In an effort to evaluate risk factors for adverse outcome, we evaluated presenting features, laboratory parameters and microbiological isolates in 64 consecutive episodes of febrile neutropenia (fever > 37.5o C for > 24 hours with absolute neutrophil count < 1000/cmm) in 35 children with malignant disorders. The most common underlying malignant disorder was acute lymphoblastic leukemia There were eight fatal episodes (mortality 12%). Of the various clinical features, only diarrhoea at presentation was associated with adverse outcome. Of the laboratory parameters, the degree of neutropenia was predictive of mortality and children with culture-proven evidence of infection were more likely to have adverse outcome. Our data suggests that enteric pathogens should be looked at more carefully as a cause of infection in febrile neutropenic patients in our environment and diarrhoeal episodes should be treated more aggressively in such immunocompromised children.
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