How is persistent fever managed in acute myeloid leukemia (AML)?

Updated: May 26, 2020
  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Patients with persistent fever should be evaluated for an alternate source of infection. Persistent fever can be due to fungal infections, viral infections (including cytomegalovirus [CMV]), Clostridium difficile, and resistant bacteria such as vancomycin-resistant enterococcus, bacteria with extended spectrum beta-lactamases, and carbapenem-resistant Enterobacteriaceae. Evaluation of persistent fever should include CT scans of the chest, abdomen, pelvis and sinuses, fungal markers (aspergillus antigen and Fungitell), and other tests depending on the symptoms of the patient. Empiric antifungal therapies include the following:

  • Lipid-preparation amphotericins (Abelcet, AmBisome)
  • Azoles (voriconazole, isavuconazole, posaconazole)
  • Echinocandins (caspofungin, anidulafungin, micafungin).

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