the episodes. On the antemortem estimation, the cause of persistent fever could not be identified in 23 of 45 (51.1%) patients with acute leukemia and 11 of 14 (78.6%) patients with BC of CML. In the post-mortem examination, 65.2% of these 23 episodes in acute leukemia and 81.8% of 11 episodes in BC of CML were determined to be infection, especially due to fungal infection responsible for 39.1% and 54.5% of infection respectively. On the other hand, fungal infection seemed to be more frequently observed at autospy in the patients with positive culture of fungi on antemortem examination than the patients with negative culture. These results suggest that fever of unknown origin in patients with acute leukemia is mainly due to infection by bacteria during remission induction therapy and by fungi before death.