Fever: Single oral temperature $\geq$ 38.3°C (101°F) OR $\geq$ 38.0°C (100.4°F) sustained for > 1 hour.
Neutropenia: Absolute Neutrophil Count (ANC) < 500 cells/mm³ OR expected to decrease to < 500 within 48 hours.
Medical Emergency: High risk of rapid progression to sepsis due to impaired inflammatory response.

Epidemiology

Etiology

Pathophysiology: Cytotoxic chemotherapy $\to$ mucositis (GI tract barrier breakdown) $\to$ translocation of endogenous flora into bloodstream.
Bacterial pathogens:
- Gram-positives (Most Common): Staph epidermidis (coag-negative staph), Staph aureus, Streptococcus viridans, Enterococcus. often catheter-related.
- Gram-negatives (Most Serious): Pseudomonas aeruginosa, E. coli, Klebsiella. Pseudomonas is the primary target for empiric therapy due to high mortality.
Fungal pathogens: Candida, Aspergillus. Usually a concern in prolonged neutropenia (> 7 days).

Signs of inflammation (purulence, fluctuance, swelling) may be absent due to lack of neutrophils.
Fever is often the only sign of infection.
Specific sites to check: Skin (catheter sites), Oropharynx (mucositis), Lungs, Perineum.

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