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Question: Heme-Onc

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For which of the following organisms should one empirically treat when there is high concern for typhlitis (neutropenic enterocolitis)?

pemsou5_wp • July 16, 2019

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  1. Kelly July 21, 2019 - 12:01 am Reply

    E) GNR, GPC, anaerobic, and fungal
    Typhlitis, also known as neutropenic enterocolitis, which typically occurs in neutropenic oncology patients undergoing chemotherapy, but can occur in other disease processes causing neutropenia. Symptoms include abdominal pain, especially RLQ, nausea, vomiting, watery and sometimes bloody diarrhea, and may progress to perforation and peritonitis. Plain films may show pneumatosis intestinalis, but CT is the imaging study of choice. Treatment includes bowel rest, broad spectrum antibiotics covering especially gram negative organisms (although gram positive cocci, anaerobes, and fungi can also contribute), and sometimes surgery if perforation or abscess occurs. GCSF is controversial but may be beneficial. Patients should be monitored in an ICU setting as mortality rates are high.

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