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Febrile Neutropenia — SCE Infectious Diseases MCQ

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ModerateFungal InfectionsFebrile NeutropeniaSCE Infectious Diseases

A 50-year-old man with AML develops neutropenic fever on day 10 of chemotherapy. Empirical Piperacillin/Tazobactam is started. After 96 hours of persistent fever, CT chest shows new bilateral nodular infiltrates. Serum galactomannan is 0.3 (negative). Serum beta-D-glucan is 85 pg/mL (positive). What is the most appropriate empirical antifungal?

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Correct answer: D — Liposomal Amphotericin B or Caspofungin empirically for suspected IFD in persistent febrile neutropenia

In persistent febrile neutropenia (>96 hours of appropriate antibiotics without response), empirical antifungal therapy is recommended. A positive beta-D-glucan with negative galactomannan raises the possibility of non-Aspergillus fungal infection (Candida, Fusarium, PJP) or early Aspergillus before galactomannan becomes positive. Liposomal Amphotericin B or Caspofungin are standard empirical options. Pre-emptive approaches using serial biomarkers and CT imaging are increasingly used as alternatives to empirical therapy.

Reference: ECIL-6 2017 – Empirical antifungal therapy; NICE 2024 – Febrile neutropenia