ABSTRACT
Fever has long been associated with malignancy and remains a common problem in cancer patients. With the advent of cytotoxic therapy, fever in the cancer patient has been closely linked with infection, especially when the patient is granulocytopenic. Because fever can be the only sign of infection in neutropenic patients, its appearance necessitates that a series of diagnostic and therapeutic measures be taken empirically (i.e., without the precise knowledge of the nature and cause of the infection). This approach is different from that which is usually recommended for fever in nonneutropenic patients. First, it is important to decide whether fever is caused by infection or another process. Second, the site of the infection and the offending pathogen are sought through a series of microbiological techniques. Third, when a precise clinical and microbiological diagnosis is available, a rational choice of therapy can be made. Depending on the acuteness of the disease, these diagnostic steps can be accelerated and, occasionally, presumptive therapy is prescribed in nonneutropenic patients.
