Bridging the Gap Between General and Transplant Infectious Disease Practice

The population of iatrogenic immunocompromised individuals is steadily rising as we continue to improve in our ability to manage diseases, including cancer, autoimmune disease, and end-organ dysfunction, with increasing access to novel agents and transplantation. Enhanced survivorship allows these patients to return to their home communities and lives, leading to an increased number of immunocompromised patients across all healthcare systems. However, expertise in immunocompromised host infectious diseases or transplant ID (TID) is concentrated in urban centers and often in academic settings. In this article, we review three cases to highlight common immunosuppressed groups that can be encountered in any health system: solid organ transplantation, hematologic malignancy, and autoimmune disease. The cases describe common illness scripts and key management considerations for the opportunistic pathogens highlighted. Finally, we outline high-yield references that can support clinical care of these patients for those interested, whether they be community-based general infectious diseases clinicians or infectious diseases fellows considering dedicated training in TID. The standards and expectations for immunocompromised infectious diseases training in both general infectious diseases fellowships and dedicated TID training are still being established. There are many societies and groups focused on addressing this need, and the importance of their collaboration and efforts is emphasized by our cases. Immunocompromising conditions are no longer niche, but rather an expected and substantial population of hospitalized patients everywhere. We will need the entire infectious diseases workforce, as well as further recruitment and retention of the next generation of physicians, to meet this ever-increasing demand.