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The immunocompromised host
1Department of Internal Medicine/Infectious Diseases, Cleveland Clinic Florida, Fort Lauderdale.
Abstract:
Infection still remains the most common immediate cause of death in the immunocompromised host. Because of the decreased host defenses leading not only to an increased susceptibility to a variety of opportunistic pathogens (in particular the fungi) but also to a decreased host inflammatory response and resultant clinical findings, infections in these patients are difficult to diagnose. Skin lesions occur in up to a third of infections in compromised hosts and can often be the first presentation of a systemic illness. The broad scope of dermatologic manifestations of infection in compromised patients is reviewed based on four presumed underlying pathophysiologic mechanisms and on the vast array of potential pathogens that have been reported to date in the literature.
Insights
Infections are the leading cause of death in immunocompromised patients, often presenting as difficult-to-diagnose skin lesions. This review explores the diverse dermatologic manifestations of infection in these vulnerable individuals.
Area of Science:
- Infectious Diseases
- Immunology
- Dermatology
Background:
- Infections are the primary cause of mortality in immunocompromised individuals.
- Reduced host defenses increase susceptibility to opportunistic pathogens, especially fungi.
- Diminished inflammatory responses complicate infection diagnosis in these patients.
Purpose of the Study:
- To review the spectrum of dermatologic manifestations of infections in immunocompromised patients.
- To correlate skin lesions with underlying pathophysiologic mechanisms.
- To highlight the variety of pathogens causing infections in this population.
Main Methods:
- Literature review of reported infections in immunocompromised hosts.
- Categorization of skin lesions based on four presumed pathophysiologic mechanisms.
- Analysis of diverse opportunistic pathogens identified in clinical cases.
Main Results:
- Skin lesions are a common presentation, seen in up to one-third of infections.
- Dermatologic manifestations can be the initial sign of systemic illness.
- A wide array of pathogens contribute to these infections.
Conclusions:
- Understanding the diverse skin manifestations is crucial for diagnosing infections in immunocompromised patients.
- Pathophysiologic mechanisms and specific pathogens inform diagnosis and management.
- Early recognition of skin lesions can lead to timely intervention.