Dear Colleagues
As you are aware, typhilitis is a form of enterocoloitis or neutropenic colitis, a significant necrotising process that develops in the gastrointestinal tract of patients with neutropenia. It involves caecum and terminal ileum and often presents with fever, abdominal pain, diarrhoea, abdominal distension and rebound tenderness in the right lower quadrant. I would appreciate your valued comments on optimal management of this condition. Many thanks in anticipation for your contribution.
Sayed S Bukhari MD FRCPath
Consultant in Infection
Midlands, UK
if early administration of antibiotic that cover clostridial organism and translocating bacteria and combined with restoration of neutrophil counts may be highly effective. B-Lactum antibiotic coadministered with aminoglycoside like gentamycin is given to cover the gram negative bacteria and anaerobic bacteria is managed by giving metronidazole. if patient remains febrile after completion of 72 hours then antifungal like flucanazole is given with antibiotic. Granulocyte colony-stimulating factor infusion is an emerging therapy; it hastens neutrophil recovery and has been used to shorten the duration of granulocytopenia.
many surgeon prefer right hemicolectomy. Less extensive surgical interventions such as appendicectomy may be inadequate as the extent of mucosal necrosis may often be greater than what is obvious by the naked eye inspection of the serosa (13,25). by naked eye one can not give appropriate impression that up to what extent the necrosis is in the mucosal . At operation, the surgeon must also decide whether to perform an end-to-end anastomosis or to exteriorise the bowel. If extensive sepsis or significant peritoneal soiling is present, primary anastomosis is inappropriate. In this situation an end ileostomy and a mucous fistula is recommended.
Please review the following article
Crit Care Clin. 2001 Jul;17(3):531-70, vii-viii.
Infectious morbidity in critically ill patients with cancer.
Safdar A1, Armstrong D.
Author information
1Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, South Carolina, USA. [email protected]
Abstract
Infection frequently complicates the course of cancer treatment and often adversely affects the outcome. Patients have a greater tendency for acquiring infections caused by opportunistic microorganisms. Agents with low virulence potential may lead to invasive and often life-threatening infections because of altered host immune function. The immune dysfunction may be caused by the underlying malignancy, by antineoplastic chemotherapy, or by invasive procedures during supportive care.
PMID:
11525048
[PubMed - indexed for MEDLINE]
Zosyn + imaging add flagyl if does.not improve . Pain.control and monitior lactoc acid
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