Fever, infection and host resistance in acute leukemia

1. 1. Fever and infection were studied with comprehensive bacterial, fungal and viral technics in thirty-six consecutive patients with acute leukemia. 2. 2. As a group, these patients were febrile for almost one-half of the total 2,614 patient days. Only two patients had no febrile episodes during the period of observation. Of the ninety-two febrile episodes recorded, fifty-nine appeared to be related to infection. In the remaining thirty-three febrile episodes, bacterial, viral or fungal infection could not be incriminated as a cause for fever. 3. 3. Age and type of leukemia did not influence the frequency of febrile episodes. However, more febrile episodes related to proved or presumptive infection developed in adults than in children. 4. 4. The most common clinical illnesses associated with the proved infections were pharyngitis, pyelonephritis and septicemia. On occasion, relatively avirulent bacteria were capable of causing serious clinical infection. The most frequently encountered organisms were E. coli, M. pyogenes var. aureus, coagulase-positive, and Ps. aeruginosa. Infections due to Ps. aeruginosa were the most difficult to treat. 5. 5. Survival after infection was common, in the absence of bacteremia, if intensive and appropriate antimicrobial therapy was employed. Nevertheless, infection remained a leading cause of death in those patients who died during the study. 6. 6. The majority of the presumptive infections were related to infections of the respiratory tract. 7. 7. In the initial evaluation of the febrile leukemic patient it is to be emphasized that a negative physical examination does not exclude infection as a cause for fever in a patient with acute leukemia. 8. 8. Of the fourteen fevers of undetermined origin which persisted after two weeks of antibiotic therapy, eight eventually terminated in serious bacterial infection. Appropriate management for persistent fever of undetermined origin requires continual reappraisal to insure that a superimposed infection, masked by preceding unexplained fever, has been detected.