Environmental precautions for patients with chronic neutropenia

Madeleine Verhovsek, MD, is an associate professor in the Department of Pathology and Molecular Medicine at McMaster University.

Are there any environmental precautions (including those related to diet) that should be followed by patients with chronic neutropenia?

People with chronic neutropenia may have it because of maybe some medication that they’re on. Particularly common would be somebody who’s on high doses of chemotherapy for cancer. A lot of times the precautions that we’ll tell patients will be guided by the circumstances of their neutropenia and whether it’s coming up and down over time, whether it’s stable, low, and also whether they have other risk factors, as somebody who, for example, on high-dose chemotherapy may have.

As general principles, though, we do recommend all of these methods of preventing infections. We mentioned before immunization being an important part of that. We also mentioned good hand hygiene and reminding patients to keep their hands washed and to avoid touching their face and eyes. The mouth can be a source of bacteria and usually our bodies are very able to fight it off. But if somebody has neutropenia and maybe they’re brushing their teeth very hard or they haven’t been brushing their teeth and the germs are accumulating in their mouth, then they could potentially get the bacteria into their bloodstream and get an infection. It is very important to emphasize good oral hygiene, brushing teeth, and proper schedule of visits to a dentist.

Sometimes there are questions beyond hand hygiene and oral hygiene. Also questions about whether someone’s diet should be adjusted or whether there are certain things they need to be careful of eating. I’m not aware of any evidence to say yes or no, but some of the principles that you will sometimes hear are things like making sure if someone is eating meat, that it’s well cooked rather than anything that might be raw, or avoiding raw fish, raw eggs, those kinds of things.

Those are principles that a patient who is wanting to do everything they can to prevent any infection could follow. But it is very hard to do a research study on or really know for sure how important those precautions are.