Typhlitis: Difference between revisions

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__NOTOC__
__NOTOC__
{{SI}}
{{SI}}
{{CMG}}
{{CMG}} {{AE}} {{SHM}}


{{SK}} neutropenic colitis; neutropenic enterocolitis; cecitis
{{SK}} Neutropenic colitis; Neutropenic enterocolitis; cecitis


==Overview==
==Overview==
Typhlitis occurs in neutropenic patients undergoing treatment for a malignancy, most frequently patients with acute leukemia who are receiving chemotherapy. It has also been reported in patients with aplastic anemia, lymphoma, or acquired immunodeficiency syndrome and after kidney transplantation. Typhlitis is characterized by edema and inflammation of the cecum, the ascending colon, and sometimes the terminal ileum. The inflammation can be so severe that transmural necrosis, perforation, and death can result. The mechanism of the condition is not known, but it is probably due to a combination of ischemia, infection (especially with cytomegalovirus), mucosal hemorrhage, and perhaps neoplastic infiltration. Treatment consists of bowel rest, total parenteral nutrition, antibiotics, and aggressive fluid and electrolyte replacement.
Typhlitis is most commonly seen in [[Neutropenic fever|neutropenic]] [[patients]] receiving [[chemotherapy]] for a cancer. It is also been seen in people with [[aplastic anemia]], [[lymphoma]], [[Acquired immunodeficiency syndrome|acquired immunodeficiency]] [[syndrome]], as well as people who have had a [[Kidney transplant|kidney transplant]]. Typhlitis is distinguished by [[edema]] and [[inflammation]] of the [[cecum]], [[ascending colon]], and, in some cases, [[terminal ileum]]. Transmural [[necrosis]], [[perforation]], and [[mortality]] can occur as a result of the [[inflammation]]. The exact cause of the [[condition]] is unknown, but it is most likely caused by a combination of [[ischemia]], [[infection]] (particularly with [[cytomegalovirus]]), [[mucosal]] [[hemorrhage]], and possibly [[neoplastic]] [[Infiltration (medical)|infiltration]]. The treatment includes [[bowel]] rest, [[parenteral nutrition]], [[antibiotics]], and intensive fluid and [[electrolyte]] replacement.
==Historical Perspective==
==Historical Perspective==
[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].


The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
*In 1970, Wagner et al found and described typhlitis as [[necrotizing]] [[colitis]] after [[autopsy]] of 191 [[leukemic]] children with terminal illness at the Texas Children's Hospital, Baylor College of Medicine, Houston, between 1958 and 1970.<ref name="KatzMahoney1990">{{cite journal|last1=Katz|first1=Julie A.|last2=Mahoney|first2=Donald H.|last3=Fernbach|first3=Donald J.|last4=Wagner|first4=Milton L.|last5=Gresik|first5=Mary V.|title=Typhlitis. An 18-year experience and postmortem review|journal=Cancer|volume=65|issue=4|year=1990|pages=1041–1047|issn=0008-543X|doi=10.1002/1097-0142(19900215)65:4<1041::AID-CNCR2820650433>3.0.CO;2-A}}</ref>
 
In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
 
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
 
There have been several outbreaks of [disease name], including -----.
 
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].


==Classification==
==Classification==
There is no established system for the classification of [disease name].
OR
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
OR
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
OR
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
OR
If the staging system involves specific and characteristic findings and features:
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
OR
The staging of [malignancy name] is based on the [staging system].
OR


There is no established system for the staging of [malignancy name].
*There is no established system for the classification of Typhlitis.


==Pathophysiology==
==Pathophysiology==
The exact pathogenesis of [disease name] is not fully understood.


OR
*The precise [[pathophysiology]] of [[Neutropenic sepsis|Neutropenic]] [[enterocolitis]] is unknown.<ref name="pmid10593241">{{cite journal| author=Urbach DR, Rotstein OD| title=Typhlitis. | journal=Can J Surg | year= 1999 | volume= 42 | issue= 6 | pages= 415-9 | pmid=10593241 | doi= | pmc=3795130 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10593241  }}</ref>
 
*The primary variables in illness beginning appear to be [[intestinal]] [[mucosal]] injury, [[Neutropenia causes|neutropenia]], and the [[immunocompromised]] status of the [[patients]].<ref name="pmid19646645">{{cite journal| author=Cloutier RL| title=Neutropenic enterocolitis. | journal=Emerg Med Clin North Am | year= 2009 | volume= 27 | issue= 3 | pages= 415-22 | pmid=19646645 | doi=10.1016/j.emc.2009.04.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19646645  }}</ref>
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
*[[Gram-negative]] rods, [[gram-positive cocci]], [[enterococci]], [[fungi]], and [[viruses]] have all been blamed for the outbreak.<ref name="pmid28104979">{{cite journal| author=Rodrigues FG, Dasilva G, Wexner SD| title=Neutropenic enterocolitis. | journal=World J Gastroenterol | year= 2017 | volume= 23 | issue= 1 | pages= 42-47 | pmid=28104979 | doi=10.3748/wjg.v23.i1.42 | pmc=5221285 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28104979  }}</ref><ref name="pmid31869058">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume=  | issue=  | pages=  | pmid=31869058 | doi= | pmc= | url= }}</ref>
 
*These early circumstances cause [[intestinal]] [[edema]], engorged [[veins]], and a disrupted mucosal surface, making the mucosa more susceptible to [[bacterial]] intramural invasion.
OR
*The [[distension]] and [[necrosis]] generated by [[Chemotherapy agents|chemotherapy]] drugs directly influence [[intestinal]] motility.
 
*Superimposed [[infections]] caused by [[bacteria]],[[fungi]] and [[viruses]] can also disrupts the already damaged [[mucosa]] leading further [[intestinal]] [[edema]], distension and [[necrosis]] of [[intestinal]] layer which lead to [[intestinal]] [[perforation]].
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
 
OR
 
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
 
OR
 
 
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
 
OR
 
The progression to [disease name] usually involves the [molecular pathway].
 
OR
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.


==Causes==
===Causes by Organ System===
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
{| style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
| style="width:75%" bgcolor="Beige" ; border="1" |No underlying causes
|-
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
| bgcolor="LightSteelBlue" |'''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dental'''
|'''Dental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
|'''Dermatologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|'''Drug Side Effect'''
|bgcolor="Beige"| [[Doxorubicin Hydrochloride]], [[Sulfasalazine]]
| bgcolor="Beige" |[[Doxorubicin Hydrochloride]], [[cytosine arabinoside]], [[gemcitabine]], [[vincristine]], [[doxorubicin]], [[cyclophosphamide]], [[5-fluorouracil]], [[leucovorin]], and [[daunorubicin]] are some of the drugs used to treat cancer.<ref name="pmid281049792">{{cite journal| author=Rodrigues FG, Dasilva G, Wexner SD| title=Neutropenic enterocolitis. | journal=World J Gastroenterol | year= 2017 | volume= 23 | issue= 1 | pages= 42-47 | pmid=28104979 | doi=10.3748/wjg.v23.i1.42 | pmc=5221285 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28104979  }}</ref>[[Antibiotics]], [[sulfasalazine]], and [[immunosuppressive]] medication for [[organ transplantation]]<ref name="ChakravartyScott1992">{{cite journal|last1=Chakravarty|first1=K.|last2=Scott|first2=D. G. I.|last3=Mccann|first3=B. G.|title=FATAL NEUTROPENIC ENTEROCOLITIS ASSOCIATED WITH SULPHASALAZINE THERAPY FOR RHEUMATOID ARTHRITIS|journal=Rheumatology|volume=31|issue=5|year=1992|pages=351–353|issn=1462-0324|doi=10.1093/rheumatology/31.5.351}}</ref><ref name="pmid11038099">{{cite journal| author=Bibbo C, Barbieri RA, Deitch EA, Brolin RE| title=Neutropenic enterocolitis in a trauma patient during antibiotic therapy for osteomyelitis. | journal=J Trauma | year= 2000 | volume= 49 | issue= 4 | pages= 760-3 | pmid=11038099 | doi=10.1097/00005373-200010000-00029 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11038099  }}</ref>
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|'''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
|'''Endocrine'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Environmental'''
|'''Environmental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|'''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
|'''Genetic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
|'''Hematologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |Adults with [[Hematologic malignancy|hematologic]] malignancies such [[leukemia]], [[lymphoma]], [[multiple myeloma]], [[aplastic anemia]], and [[Myelodysplastic syndrome|myelodysplastic syndromes]].<ref name="pmid16319675">{{cite journal| author=Davila ML| title=Neutropenic enterocolitis. | journal=Curr Opin Gastroenterol | year= 2006 | volume= 22 | issue= 1 | pages= 44-7 | pmid=16319675 | doi=10.1097/01.mog.0000198073.14169.3b | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16319675  }}</ref>
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|'''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|'''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|'''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
|'''Neurologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|'''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|'''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
|'''Oncologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|'''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|'''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
|'''Psychiatric'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
|'''Pulmonary'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|'''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|'''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
|'''Sexual'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Trauma'''
|'''Trauma'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Urologic'''
|'''Urologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|'''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|}
|}


===Causes in Alphabetical Order===
{{columns-list}}
{{columns-list|
* [[Clofarabine]]
* [[Doxorubicin Hydrochloride]]
}}


==Differentiating ((Page name)) from other Diseases==
==Differentiating Typhlitis from other Diseases==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
Typhlitis must be distinguished from other diseases that exhibit [[symptoms]] such as [[Feve|fever]], [[abdomrinal pain|abdominal pain]], and [[diarrhea]].<ref name="pmid16632437">{{cite journal| author=Cardona Zorrilla AF, Reveiz Herault L, Casasbuenas A, Aponte DM, Ramos PL| title=Systematic review of case reports concerning adults suffering from neutropenic enterocolitis. | journal=Clin Transl Oncol | year= 2006 | volume= 8 | issue= 1 | pages= 31-8 | pmid=16632437 | doi=10.1007/s12094-006-0092-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16632437  }}</ref>


OR
*[[Clostridium difficile|1. Clostridium difficile]] [[infection]]<ref name="pmid30945014">{{cite journal| author=Czepiel J, Dróżdż M, Pituch H, Kuijper EJ, Perucki W, Mielimonka A | display-authors=etal| title=Clostridium difficile infection: review. | journal=Eur J Clin Microbiol Infect Dis | year= 2019 | volume= 38 | issue= 7 | pages= 1211-1221 | pmid=30945014 | doi=10.1007/s10096-019-03539-6 | pmc=6570665 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30945014  }}</ref>
 
*[[Cytomegalovirus|2. Cytomegalovirus]] [[colitis]]<ref name="pmid26877608">{{cite journal| author=Pillet S, Pozzetto B, Roblin X| title=Cytomegalovirus and ulcerative colitis: Place of antiviral therapy. | journal=World J Gastroenterol | year= 2016 | volume= 22 | issue= 6 | pages= 2030-45 | pmid=26877608 | doi=10.3748/wjg.v22.i6.2030 | pmc=4726676 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26877608  }}</ref>
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
*[[Norovirus|3. Norovirus]] [[infection]]<ref name="pmid31335045">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume=  | issue=  | pages=  | pmid=31335045 | doi= | pmc= | url= }}</ref>
*[[Graft versus host disease|4. Graft versus host disease]]<ref name="pmid31466596">{{cite journal| author=Ramachandran V, Kolli SS, Strowd LC| title=Review of Graft-Versus-Host Disease. | journal=Dermatol Clin | year= 2019 | volume= 37 | issue= 4 | pages= 569-582 | pmid=31466596 | doi=10.1016/j.det.2019.05.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31466596  }}</ref>
*[[Acute appendicitis|5. Acute appendicitis]]<ref name="pmid26460662">{{cite journal| author=Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT| title=Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. | journal=Lancet | year= 2015 | volume= 386 | issue= 10000 | pages= 1278-1287 | pmid=26460662 | doi=10.1016/S0140-6736(15)00275-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26460662  }}</ref>
*6. [[Ischemic colitis]]<ref name="pmid19109863">{{cite journal| author=Theodoropoulou A, Koutroubakis IE| title=Ischemic colitis: clinical practice in diagnosis and treatment. | journal=World J Gastroenterol | year= 2008 | volume= 14 | issue= 48 | pages= 7302-8 | pmid=19109863 | doi=10.3748/wjg.14.7302 | pmc=2778113 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19109863  }}</ref>
*


==Epidemiology and Demographics==
==Epidemiology and Demographics==
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
OR
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
OR
In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
Patients of all age groups may develop [disease name].
OR
The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
OR
[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
OR
[Chronic disease name] is usually first diagnosed among [age group].
OR
[Acute disease name] commonly affects [age group].


There is no racial predilection to [disease name].
*The prevalence of [[Febrile neutropenia|Neutropenic]] [[enterocolitis]] varies between studies. Gorschlüter et al. conducted a systematic review and found that the incidence rate from 21 studies was 5.3 percent in patients hospitalized for [[hematological malignancies]], high-dose [[chemotherapy]] for [[solid tumors]], or [[aplastic anemia]]. Another [[cohort study]] discovered it in 3.5% of 317 severely [[neutropenic]] patients. The [[prevalence]] of [[neutropenic]] [[enterocolitis]] has been increasing in tandem with the increased use of [[chemotherapy]], especially the agents known for causing [[mucositis]].<ref name="pmid15946304">{{cite journal| author=Gorschlüter M, Mey U, Strehl J, Ziske C, Schepke M, Schmidt-Wolf IG | display-authors=etal| title=Neutropenic enterocolitis in adults: systematic analysis of evidence quality. | journal=Eur J Haematol | year= 2005 | volume= 75 | issue= 1 | pages= 1-13 | pmid=15946304 | doi=10.1111/j.1600-0609.2005.00442.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15946304  }}</ref><ref name="pmid17023562">{{cite journal| author=Aksoy DY, Tanriover MD, Uzun O, Zarakolu P, Ercis S, Ergüven S | display-authors=etal| title=Diarrhea in neutropenic patients: a prospective cohort study with emphasis on neutropenic enterocolitis. | journal=Ann Oncol | year= 2007 | volume= 18 | issue= 1 | pages= 183-189 | pmid=17023562 | doi=10.1093/annonc/mdl337 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17023562  }}</ref>


OR
*Patients with [[Hematologic malignancy|hematologic malignancie]][[Malignancies|s]] are more likely to develop [[Febrile neutropenia|Neutropenic]] [[enterocolitis]] as a result of their underlying [[malignancy]] as well as their treatment regimens. [[Febrile neutropenia|Neutropenic]] [[enterocolitis]] has also been reported in patients taking [[immunosuppressive]] [[medications]], patients diagnosed with solid [[tumors]] and [[autoimmune]] conditions.<ref name="pmid23196957">{{cite journal| author=Nesher L, Rolston KV| title=Neutropenic enterocolitis, a growing concern in the era of widespread use of aggressive chemotherapy. | journal=Clin Infect Dis | year= 2013 | volume= 56 | issue= 5 | pages= 711-7 | pmid=23196957 | doi=10.1093/cid/cis998 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23196957  }}</ref>
 
[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
 
 
 
[Disease name] affects men and women equally.
 
OR
 
[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
 
 
 
The majority of [disease name] cases are reported in [geographical region].
 
OR
 
[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].


==Risk Factors==
==Risk Factors==
There are no established risk factors for [disease name].
Common risk factors in the development of Typhlitis include [[hematological]], solid [[tumors]], [[Neutropenic fever|neutropenic]] and [[Immunocompromised]] individuals.<ref name="BiasoliNucci19972">{{cite journal|last1=Biasoli|first1=I|last2=Nucci|first2=M|last3=Spector|first3=N|last4=Portugal|first4=R|last5=Domingues|first5=A|last6=Pulcheri|first6=W|title=Risk factors for typhlitis|journal=Oncology Reports|year=1997|issn=1021-335X|doi=10.3892/or.4.5.1029}}</ref>
 
OR
 
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
 
OR
 
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
 
OR
 
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.


==Screening==
==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].
There is insufficient evidence to recommend routine [[screening]] for [[Febrile neutropenia|Neutropenic]] [[enterocolitis]].
 
OR
 
According to the [guideline name], screening for [disease name] is not recommended.
 
OR
 
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].


OR
*Common complications of [[Febrile neutropenia|Neutropenic]] [[enterocolitis]] include [[perforation]], [[peritonitis]], [[sepsis]], and [[abscess]] formation, which are all caused by the [[pathology]] ([[bowel]] wall [[inflammation]]). Other risks are related to [[pancytopenia]] include [[thrombocytopenia]]-related extreme bleeding and delayed healing.<ref name="pmid159463042">{{cite journal| author=Gorschlüter M, Mey U, Strehl J, Ziske C, Schepke M, Schmidt-Wolf IG | display-authors=etal| title=Neutropenic enterocolitis in adults: systematic analysis of evidence quality. | journal=Eur J Haematol | year= 2005 | volume= 75 | issue= 1 | pages= 1-13 | pmid=15946304 | doi=10.1111/j.1600-0609.2005.00442.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15946304  }}


Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*[[Prognosis]] is generally poor, and the [[mortality rate]] of patients with [[Febrile neutropenia|Neutropenic]] [[enterocolitis]] is as high as 50% especially in patients with transmural [[inflammation]] or [[intestinal perforation]]</ref><ref name="pmid1727660">{{cite journal| author=Wade DS, Nava HR, Douglass HO| title=Neutropenic enterocolitis. Clinical diagnosis and treatment. | journal=Cancer | year= 1992 | volume= 69 | issue= 1 | pages= 17-23 | pmid=1727660 | doi=10.1002/1097-0142(19920101)69:1<17::aid-cncr2820690106>3.0.co;2-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1727660  }}</ref>
*Neutrophilic enterocolitis has documented mortality rates as high as 50%, especially in patients with transmural inflammation or intestinal rupture.


OR
==Diagnosis==
 
[[Febrile neutropenia|Neutropenic]] [[enterocolitis]] is typically diagnosed based on a combination of [[clinical]] and [[Radiology|radiological]] findings.<ref name="pmid8218694">{{cite journal| author=Sloas MM, Flynn PM, Kaste SC, Patrick CC| title=Typhlitis in children with cancer: a 30-year experience. | journal=Clin Infect Dis | year= 1993 | volume= 17 | issue= 3 | pages= 484-90 | pmid=8218694 | doi=10.1093/clinids/17.3.484 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8218694  }}</ref>
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.


==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
There are no established criteria for the diagnosis of typhlitis.
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
There are no established criteria for the diagnosis of [disease name].


===History and Symptoms===
===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.
The most common symptoms of typhlitis include [[fever]], [[abdominal pain]], and [[diarrhea]]. In severe cases, [[diarrhea]] can be [[Bloody diarrhea|bloody]]. [[Abdominal distension]] and [[paralytic ileus]] may also occur in patients.<ref name="pmid231969572">{{cite journal| author=Nesher L, Rolston KV| title=Neutropenic enterocolitis, a growing concern in the era of widespread use of aggressive chemotherapy. | journal=Clin Infect Dis | year= 2013 | volume= 56 | issue= 5 | pages= 711-7 | pmid=23196957 | doi=10.1093/cid/cis998 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23196957  }}</ref>
 
OR
 
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].


===Physical Examination===
===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Common physical examination of patients with [[Febrile neutropenia|Neutropenic]] [[enterocolitis]] is usually remarkable for [[Abdominal]] discomfort which can be [[diffuse]] or [[Localized disease|localized]], with the [[Right lower quadrant abdominal pain resident survival guide|right lower quadrant]] being the most common location. A rigid abdomen could be an indication of [[bowel perforation]].<ref name="NesherRolston20122">{{cite journal|last1=Nesher|first1=L.|last2=Rolston|first2=K. V. I.|title=Neutropenic Enterocolitis, a Growing Concern in the Era of Widespread Use of Aggressive Chemotherapy|journal=Clinical Infectious Diseases|volume=56|issue=5|year=2012|pages=711–717|issn=1058-4838|doi=10.1093/cid/cis998}}</ref>
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Laboratory Findings===
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
Laboratory findings consistent with the diagnosis of typhlitis include [[Neutropenia causes|neutropenia]] with absolute neutrophil count <500 cells/microL, [[thrombocytopenia]] ranged from 4000/pl to 120,000/pl.<ref name="pmid2404562">{{cite journal| author=Katz JA, Wagner ML, Gresik MV, Mahoney DH, Fernbach DJ| title=Typhlitis. An 18-year experience and postmortem review. | journal=Cancer | year= 1990 | volume= 65 | issue= 4 | pages= 1041-7 | pmid=2404562 | doi=10.1002/1097-0142(19900215)65:4<1041::aid-cncr2820650433>3.0.co;2-a | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2404562  }}</ref>
 
OR
 
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 
OR
 
[Test] is usually normal among patients with [disease name].
 
OR
 
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR
 
There are no diagnostic laboratory findings associated with [disease name].
 
===Electrocardiogram===
There are no ECG findings associated with [disease name].


OR
===Ultrasound===


An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
*[[Ultrasound]] (US) may be helpful in the [[diagnosis]] of [[Febrile neutropenia|Neutropenic]] [[enterocolitis]]. Findings on an [[ultrasound]] suggestive of [[Febrile neutropenia|Neutropenic]] [[enterocolitis]] include circumferential wall thickening and prominent [[submucosa]] .<ref name="TamburriniSetola2018">{{cite journal|last1=Tamburrini|first1=Stefania|last2=Setola|first2=Francesca Rosa|last3=Belfiore|first3=Maria Paola|last4=Saturnino|first4=Pietro Paolo|last5=Della Casa|first5=Maria Gabriella|last6=Sarti|first6=Giuseppe|last7=Abete|first7=Roberta|last8=Marano|first8=Ines|title=Ultrasound diagnosis of typhlitis|journal=Journal of Ultrasound|volume=22|issue=1|year=2018|pages=103–106|issn=1876-7931|doi=10.1007/s40477-018-0333-2}}</ref>


===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].
An [[x-ray]] may be helpful in the [[diagnosis]] of Typhlitis but nonspecific. Findings on an [[x-ray]] suggestive of [[Febrile neutropenia|Neutropenic]] [[enterocolitis]] include inflated [[cecum]] with dilated [[small bowel]] loops, can detect free air.<ref name="pmid727660">{{cite journal| author=Terzis JK, Daniel RK, Williams HB, Spencer PS| title=Benign fatty tumors of the peripheral nerves. | journal=Ann Plast Surg | year= 1978 | volume= 1 | issue= 2 | pages= 193-216 | pmid=727660 | doi=10.1097/00000637-197803000-00011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=727660  }}</ref>
 
OR
 
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].
 
OR
 
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


OR
===CT Scan===


There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
*A [[computed tomography]] (CT) scan of the [[abdomen]] may be helpful in the diagnosis of [[Febrile neutropenia|Neutropenic]] [[enterocolitis]]. Findings on CT scan suggestive of [[Febrile neutropenia|Neutropenic]] [[enterocolitis]] include [[Intestinal wall]] thickening, [[mesenteric|mesenteric]] stranding, [[intestinal]] [[dilatation]], [[Pneumatosis intestinalis CT|pneumatosis, ]]distention and circumferential thickening of the cecal wall.<ref name="KirkpatrickGreenberg2003">{{cite journal|last1=Kirkpatrick|first1=Iain D. C.|last2=Greenberg|first2=Howard M.|title=Gastrointestinal Complications in the Neutropenic Patient: Characterization and Differentiation with Abdominal CT|journal=Radiology|volume=226|issue=3|year=2003|pages=668–674|issn=0033-8419|doi=10.1148/radiol.2263011932}}</ref>
===CT===
* Cecal distention and circumferential thickening of the cecal wall
* Inflammatory stranding of the adjacent mesenteric fat is a common finding.
* Detection of complications such as pneumatosis, pneumoperitoneum, and pericolic fluid collections is important because they indicate a need for urgent surgical management.
<gallery>
<gallery>
Image:
File:Typhlitis-001.jpg
 
File:Typhlitis-002.jpg
Typhlitis-001.jpg
File:Typhlitis-003.jpg
 
File:Typhlitis-004.jpg
Image:
 
Typhlitis-002.jpg
 
Image:
 
Typhlitis-003.jpg
 
Image:
 
Typhlitis-004.jpg
 
</gallery>
</gallery>


==Causes==


===Life Threatening Causes===
==Treatment==
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
===MRI===
There are no MRI findings associated with [disease name].
 
OR
 
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
 
OR


[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].
OR
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
==Treatment==
===Medical Therapy===
===Medical Therapy===
*'''1. Community-acquired infection in adults''' <ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345  }} </ref>
:*'''1.1. Mild-to-moderate severity (perforated or abscessed appendicitis and other infections of mild-to-moderate severity):'''
::*'''1.1.1. Single agent:'''
:::*Preferred regimen (1): [[Cefoxitin]] 2 g IV q6h
:::*Preferred regimen (2): [[Ertapenem]] 1 g IV q24h
:::*Preferred regimen (3): [[Moxifloxacin]] 400 mg IV q24h
:::*Preferred regimen (4): [[Tigecycline]] 100 mg initial dose, {{then}} 50 mg IV q12h
:::*Preferred regimen (5): [[Ticarcillin]]-[[clavulanic acid]] 3.1 g IV q6h; FDA labeling indicates 200 mg/kg/day in divided doses every 6 h for moderate infection
::*'''1.1.2. Combination:'''
:::*Preferred regimen (1): [[Cefazolin]] 1–2 g IV q8h {{and}} [[Metronidazole]] 500 mg IV q8–12 h {{or}} 1500 mg q24h
:::*Preferred regimen (2): [[Cefuroxime]] 1.5 g IV q8h {{and}} [[Metronidazole]] 500 mg IV q8–12 h {{or}} 1500 mg q24h
:::*Preferred regimen (3): [[Ceftriaxone]] 1–2 g IV q12–24 h {{and}} [[Metronidazole]] 500 mg IV q8–12 h {{or}} 1500 mg q24h
:::*Preferred regimen (4): [[Cefotaxime]] 1–2 g IV  q6–8 h {{and}} [[Metronidazole]] 500 mg IV q8–12 h {{or}} 1500 mg q24h
:::*Preferred regimen (5): [[Ciprofloxacin]] 400 mg IV q12h {{and}} [[Metronidazole]] 500 mg IV q8–12 h {{or}} 1500 mg q24h
:::*Preferred regimen (6): [[Levofloxacin]] 750 mg IV  q24h {{and}} [[Metronidazole]] 500 mg IV q8–12 h {{or}} 1500 mg q24h


:*'''1.2. High risk or severity (severe physiologic disturbance, advanced age, or immunocompromised state):'''
*The mainstay of treatment for [[Febrile neutropenia|Neutropenic]] [[enterocolitis]] consists of both supportive [[therapy]] and [[antimicrobials]]<ref name="pmid19231539">{{cite journal| author=Mullassery D, Bader A, Battersby AJ, Mohammad Z, Jones EL, Parmar C | display-authors=etal| title=Diagnosis, incidence, and outcomes of suspected typhlitis in oncology patients--experience in a tertiary pediatric surgical center in the United Kingdom. | journal=J Pediatr Surg | year= 2009 | volume= 44 | issue= 2 | pages= 381-5 | pmid=19231539 | doi=10.1016/j.jpedsurg.2008.10.094 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19231539  }}</ref>
::*'''1.2.1. Single agent:'''
:::*Preferred regimen (1): Imipenem-cilastatin 500 mg IV q6h {{or}} 1 g q8h
:::*Preferred regimen (2): [[Meropenem]] 1 g IV q8h
:::*Preferred regimen (3): [[Doripenem]] 500 mg IV q8h
:::*Preferred regimen (4): [[Piperacillin-tazobactam]] 3.375 g IV q6h


::*'''1.2.2. Combination:'''
*Supportive [[therapy]] for [[Febrile neutropenia|Neutropenic]] [[colitis]] include [[bowel]] rest with [[Nasogastric aspiration|nasogastric]] suction, [[intravenous fluids]], and, if necessary, [[Parenteral nutrition|parenteral nutrition.]]
:::*Preferred regimen (1): [[Cefepime]] 2 g  q8–12 h {{and}} [[Metronidazole]] 500 mg IV q8–12 h or 1500 mg q24h
:::*Preferred regimen (2): [[Ceftazidime]] 2 g q8h {{and}} [[Metronidazole]] 500 mg IV q8–12 h or 1500 mg q24h
:::*Preferred regimen (3): [[Ciprofloxacin]] 400 mg q12h {{and}} [[Metronidazole]] 500 mg IV q8–12 h or 1500 mg q24h
:::*Preferred regimen (4): [[Levofloxacin]]  750 mg q24h {{and}} [[Metronidazole]] 500 mg IV q8–12 h or 1500 mg q24h
:::*Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.


*'''2. Health Care–Associated Complicated Intra-abdominal Infection''' <ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345 }} </ref>
*[[Empiric therapy]] for [[Febrile neutropenia|Neutropenic]] [[colitis]] depends on [[antimicrobial]] exposure, [[bacteremia]] and local resistance pattern.
:*'''2.1. Less than 20% Resistant Pseudomonas aeruginosa, Extended-spectrum B-lactamase-producing Enterobacteriaceae, Acinetobacter, or other  multidrug resistant gram-negative bacilli:'''
*Pipericillin-tazobactum, carbapenam, or an antipseudomonal [[cephalosporin]] is recommended among  patients who develop [[neutropenic]] [[colitis]] and [[vancomycin]] is considered in case of [[mucositis]] is suspected, which is against [[gram positive bacteria]].<ref name="pmid21258094">{{cite journal| author=Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA | display-authors=etal| title=Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 4 | pages= e56-93 | pmid=21258094 | doi=10.1093/cid/cir073 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21258094 }}</ref><ref name="pmid10037047">{{cite journal| author=Salazar R, Solá C, Maroto P, Tabernero JM, Brunet J, Verger G | display-authors=etal| title=Infectious complications in 126 patients treated with high-dose chemotherapy and autologous peripheral blood stem cell transplantation. | journal=Bone Marrow Transplant | year= 1999 | volume= 23 | issue= 1 | pages= 27-33 | pmid=10037047 | doi=10.1038/sj.bmt.1701520 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10037047  }}</ref>
::*Preferred regimen (1): [[Meropenem]]  1 g IV q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g IV q6h {{and}} [[Ceftazidime]] 2 g IV q8h {{and}} [[Metronidazole]] 500 mg q8–12 h or 1500 mg q24h
::*Preferred regimen (2): Imipenem-cilastatin 500 mg IV 6 h {{or}} 1 g  q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g IV q6h {{and}} [[Ceftazidime]] 2 g IV q8h {{and}} [[Metronidazole]] 500 mg IV q8–12 h or 1500 mg q24h
::*Preferred regimen (3): [[Doripenem]] 500 mg IV q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g IV q6h {{and}} [[Ceftazidime]] 2 g IV q8h {{and}} [[Metronidazole]] 500 mg IV every 8–12 h or 1500 mg q24h
::*Preferred regimen (4): [[Meropenem]]  1 g IV q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g IV q6h {{and}} [[Cefepime]] 2 g IV q8–12 h {{and}} [[Metronidazole]] 500 mg q8–12 h or 1500 mg q24h
::*Preferred regimen (5): Imipenem-cilastatin 500 mg IV q6h {{or}} 1 g q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g IV q6h {{and}} [[Cefepime]] 2 g IV q8–12 h {{and}} [[Metronidazole]] 500 mg IV q8–12 h or 1500 mg q24h
::*Preferred regimen (6): [[Doripenem]] 500 mg IV q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g IV q6h {{and}} [[Cefepime]] 2 g IV q8–12 h {{and}} [[Metronidazole]] 500 mg IV q8–12 h or 1500 mg q24h


:*'''2.2. Extended-spectrum B-lactamase-producing Enterobacteriaceae:'''
===Surgery===
::*Preferred regimen (1): [[Meropenem]]  1 g IV q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Gentamicin]] 5–7 mg/kg IV q24h
::*Preferred regimen (2): [[Meropenem]]  1 g IV q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Tobramycin]] 5–7 mg/kg IV q24h
::*Preferred regimen (3): [[Meropenem]]  1 g IV q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Amikacin]] 15–20 mg/kg IV q24h
::*Preferred regimen (4): Imipenem-cilastatin 500 mg IV q6h {{or}} 1 g q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Gentamicin]] 5–7 mg/kg IV q24h
::*Preferred regimen (5): Imipenem-cilastatin 500 mg IV q6h {{or}} 1 g q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Tobramycin]] 5–7 mg/kg IV q24h
::*Preferred regimen (6): Imipenem-cilastatin 500 mg IV q6h {{or}} 1 g q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Amikacin]] 15–20 mg/kg IV q24h
::*Preferred regimen (7): [[Doripenem]] 500 mg IV q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Gentamicin]] 5–7 mg/kg IV q24h
::*Preferred regimen (8): [[Doripenem]] 500 mg IV q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Tobramycin]] 5–7 mg/kg IV q24h
::*Preferred regimen (9): [[Doripenem]] 500 mg IV q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Amikacin]] 15–20 mg/kg IV q24h


:*'''2.3. Pseudomonas aeruginosa with more than 20% resistant to ceftazidime:'''
*All individuals with [[Febrile neutropenia|Neutropenic]] [[enterocolitis]] should seek surgical advice as soon as possible.<ref name="pmid3484659">{{cite journal| author=Shamberger RC, Weinstein HJ, Delorey MJ, Levey RH| title=The medical and surgical management of typhlitis in children with acute nonlymphocytic (myelogenous) leukemia. | journal=Cancer | year= 1986 | volume= 57 | issue= 3 | pages= 603-9 | pmid=3484659 | doi=10.1002/1097-0142(19860201)57:3<603::aid-cncr2820570335>3.0.co;2-k | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484659 }}</ref>
::*Preferred regimen (1): [[Meropenem]] 1 g IV q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Gentamicin]] 5–7 mg/kg IV q24h
*[[Surgery]] is usually reserved for patients with either [[bowel perforation]], [[pneumoperitoneum]], or persistent [[gastrointestinal bleeding]].
::*Preferred regimen (2): [[Meropenem]]  1 g IV q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Tobramycin]] 5–7 mg/kg IV q24h
::*Preferred regimen (3): [[Meropenem]]  1 g IV q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Amikacin]] 15–20 mg/kg IV q24h
::*Preferred regimen (4): Imipenem-cilastatin 500 mg IV q6h {{or}} 1 g q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Gentamicin]] 5–7 mg/kg IV q24h
::*Preferred regimen (5): Imipenem-cilastatin 500 mg IV q6h {{or}} 1 g q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Tobramycin]] 5–7 mg/kg IV q24h
::*Preferred regimen (6): Imipenem-cilastatin 500 mg IV q6h {{or}} 1 g q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Amikacin]] 15–20 mg/kg IV q24h
::*Preferred regimen (7): [[Doripenem]] 500 mg IV q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g IV q6h {{and}} [[Gentamicin]] 5–7 mg/kg IV q24h
::*Preferred regimen (8): [[Doripenem]] 500 mg IV q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Tobramycin]] 5–7 mg/kg IV q24h
::*Preferred regimen (9): [[Doripenem]] 500 mg IV q8h {{and}} [[Piperacillin-tazobactam]] 3.375 g  IV q6h {{and}} [[Amikacin]] 15–20 mg/kg IV q24h


:*'''2.4.Methicillin-resistant Staphylococcus aureus (MRSA):'''
===Primary Prevention===
::*Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12 h
Effective measures for the [[primary prevention]] of [[Febrile neutropenia|Neutropenic]] [[enterocolitis]] include early detection and treatment can help to avoid problems and improve outcomes in patients who have undergone intensive chemotherapy or a stem cell transplant.Treatment with G-CSF not only speeds recovery from neutropenia episodes that occur during chemotherapy, but it also reduces the risk of consequences including mucositis.<ref name="pmid7687319">{{cite journal| author=Steward WP| title=Granulocyte and granulocyte-macrophage colony-stimulating factors. | journal=Lancet | year= 1993 | volume= 342 | issue= 8864 | pages= 153-7 | pmid=7687319 | doi=10.1016/0140-6736(93)91350-u | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7687319  }}</ref>
::*Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.


*'''3. Community-acquired infection in pediatric patients'''<ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345  }} </ref>
===Secondary Prevention===
:*'''3.1. Single agent:'''
Effective measures for the [[secondary prevention]] include early surgical evaluation in the management of this condition, as it can be life-saving for some patients who present with a complicated [[Neutropenic fever|Neutropenic]] [[enterocolitis]]<ref name="VarkiArmitage1979">{{cite journal|last1=Varki|first1=Ajit P.|last2=Armitage|first2=James O.|last3=Feagler|first3=John R.|title=Typhlitis in acute leukemia.Successful treatment by early surgical intervention|journal=Cancer|volume=43|issue=2|year=1979|pages=695–697|issn=0008-543X|doi=10.1002/1097-0142(197902)43:2<695::AID-CNCR2820430242>3.0.CO;2-9}}</ref>
::*Preferred regimen (1): [[Ertapenem]] 3 months to 12 years 15 mg/kg bid (not to exceed 1 g/day) Every 12 h, older than 13 years 1 g/day Every 24 h {{or}}
::*Preferred regimen (2): [[Meropenem]] 60 mg/kg/day q8h
::*Preferred regimen (3): Imipenem-cilastatin 60–100 mg/kg/day IV q6h
::*Preferred regimen (4): [[Ticarcillin-clavulanate]] 200–300 mg/kg/day IV of ticarcillin component q4–6 h
::*Preferred regimen (5): [[Piperacillin-tazobactam]] 200–300 mg/kg/day IV of piperacillin component q6–8 h
:*'''3.2.Combination:'''
::*Preferred regimen(1): [[Ceftriaxone]] 50–75 mg/kg/day q12–24 h, {{and}} [[Metronidazole]] 30–40 mg/kg/day q8h
::*Preferred regimen(2): [[Cefotaxime]] 150–200 mg/kg/day q6–8 h, {{and}} [[Metronidazole]] 30–40 mg/kg/day q8h
::*Preferred regimen(3): [[Cefepime]] 100 mg/kg/day q12h, {{and}} [[Metronidazole]] 30–40 mg/kg/day q8h
::*Preferred regimen(4): [[Ceftazidime]] 150 mg/kg/day q8 h, {{and}} [[Metronidazole]] 30–40 mg/kg/day q8h
::*Preferred regimen(5): [[Gentamicin]] 3–7.5 mg/kg/day q2–4 h, {{and}} [[Metronidazole]] 30–40 mg/kg/day q8h {{withorwithout}} [[Ampicillin]] 200 mg/kg/day q6h
::*Preferred regimen(6): [[Gentamicin]] 3–7.5 mg/kg/day q2–4 h, {{and}} [[Clindamycin]] 20–40 mg/kg/day q6–8 h {{withorwithout}} [[Ampicillin]] 200 mg/kg/day q6h
::*Preferred regimen(7): [[Tobramycin]] 3.0–7.5 mg/kg/day q8–24 h, {{and}} [[Metronidazole]] 30–40 mg/kg/day q8h {{withorwithout}} [[Ampicillin]] 200 mg/kg/day q6h
::*Preferred regimen(8): [[Tobramycin]] 3.0–7.5 mg/kg/day q8–24 h, {{and}} [[Clindamycin]] 20–40 mg/kg/day q6–8 h {{withorwithout}} [[Ampicillin]] 200 mg/kg/day q6h
::*Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.


==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 00:54, 28 July 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shameera Shaik Masthan MBBS, DLO, DNB[2]

Synonyms and keywords: Neutropenic colitis; Neutropenic enterocolitis; cecitis

Overview

Typhlitis is most commonly seen in neutropenic patients receiving chemotherapy for a cancer. It is also been seen in people with aplastic anemia, lymphoma, acquired immunodeficiency syndrome, as well as people who have had a kidney transplant. Typhlitis is distinguished by edema and inflammation of the cecum, ascending colon, and, in some cases, terminal ileum. Transmural necrosis, perforation, and mortality can occur as a result of the inflammation. The exact cause of the condition is unknown, but it is most likely caused by a combination of ischemia, infection (particularly with cytomegalovirus), mucosal hemorrhage, and possibly neoplastic infiltration. The treatment includes bowel rest, parenteral nutrition, antibiotics, and intensive fluid and electrolyte replacement.

Historical Perspective

  • In 1970, Wagner et al found and described typhlitis as necrotizing colitis after autopsy of 191 leukemic children with terminal illness at the Texas Children's Hospital, Baylor College of Medicine, Houston, between 1958 and 1970.[1]

Classification

  • There is no established system for the classification of Typhlitis.

Pathophysiology

Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Doxorubicin Hydrochloride, cytosine arabinoside, gemcitabine, vincristine, doxorubicin, cyclophosphamide, 5-fluorouracil, leucovorin, and daunorubicin are some of the drugs used to treat cancer.[6]Antibiotics, sulfasalazine, and immunosuppressive medication for organ transplantation[7][8]
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic Adults with hematologic malignancies such leukemia, lymphoma, multiple myeloma, aplastic anemia, and myelodysplastic syndromes.[9]
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes


Differentiating Typhlitis from other Diseases

Typhlitis must be distinguished from other diseases that exhibit symptoms such as fever, abdominal pain, and diarrhea.[10]

Epidemiology and Demographics

Risk Factors

Common risk factors in the development of Typhlitis include hematological, solid tumors, neutropenic and Immunocompromised individuals.[20]

Screening

There is insufficient evidence to recommend routine screening for Neutropenic enterocolitis.

Natural History, Complications, and Prognosis

Diagnosis

Neutropenic enterocolitis is typically diagnosed based on a combination of clinical and radiological findings.[23]

Diagnostic Study of Choice

There are no established criteria for the diagnosis of typhlitis.

History and Symptoms

The most common symptoms of typhlitis include fever, abdominal pain, and diarrhea. In severe cases, diarrhea can be bloody. Abdominal distension and paralytic ileus may also occur in patients.[24]

Physical Examination

Common physical examination of patients with Neutropenic enterocolitis is usually remarkable for Abdominal discomfort which can be diffuse or localized, with the right lower quadrant being the most common location. A rigid abdomen could be an indication of bowel perforation.[25]

Laboratory Findings

Laboratory findings consistent with the diagnosis of typhlitis include neutropenia with absolute neutrophil count <500 cells/microL, thrombocytopenia ranged from 4000/pl to 120,000/pl.[26]

Ultrasound

X-ray

An x-ray may be helpful in the diagnosis of Typhlitis but nonspecific. Findings on an x-ray suggestive of Neutropenic enterocolitis include inflated cecum with dilated small bowel loops, can detect free air.[28]

CT Scan


Treatment

Medical Therapy

Surgery

Primary Prevention

Effective measures for the primary prevention of Neutropenic enterocolitis include early detection and treatment can help to avoid problems and improve outcomes in patients who have undergone intensive chemotherapy or a stem cell transplant.Treatment with G-CSF not only speeds recovery from neutropenia episodes that occur during chemotherapy, but it also reduces the risk of consequences including mucositis.[34]

Secondary Prevention

Effective measures for the secondary prevention include early surgical evaluation in the management of this condition, as it can be life-saving for some patients who present with a complicated Neutropenic enterocolitis[35]

References

  1. ↑ Katz, Julie A.; Mahoney, Donald H.; Fernbach, Donald J.; Wagner, Milton L.; Gresik, Mary V. (1990). "Typhlitis. An 18-year experience and postmortem review". Cancer. 65 (4): 1041–1047. doi:10.1002/1097-0142(19900215)65:4<1041::AID-CNCR2820650433>3.0.CO;2-A. ISSN 0008-543X.
  2. ↑ Urbach DR, Rotstein OD (1999). "Typhlitis". Can J Surg. 42 (6): 415–9. PMC 3795130. PMID 10593241.
  3. ↑ Cloutier RL (2009). "Neutropenic enterocolitis". Emerg Med Clin North Am. 27 (3): 415–22. doi:10.1016/j.emc.2009.04.002. PMID 19646645.
  4. ↑ Rodrigues FG, Dasilva G, Wexner SD (2017). "Neutropenic enterocolitis". World J Gastroenterol. 23 (1): 42–47. doi:10.3748/wjg.v23.i1.42. PMC 5221285. PMID 28104979.
  5. ↑ "StatPearls".   ( ). 2021:  . PMID 31869058.
  6. ↑ Rodrigues FG, Dasilva G, Wexner SD (2017). "Neutropenic enterocolitis". World J Gastroenterol. 23 (1): 42–47. doi:10.3748/wjg.v23.i1.42. PMC 5221285. PMID 28104979.
  7. ↑ Chakravarty, K.; Scott, D. G. I.; Mccann, B. G. (1992). "FATAL NEUTROPENIC ENTEROCOLITIS ASSOCIATED WITH SULPHASALAZINE THERAPY FOR RHEUMATOID ARTHRITIS". Rheumatology. 31 (5): 351–353. doi:10.1093/rheumatology/31.5.351. ISSN 1462-0324.
  8. ↑ Bibbo C, Barbieri RA, Deitch EA, Brolin RE (2000). "Neutropenic enterocolitis in a trauma patient during antibiotic therapy for osteomyelitis". J Trauma. 49 (4): 760–3. doi:10.1097/00005373-200010000-00029. PMID 11038099.
  9. ↑ Davila ML (2006). "Neutropenic enterocolitis". Curr Opin Gastroenterol. 22 (1): 44–7. doi:10.1097/01.mog.0000198073.14169.3b. PMID 16319675.
  10. ↑ Cardona Zorrilla AF, Reveiz Herault L, Casasbuenas A, Aponte DM, Ramos PL (2006). "Systematic review of case reports concerning adults suffering from neutropenic enterocolitis". Clin Transl Oncol. 8 (1): 31–8. doi:10.1007/s12094-006-0092-y. PMID 16632437.
  11. ↑ Czepiel J, Dróżdż M, Pituch H, Kuijper EJ, Perucki W, Mielimonka A; et al. (2019). "Clostridium difficile infection: review". Eur J Clin Microbiol Infect Dis. 38 (7): 1211–1221. doi:10.1007/s10096-019-03539-6. PMC 6570665 Check |pmc= value (help). PMID 30945014.
  12. ↑ Pillet S, Pozzetto B, Roblin X (2016). "Cytomegalovirus and ulcerative colitis: Place of antiviral therapy". World J Gastroenterol. 22 (6): 2030–45. doi:10.3748/wjg.v22.i6.2030. PMC 4726676. PMID 26877608.
  13. ↑ "StatPearls". 2021. PMID 31335045.
  14. ↑ Ramachandran V, Kolli SS, Strowd LC (2019). "Review of Graft-Versus-Host Disease". Dermatol Clin. 37 (4): 569–582. doi:10.1016/j.det.2019.05.014. PMID 31466596.
  15. ↑ Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT (2015). "Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management". Lancet. 386 (10000): 1278–1287. doi:10.1016/S0140-6736(15)00275-5. PMID 26460662.
  16. ↑ Theodoropoulou A, Koutroubakis IE (2008). "Ischemic colitis: clinical practice in diagnosis and treatment". World J Gastroenterol. 14 (48): 7302–8. doi:10.3748/wjg.14.7302. PMC 2778113. PMID 19109863.
  17. ↑ Gorschlüter M, Mey U, Strehl J, Ziske C, Schepke M, Schmidt-Wolf IG; et al. (2005). "Neutropenic enterocolitis in adults: systematic analysis of evidence quality". Eur J Haematol. 75 (1): 1–13. doi:10.1111/j.1600-0609.2005.00442.x. PMID 15946304.
  18. ↑ Aksoy DY, Tanriover MD, Uzun O, Zarakolu P, Ercis S, Ergüven S; et al. (2007). "Diarrhea in neutropenic patients: a prospective cohort study with emphasis on neutropenic enterocolitis". Ann Oncol. 18 (1): 183–189. doi:10.1093/annonc/mdl337. PMID 17023562.
  19. ↑ Nesher L, Rolston KV (2013). "Neutropenic enterocolitis, a growing concern in the era of widespread use of aggressive chemotherapy". Clin Infect Dis. 56 (5): 711–7. doi:10.1093/cid/cis998. PMID 23196957.
  20. ↑ Biasoli, I; Nucci, M; Spector, N; Portugal, R; Domingues, A; Pulcheri, W (1997). "Risk factors for typhlitis". Oncology Reports. doi:10.3892/or.4.5.1029. ISSN 1021-335X.
  21. ↑ Gorschlüter M, Mey U, Strehl J, Ziske C, Schepke M, Schmidt-Wolf IG; et al. (2005). "Neutropenic enterocolitis in adults: systematic analysis of evidence quality". Eur J Haematol. 75 (1): 1–13. doi:10.1111/j.1600-0609.2005.00442.x. PMID 15946304.
  22. ↑ Wade DS, Nava HR, Douglass HO (1992). "Neutropenic enterocolitis. Clinical diagnosis and treatment". Cancer. 69 (1): 17–23. doi:10.1002/1097-0142(19920101)69:1<17::aid-cncr2820690106>3.0.co;2-x. PMID 1727660.
  23. ↑ Sloas MM, Flynn PM, Kaste SC, Patrick CC (1993). "Typhlitis in children with cancer: a 30-year experience". Clin Infect Dis. 17 (3): 484–90. doi:10.1093/clinids/17.3.484. PMID 8218694.
  24. ↑ Nesher L, Rolston KV (2013). "Neutropenic enterocolitis, a growing concern in the era of widespread use of aggressive chemotherapy". Clin Infect Dis. 56 (5): 711–7. doi:10.1093/cid/cis998. PMID 23196957.
  25. ↑ Nesher, L.; Rolston, K. V. I. (2012). "Neutropenic Enterocolitis, a Growing Concern in the Era of Widespread Use of Aggressive Chemotherapy". Clinical Infectious Diseases. 56 (5): 711–717. doi:10.1093/cid/cis998. ISSN 1058-4838.
  26. ↑ Katz JA, Wagner ML, Gresik MV, Mahoney DH, Fernbach DJ (1990). "Typhlitis. An 18-year experience and postmortem review". Cancer. 65 (4): 1041–7. doi:10.1002/1097-0142(19900215)65:4<1041::aid-cncr2820650433>3.0.co;2-a. PMID 2404562.
  27. ↑ Tamburrini, Stefania; Setola, Francesca Rosa; Belfiore, Maria Paola; Saturnino, Pietro Paolo; Della Casa, Maria Gabriella; Sarti, Giuseppe; Abete, Roberta; Marano, Ines (2018). "Ultrasound diagnosis of typhlitis". Journal of Ultrasound. 22 (1): 103–106. doi:10.1007/s40477-018-0333-2. ISSN 1876-7931.
  28. ↑ Terzis JK, Daniel RK, Williams HB, Spencer PS (1978). "Benign fatty tumors of the peripheral nerves". Ann Plast Surg. 1 (2): 193–216. doi:10.1097/00000637-197803000-00011. PMID 727660.
  29. ↑ Kirkpatrick, Iain D. C.; Greenberg, Howard M. (2003). "Gastrointestinal Complications in the Neutropenic Patient: Characterization and Differentiation with Abdominal CT". Radiology. 226 (3): 668–674. doi:10.1148/radiol.2263011932. ISSN 0033-8419.
  30. ↑ Mullassery D, Bader A, Battersby AJ, Mohammad Z, Jones EL, Parmar C; et al. (2009). "Diagnosis, incidence, and outcomes of suspected typhlitis in oncology patients--experience in a tertiary pediatric surgical center in the United Kingdom". J Pediatr Surg. 44 (2): 381–5. doi:10.1016/j.jpedsurg.2008.10.094. PMID 19231539.
  31. ↑ Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA; et al. (2011). "Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america". Clin Infect Dis. 52 (4): e56–93. doi:10.1093/cid/cir073. PMID 21258094.
  32. ↑ Salazar R, Solá C, Maroto P, Tabernero JM, Brunet J, Verger G; et al. (1999). "Infectious complications in 126 patients treated with high-dose chemotherapy and autologous peripheral blood stem cell transplantation". Bone Marrow Transplant. 23 (1): 27–33. doi:10.1038/sj.bmt.1701520. PMID 10037047.
  33. ↑ Shamberger RC, Weinstein HJ, Delorey MJ, Levey RH (1986). "The medical and surgical management of typhlitis in children with acute nonlymphocytic (myelogenous) leukemia". Cancer. 57 (3): 603–9. doi:10.1002/1097-0142(19860201)57:3<603::aid-cncr2820570335>3.0.co;2-k. PMID 3484659.
  34. ↑ Steward WP (1993). "Granulocyte and granulocyte-macrophage colony-stimulating factors". Lancet. 342 (8864): 153–7. doi:10.1016/0140-6736(93)91350-u. PMID 7687319.
  35. ↑ Varki, Ajit P.; Armitage, James O.; Feagler, John R. (1979). "Typhlitis in acute leukemia.Successful treatment by early surgical intervention". Cancer. 43 (2): 695–697. doi:10.1002/1097-0142(197902)43:2<695::AID-CNCR2820430242>3.0.CO;2-9. ISSN 0008-543X.
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