From the FDA Drug Label
Infections and Infestations Genital fungal infection (0. 1%). Hematologic Eosinophilia (6%), thrombocytosis (5.1%) and leukopenia (2.1%). Body as a Whole:pain, abdominal pain, chest pain, fever, back pain, abdominal enlargement, chills, pelvic pain The fever that causes leukopenia is not explicitly stated in the provided drug labels. However, based on the information provided, fever is listed as a possible adverse reaction, and leukopenia is also reported as an adverse reaction.
- Leukopenia is reported in 2.1% of patients.
- Fever is reported as an adverse reaction, but the exact percentage is not specified. It is essential to note that the provided drug labels do not establish a direct causal relationship between fever and leukopenia. Therefore, a conservative clinical decision would be to monitor patients for both fever and leukopenia as potential adverse reactions, but not to conclude that fever causes leukopenia based on the provided information 1.
From the Research
Typhoid fever is the most commonly associated fever with leukopenia, as it typically produces leukopenia rather than the leukocytosis seen in many other bacterial infections. Leukopenia (abnormally low white blood cell count) is commonly associated with viral fevers, particularly dengue fever, typhoid fever, influenza, and viral hepatitis. According to a study published in 2000 2, leukopenia was present in 7 out of 21 patients with typhoid fever. Another study published in 1992 3 found that leucopenia was found in only 24.6% of patients with typhoid fever. The mechanism behind fever-associated leukopenia involves viral suppression of bone marrow function, redistribution of white blood cells from circulation to infected tissues, or direct destruction of white blood cells by pathogens. When evaluating a patient with fever and leukopenia, these infections should be considered in the differential diagnosis, particularly in endemic areas or with relevant travel history.
Some key points to consider:
- Typhoid fever is a common cause of non-specific febrile infection in adults and children presenting to health care facilities in low resource settings such as South Asia 4.
- The World Health Organization (WHO) currently recommends treatment with azithromycin, ciprofloxacin, or ceftriaxone due to widespread resistance to older, first-line antimicrobials 5.
- Ceftriaxone may result in a decrease in clinical failure compared to azithromycin, and it is unclear whether ceftriaxone has an effect on microbiological failure compared to azithromycin in two small trials published over 18 years ago and in one more recent trial, all conducted in participants under 18 years of age 5.
- Leukopenia is a common finding in patients with typhoid fever, and it is essential to consider this infection in the differential diagnosis of febrile patients from Latin America or those with a history of recent travel to endemic countries 2.