A little boy I know (2 years old) is receiving Chemotherapy. Following his Chemotherapy, he had been receiving daily shots of G-CSF, GM-CSF
(Neupogen, Leukine, Prokine) for three days when he developed a fever of 101 degrees. He was taken to hospital and admitted for very low white blood count and a visible infection of left ear.

Standard antibiotics given through IV on the daily basis do not seem to have helped him too much (His temperature seems to go up and down). He has a cough, sore throat, and apprent cold/flu.

Although all his cultures have been clean, the Doctors have decided he may have fungal infection and have recommended he join a Double-Blind Research comparing Amphotericin B and Amisome (Liposomal Amphotericin B). Both of these medications have serious possible side effects.

Questions: Isn't a side effect of Neupogen shots fever? How do the Doctors determine it is fungal infection (and not cold or flu)? Are there any other treatment methods available? Do you know anything about the mentioned antifungal drugs and do you recommend participating in the study or taking Amphotericin B (may be with Flucytosine-Toxic to Bone Marrow).

-the internet is read by thousands of people around the world. This provides access to a wealth of information otherwise very difficult to get a hold of. Due to the seriousness of the illness (this Cancer and possible fungal infection) and very discouraging results produced by "traditional" medicine, I believe it is reasonable to get as much information about various complications as possible.

It is the duty of the parents to be completely informed on the latest options available. The intent here is not to second guess the physician; but rather to help avoid possible mistakes and provide the best treatment for the child. (Think of it as a last minute research the Doctors often do not have the time to do). I have found this child's Oncologist to "appear" quite acceptable to this idea: Afterall, the parents just provide some information and asks questions from the Physician. An uninformed individual can not do that!

After posting this question, I did a research at several online data banks.(Including PDQ article from 1/94) The children's hospital of Philadelphia (June 1995 case of the month) dealt with fungal infection. They mentioned use of injected Amphotericin B (16% effective!), Liposomal Amphotericin B (open question on effectivity), AmB with 5-Flucytosine
(Myelotoxic at high levels), and Itraconazole (as well as other reasons for possible fever). At least now the parents know what to ask...