Symptom Specific Services

Fever and Infections
• What causes fever and infections?
• What causes low blood count?
• How can an infection be recognized?
• What can I do to prevent infections?
• What can I expect as I receive treatment for fever and infections?

What causes fever and infections?
People with cancer are more likely to get fevers, which are usually associated with infections. Common sites of infection are the lungs, bladder, skin, mouth, gastrointestinal tract, and ears. If you are receiving chemotherapy, you may have low white blood cell counts, also referred to as neutropenia, which make you more likely to get fevers and infections.

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What causes low blood count?
Chemotherapy affects both cancerous cells and other normal cells in your body. The normal cells in your body that are most at risk of being killed by chemotherapy are those that are growing at a fast rate, such as your blood cells. Chemotherapy can cause low blood counts. A low white blood count affects as many as one third of all patients receiving chemotherapy treatment.

A low white blood count can occur when the marrow does not make enough white blood cells, called neutrophils, or when neutrophils are being consumed as they try to fight infections. The lower the white blood cell count and the longer the duration of low counts, the greater the chance of infection.

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How can an infection be recognized?
Since white blood cells play an important role in preventing and fighting infection, you are at a higher risk of getting infection any time your white blood cell count drops. Since these cells help to fight off infections, it's harder to get over an infection when your white counts are low. Therefore, when receiving chemotherapy, it's important to be aware of the increased risk of serious infection requiring antibiotics.

You should report any signs of infection to your doctor or nurse. These signs include:

• Fevers. It is important to know how to take your temperature accurately. Digital thermometers, which are now relatively inexpensive, can be accurate when used properly. Your doctor or nurse can teach you how to use one. Thermometers that are inserted into the ear are not recommended. If you have a temperature of 101 degrees or higher, call your doctor or nurse.

• Chills or sweats

• Cough, mucous production, shortness of breath, or painful breathing

• Soreness or swelling in your mouth, ulcers, canker sores, white patches in your mouth, or a change in the color of your gums

• Pain or burning with urination, or an unusual odor to your urine

• Redness, pain or swelling of any kind on your skin

• Redness, pain, swelling or drainage from any tubes

• Pus or drainage from any open cut or sore

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What can I do to prevent infections?
There are several things you can do to prevent infections when your white blood cells are low:

• Perform excellent personal hygiene.

• Wash your hands frequently, especially before eating and after using the bathroom.

• Use antiseptic mouthwashes daily, but beware that some over the counter mouthwashes can cause mouth dryness.

• Do not cut or pick at cuticles. Use cuticle cream instead.

• Use a deodorant rather than an antiperspirant. Antiperspirants block sweat glands and may promote infection.

• When menstruating, use sanitary napkins rather than tampons. Tampons can promote infection in a person with a low white blood cell count.

• Stay away from anyone who has recently been vaccinated, including infants and children.

• Avoid crowds as much as possible. Try to visit public places when they are less crowded.

• If possible, do not use public transportation. If you must, travel during off-peak times.

• Avoid uncooked foods that may harbor bacteria. Your nutritionist can identify those foods and make recommendations about food preparation when your counts are low.

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What can I expect as I receive treatment for fever and infections?
If you show signs of infection, your doctors will use blood tests to find out whether you have enough neutrophils, or white blood cells. Chemotherapy may have to be delayed until the body can produce more neutrophils. Sometimes a lower dosage of chemotherapy can be given.

Your doctor also may prescribe antibiotics to treat the infection, or medications to increase blood count. New drugs have become available to help shorten the time your white blood cell count stays low. These growth factor medications, G-CSF or GM-CSF, are used widely with cancer patients, especially those receiving chemotherapy. They work to stimulate the growth of white blood cells and are effective in preventing and treating fevers and infections.

If the chemotherapy you are receiving is known to have a severe impact on the white blood cell count, or if you experience a severe decrease in your white blood cell count after chemotherapy, your doctor may prescribe a growth factor before, during or after future courses of chemotherapy. The growth factor is given as an injection under the skin. Although it can be administered by a nurse, most patients or their care partners learn to administer the injection themselves. By increasing your body's production of white blood cells, the growth factor is very effective in decreasing the likelihood that you will develop an infection.

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