Neutropenic sepsis: how to spot the signs and symptoms and take rapid action

Erin Dean

doi:10.7748/en.30.1.6.s2

Management of clozapine treatment during the COVID-19 pandemic

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125320928167 ◽

2020 ◽

Vol 10 ◽

pp. 204512532092816 ◽

Cited By ~ 4

Author(s):

Siobhan Gee ◽

Fiona Gaughran ◽

James MacCabe ◽

Sukhi Shergill ◽

Eromona Whiskey ◽

...

Keyword(s):

Healthcare Workers ◽

Signs And Symptoms ◽

Physical Contact ◽

Full Blood Count ◽

Risk Of Infection ◽

Clozapine Treatment ◽

Neutropenic Sepsis ◽

Blood Assay ◽

Blood Monitoring ◽

Increased Risk

Clozapine is the only available treatment for refractory schizophrenia but its use involves frequent physical contact with healthcare workers for the purpose of mandatory blood monitoring. During the COVID-19 pandemic, patients taking clozapine will be self-isolating to reduce the risk of infection, not least because these patients are at high risk of serious illness and fatality because of high rates of diabetes, obesity and pulmonary disease and an increased risk of pneumonia. Problems may also arise because both clozapine-induced myocarditis and neutropenic sepsis share signs and symptoms with COVID-19 (fever, chest pain, dyspnoea, etc.). We recommend decreasing the frequency of physical contacts by extending the blood monitoring interval to 12 weeks in those patients taking clozapine for more than 1 year. To distinguish COVID-19 from clozapine-related physical adverse effects, we suggest an urgent antigen test alongside a full blood count. In those taking clozapine who develop COVID-19, we suggest continuing with clozapine whenever possible (even during ventilation), reducing the dose if necessary in line with blood assay results. Blood monitoring should continue but clozapine should only cease if there is a significant fall in neutrophils (COVID-19 is linked to lymphopenia but not neutropenia). To protect against the likelihood and severity of respiratory infection, we recommend the use of vitamin D in all clozapine patients. Initiation of clozapine is likely to remain problematic while the risk of infection remains, given the degree of physical contact required to assure safety.

Download Full-text

Ambulatory management in low risk neutropenic sepsis – A plea for integrated acute cancer care

Acute Medicine Journal ◽

10.52964/amja.0740 ◽

2019 ◽

Vol 18 (1) ◽

pp. 6-7

Author(s):

E Marshall ◽

Keyword(s):

Signs And Symptoms ◽

Cytotoxic Chemotherapy ◽

Medical Emergency ◽

Acute Medicine ◽

Management Guidelines ◽

Neutropenic Sepsis ◽

Incidence And Mortality ◽

Nice Guidance ◽

Treatment Complication ◽

Sepsis Care

Neutropenic Sepsis (NS) is a well recognised treatment complication, typically occurring 7-10 days following cancer cytotoxic chemotherapy. Colleagues in acute medicine will be only too familiar with the scenario of cancer patients that present with fever in the absence of localising signs and symptoms and with a very low yield from microbiological cultures. The incidence and mortality of NS are poorly defined and historically, management guidelines have often been developed in relative isolation from the broader subject of infection and sepsis care. Despite the lack of a clear and pragmatic definition, NICE guidance CG151 (2012) identified suspected NS as a medical emergency requiring prompt empirical broad spectrum antibiotics.

Download Full-text

“Where is Dementia?” A Systematic Literature Review Exploring Neuroanatomical Aspects of Dementia

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp2.sig15.9 ◽

2017 ◽

Vol 2 (15) ◽

pp. 9-23 ◽

Cited By ~ 1

Author(s):

Chorong Oh ◽

Leonard LaPointe

Keyword(s):

English Language ◽

Signs And Symptoms ◽

Behavioral Symptoms ◽

Journal Articles ◽

People With Dementia ◽

Different Types ◽

Precise Diagnosis ◽

Physical Changes ◽

The Brain ◽

Language Literature

Dementia is a condition caused by and associated with separate physical changes in the brain. The signs and symptoms of dementia are very similar across the diverse types, and it is difficult to diagnose the category by behavioral symptoms alone. Diagnostic criteria have relied on a constellation of signs and symptoms, but it is critical to understand the neuroanatomical differences among the dementias for a more precise diagnosis and subsequent management. With this regard, this review aims to explore the neuroanatomical aspects of dementia to better understand the nature of distinctive subtypes, signs, and symptoms. This is a review of English language literature published from 1996 to the present day of peer-reviewed academic and medical journal articles that report on older people with dementia. This review examines typical neuroanatomical aspects of dementia and reinforces the importance of a thorough understanding of the neuroanatomical characteristics of the different types of dementia and the differential diagnosis of them.

Download Full-text