Neutropenic Sepsis: Causes, Symptoms, Treatment

Chemotherapy may depress the neutrophil count and expose people being treated for cancer to a severe infection known as neutropenic sepsis. It is a risk of cancer treatment. Neutrophils are a type of white blood cell. They fight infection. Neutropenic sepsis is especially dangerous because it occurs when the body's immune system is weak.

The symptoms of sepsis can include fluctuating blood pressure, respiratory distress, and unstable heart function. The infection requires treatment, and the systemic (whole-body) effects require intensive care. Treatment of neutropenia can lower the risk of recurrent sepsis.

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What Is Sepsis? 

Sepsis is a systemic reaction that can occur with septicemia, which is an infection in the blood. Sepsis can occur when an infection is so severe that it overwhelms organs throughout the body. 

Effects of sepsis can include any of the following:

A high fever above 103 degrees Fahrenheit 
Chills, sweats 
Lethargy, confusion, changes in consciousness
Tachycardia (rapid heart rate)
Tachypnea (rapid breathing)
Dyspnea (difficulty breathing)
Low blood pressure or fluctuations in blood pressure
Decreased urination
Changes in glucose levels
An increase in the risk of blood clots, such as deep vein thrombosis (a clot in a vein), pulmonary embolus (a clot lodges in an artery in the lung), heart attack, and stroke (clot blocking a blood vessel in the brain)

Additionally, symptoms of the infection can include pain, swelling, abdominal or pelvic pain, trouble breathing, and more.

Sepsis is a medical emergency that can worsen rapidly. This condition requires urgent and intensive medical care. 

What Is Neutropenia? 

White blood cells are immune cells, and there are several different types. Neutrophils are the most common type of white blood cell. They help fight bacterial and other types of infections and aid in healing and recovery from illnesses. 

Neutropenia is a low white blood cell count. This condition can occur due to cancer, cancer therapy, as a result of infections or illnesses, or as a medication side effect. 

Cancer treatment is the most common cause of severe neutropenia, and it increases the risk of infections. With neutropenia, infections can worsen and lead to neutropenic sepsis. 

How Is Neutropenic Sepsis Different From Non-Neutropenic Sepsis?

Chemotherapy and/or cancer itself predisposes a person to neutropenia. Usually, sepsis occurs when a localized bacteria or fungal infection spreads throughout the body. The original infection can start anywhere in the body. The initial symptoms that occur before sepsis develops usually correspond to the initial site of the infection.

Examples of initial sites of infection include: 

Respiratory infection, which can cause chest tightness, cough, and wheezing 
Gastrointestinal infection, which can cause abdominal discomfort, nausea, vomiting, and diarrhea 
Urinary tract infection, which can cause dysuria (painful urination) and blood in the urine 
Skin infection, which can cause redness, pus, or tenderness

In a person with neutropenic sepsis, however, the signs and symptoms may present differently. For instance, there may be no fever and vague symptoms, like confusion or gastrointestinal upset.

In those undergoing chemotherapy or who have cancer, there is a predisposition to infection. If they are neutropenic, this can be an even more dangerous situation and contribute to a higher risk of complications than those who are not neutropenic. Therefore, the treatment for neutropenic sepsis may be different than treatments for non-neutropenic sepsis.

How Is Neutropenic Sepsis Diagnosed and Treated? 

The diagnostic process for neutropenic sepsis includes a complete blood count (CBC), kidney and liver function tests, and other special tests like for C-reactive protein and venous lactate.

Diagnosis also includes identifying the site of infection. If the person has a central venous line (thin, flexible tube inserted in a vein in the neck, chest, or arm), blood cultures (tests to see if bacteria are present in the blood) should be drawn from both a vein and from the line. Blood cultures can sometimes be false-positive, however, indicating a condition exists when it doesn't.

Neutropenic sepsis requires intensive treatment. The treatment involves close monitoring and control of vital signs (pulse, breathing rate, blood pressure, temperature) to prevent complications, including organ failure.

Treatment of the infection is crucial. With neutropenia, medications to treat the infection can include antibiotics that are targeted to the specific infectious bacteria to avoid problems with antibiotic resistance.

Sometimes antifungal treatment is needed for the treatment of a systemic fungal infection. Candida and Aspergillus are the most common fungal infections in neutropenic sepsis.

Systemic treatments may include intravenous fluids, electrolytes, and nutrition supplementation, medications to control blood pressure and heart rate, control of glucose levels, oxygen supplementation, mechanical breathing assistance, or dialysis (mechanical filtering of the blood).

Other important interventions include measures to prevent blood clots and precautions to reduce the risk of sores and additional infections.

Prevention

If you have neutropenia, your medical team will advise you about neutropenic precautions to lower your risk of infections.

Precautions can include:

Ensuring meat, chicken, and seafood are fully cooked before eating
Washing raw fruit and vegetables carefully before eating
Proper handwashing after touching anything that's potentially contaminated and after using the bathroom
Avoiding exposure to anyone who you know has a contagious infection
Avoiding crowds
Getting enough rest, staying hydrated, and eating a balanced diet
Keeping active

Staying updated on your recommended vaccinations is important, although the timing is tricky. Sometimes a low white blood cell count can make vaccines less effective.

You might need treatment for mild infections so that you won't experience progression to neutropenic sepsis. Talk to your medical team if you develop a fever, a wound with redness or pus, vomiting, diarrhea, cough, congestion, pain or burning with urination, or any concerning symptoms.

Summary 

Neutropenic sepsis is a serious medical condition, with chemotherapy and/or cancer being a risk factor. Neutropenia is a major risk factor for sepsis, and it is important to take neutropenic precautions. The treatment of neutropenic sepsis involves treatment of the infection and close and careful management of the systemic effects.

A Word From Verywell

Neutropenic sepsis is a serious condition. If you are neutropenic due to a medical condition or medical treatment, it's important that you take precautions to avoid infections that could become serious and cause you to develop sepsis.

One of the goals of your treatment is that your white blood count, including your neutrophil count, will return to normal in time. When your immune system recovers, your risk of neutropenic sepsis will go down as well.

Frequently Asked Questions

While a fever may be present in the non-neutropenic patient with sepsis, it may be absent in the neutropenic patient with sepsis. In addition, confusion or gastrointestinal distress may be present in the neutropenic patient with sepsis.
Other signs of sepsis include fluctuating blood pressure, altered glucose levels, trouble breathing, a rapid heart rate, and altered mental status.
Neutropenic sepsis can be very dangerous. The systemic effects can cause permanent organ damage, blood clots, and may be life threatening. Close medical care can sometimes lead to a full recovery, and an improvement in the neutrophil count can prevent further risk.
The types of bacteria that most frequently cause sepsis in people who are neutropenic have shifted over the years, and bacterial causes can vary among hospitals and countries. Often, a mixed infection can occur. And resistant organisms that can't be treated with standard antibiotics can cause neutropenic sepsis as well.
Neutropenic sepsis can occur in 70%–100% of people who have a low neutrophil count due to chemotherapy. Because it can result in death, neutropenic sepsis is considered a medical emergency.
Anyone who is neutropenic is at risk of neutropenic sepsis. The risk is higher when the neutrophil count is very low, if it's low for a long time, and if other white blood cells are also low.

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