Pulmonary infections in the adolescent with immunodeficiency

Pulmonary infections in the immunocompromised adolescent are important causes of significant morbidity and mortality. Advances in the fields of chemotherapy, organ transplantation, and use of corticosteroid and immunosuppressive therapies have led to significant improvement in the outcome of patients with malignancy and a variety of other disorders. HIV infection has become a major additional cause of immune suppression. In turn, physicians are encountering growing numbers of patients with an impaired immune system presenting with respiratory and other infections. This article presents a brief review of defense mechanisms in the respiratory tract, selected conditions leading to impaired immune responses in the adolescent, specific pulmonary pathogens and their evaluation in the immunocompromised adolescent, and general considerations of the management of pulmonary infections in the immunocompromised adolescent. Infections of the upper respiratory tract and pulmonary infections seen in adolescents with cystic fibrosis are not discussed.