First of all, it should be clear that fever in patients with leukemia is not always due to infection; leukemia itself can also cause fever. However, fever due to leukemia is in most cases ≤ 38.5°C, and this fever can only be controlled by remission of the leukemia after chemotherapy.
But, in general, most fevers in leukemia patients are caused by infection, especially in older leukemia patients, who are more prone to infectious fevers due to decreased immunity and organ function.
There are more sites of co-infection in elderly patients with leukemia, commonly: upper respiratory tract, lung, oral cavity, perianal, urinary tract, and systemic.
In addition to fever, there may be a combination of the following symptoms:
- Infection of the upper respiratory tract (including trachea and bronchi) and lungs: often with cough, sputum, chest pain, or wheezing.
- Mouth: manifests as ulceration or erosion, bleeding, and in severe cases, cellulitis due to soft tissue infection.
- Perianal: It is likely to occur in patients with hemorrhoids, anal fissures, or fecal impaction, often with localized pain, redness, swelling, erosion, and cellulitis.
- Urinary tract: Relatively common in women, manifesting as frequent, urgent, painful urination or hematuria.
The flora of the infection varies from site to site, and the use of antibiotics is often limited in older patients because of the high number of comorbidities. Therefore, it is important not to simply reduce heat treatment in the case of fever. The site of infection and flora should first be identified based on appropriate symptoms, physical examination, and laboratory tests (e.g., chest CT, pharyngeal swab culture, sputum culture, mid-segment urine culture, etc.), and appropriate antibiotics should be selected based on drug susceptibility testing, which requires empirical treatment with broad-spectrum antibiotics until drug sensitivity results are returned.
The combination of anti-Gram-negative and positive bacteria and antifungal drugs, or even small doses of hormones for temperature control and gammaglobulin for immune enhancement, is often required when fever is difficult to control, and the heart, lung, liver, and kidney functions of elderly patients need to be attended to.
If uncontrollable hyperthermia and severe bone marrow suppression occur during chemotherapy, chemotherapy needs to be discontinued if necessary.
Care is recommended to avoid going outside, keep the room clean and air circulating, wear a mask to prevent infection, and strictly sterilize the diet and living conditions, as well as the chaperones, and reduce visits from family and friends to prevent cross-infection.