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Pulmonary infection in the immunocompromised patient

D A White1

  • 1Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.

Seminars in Thoracic and Cardiovascular Surgery
|April 1, 1995
PubMed

Insights

Pneumonia in immunocompromised patients is serious, with infection type predictable by immune status and illness presentation. Advances offer improved outcomes, but new risks like pneumothorax with Pneumocystis pneumonia emerge.

Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Oncology
  • Immunology

Background:

  • Immunocompromised patients face significant morbidity and mortality from pneumonia.
  • Susceptibility to diverse pathogens is high, with infection patterns linked to immune status and clinical context.

Purpose of the Study:

  • To review the spectrum of pneumonia in immunocompromised patients.
  • To discuss diagnostic modalities and therapeutic advances.
  • To highlight emerging challenges in managing these infections.

Main Methods:

  • Review of existing literature on pneumonia in immunocompromised hosts.
  • Analysis of factors influencing pathogen prediction (immune defect, exposures, chemotherapy, radiography, illness acuity).
  • Discussion of diagnostic tools including bronchoscopy with bronchoalveolar lavage and open lung biopsy.
  • Evaluation of therapeutic strategies, including growth factors, oral antifungals, and antivirals (ganciclovir, acyclovir).

Main Results:

  • Infection type is often predictable based on clinical and host factors.
  • New treatments have improved prognosis in some cases.
  • Emerging complications include spontaneous pneumothorax associated with Pneumocystis carinii infection.

Conclusions:

  • Bronchoscopy with bronchoalveolar lavage is crucial for diagnosing infections like Pneumocystis carinii and cytomegalovirus.
  • Open lung biopsy remains essential for diagnosis in select cases.
  • Management involves a multidisciplinary approach, including surgical resection for fungal infections and hemoptysis.

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