Etiology, diagnosis, and management of pneumonia in immunosuppressed patients

ABSTRACT

Patients with a compromised immune system suffer awide variety of insults. Pulmonary complications remain amajor cause of both morbidity and mortality in immunocompromised patients. When such individuals present with radiographic infiltrates, the clinician faces a diagnostic challenge.The differential diagnosis in this setting is broad and includesboth infectious and non-infectious conditions. Evaluation ofthe immunocompromised host with diffuse pulmonary infiltrates can be difficult, frustrating, and time-consuming. Thiscommon and serious problem results in significant morbidityand mortality, approaching 90%. Infections are the most common causes of both acute and chronic lung diseases leading torespiratory failure. Non-invasive diagnostic methods for evaluation are often of little value, and an invasive procedure (suchas bronchoalveolar lavage, transbronchial biopsy or even openlung biopsy) is therefore performed to obtain a microbiologicand histologic diagnosis. Bronchoscopy allows certain identification of some aetiologies, and often allows the exclusion ofinfectious agents. Early use of computed tomography scanning is able to demonstrate lesions missed by conventionalchest X-ray. However, even when a specific diagnosis is made,it might not impact patient’s overall survival and outcomes (AU)