Managing Infections and Sepsis in People with Cancer

Sepsisis a very serious condition that can develop in anyone when their body overreacts to infection, but people with a weak immune system or neutropenia have a higher risk. Instead of just attacking the infection, sepsis causes inflammation throughout the body, attacking the tissues and organs.

Signs and symptoms of infection

Cancer and cancer treatments can increase a person’s risk for different types of infections. Infections that might not usually be a problem can make a person with cancer very sick. Signs and symptoms of an infection depend on its cause and where the infection is. Some of the most common signs of infection for people with cancer include:

• Fevers
• Chills and sweats
• Fast heartbeat
• Breathing problems or cough
• Dizziness or lightheadedness
• Rash, redness, swelling, or sores on the skin (especially near the genitals, rectum, or around a catheter, tube, or drain)
• Pain or swelling in the joints or bones
• Pain, swelling, or sores in the gums, mouth, or throat
• Pain in the abdomen (belly) or rectum
• Pain or burning when peeing
• Sore throat
• Sores or white patches in the mouth or on the tongue

It's very important to protect yourself from infection if you have neutropenia (a lower white blood cell count). A fever is often the only sign of an infection in people with neutropenia. Ask your cancer care team if and how often you need to check your temperature and when to call or get medical help.

Some cancer care teams can give you a thermometer if you don’t have one. You can also get an oral thermometer (one that goes in your mouth) at any drugstore or pharmacy.

Finding the cause of infection

If your doctor or cancer care team is worried you might have an infection, they’ll need to know what type of infection and where in the body it is. This helps them choose the best medicines and treatment.

Depending on what signs or symptoms you’re having, you'll get tests to look for the cause of the infection. This might include:

• Blood tests
• Imaging tests (such as an x-ray or CT scan)
• Samples of body fluids (such as sputum, urine, or stool)
• Samples of fluid from a wound or other area (such as around a catheter)

 They might start you on a few medicines right away, while waiting for test results. This is to keep the infection from getting worse. Once they find out what types of germs are causing the infection, they will make sure you’re taking the correct medicines for that type of infection.

Treating infections in people with cancer

Infections are treated most effectively  when the type of germ that is causing them is known. Anti-infectives is a general word for the different types of medicines used to treat infections. The most common types of anti-infectives used for people with cancer are:

• Antibiotics for infections caused by bacteria (such as urinary tract infections caused by E coli or Pseudomonas bacteria)
• Antivirals for infections caused by viruses (such as viral pneumonia caused by influenza or coronavirus)
• Antifungals for infections caused by fungi (such as thrush or yeast infections caused by candida yeast)
• Antiprotozoals for infections caused by protozoa (such as toxoplasmosis caused by a parasite called Toxoplasma gondii)

Signs and symptoms of sepsis

Once there are signs of organ damage from sepsis, it’s called septic shock. Common signs of septic shock include:

• A fast heart rate
• Low blood pressure
• Confusion
• Pale, cold, or clammy skin
• Nausea
• Breathing problems

Sepsis can turn into septic shock quickly. People with septic shock might need intensive care, medicines for blood pressure, and even breathing tubes. People with cancer who develop sepsis and septic shock have a higher risk of death than people who don’t have cancer. Sepsis also increases your risk for getting a blood clot.

When to get help

If you have a fever or other signs of infection, call your cancer care team, or get medical attention right away.

Signs of infection and sepsis to watch for:

• Fever or lower body temperature than normal
• Chills or sweats
• Cold, clammy, or pale skin
• Cough or trouble breathing
• New or worse confusion
• Feeling dizzy, lightheaded, or falling down
• Chest pain
• Not able to get out of bed for more than 24 hours
• Not having to pee or peeing only very little amounts that are dark orange or brown

If you go to the doctor, clinic, or emergency department, wear a face mask to protect yourself from other sick people.