Pneumonia in immunocompromised patients is often triggered by unusual pathogens, but can also be caused by the same pathogen as those that cause community-acquired pneumonia (community acquired Pneumonieund overview of pneumonia (pneumonia)). Symptoms and signs depend on the pathogen and the factors undermining the immune system. The diagnosis is based on blood cultures and bronchoscopic secretions recovery, sometimes with quantitative cultures. The treatment is based on the defect in the immune system and the pathogens.
In patients with weakened immune systems, a whole host of potential pathogens exist. Probable cause depends on the type of underlying immune defect from see table: pneumonia in immunocompromised patients. Nevertheless, respiratory symptoms and radiological changes in immunocompromised patients in addition to infection by a variety of other disorders such may be caused. B. pulmonary hemorrhage, pulmonary edema, radiation damage, toxic lung damage due to immunosuppressive and tumor infiltrates.
Pneumonia in immunocompromised patients is often triggered by unusual pathogens, but can also be caused by the same pathogen as those that cause community-acquired pneumonia (community acquired Pneumonieund overview of pneumonia (pneumonia)). Symptoms and signs depend on the pathogen and the factors undermining the immune system. The diagnosis is based on blood cultures and bronchoscopic secretions recovery, sometimes with quantitative cultures. The treatment is based on the defect in the immune system and the pathogens. In patients with weakened immune systems, a whole host of potential pathogens exist. Probable cause depends on the type of underlying immune defect from see table: pneumonia in immunocompromised patients. Nevertheless, respiratory symptoms and radiological changes in immunocompromised patients in addition to infection by a variety of other disorders such may be caused. B. pulmonary hemorrhage, pulmonary edema, radiation damage, toxic lung damage due to immunosuppressive and tumor infiltrates. Pneumonia in immunocompromised patients defect of the immune system disorders or therapy in connection with the defect * Probable pathogens defects granulocytes neutropenia Acute leukemia, aplastic anemia, cancer chemotherapy Gram-negative bacteria, Staphylococcus aureus, Aspergillus sp., Candida sp. Defects chemotaxis diabetes mellitus S. aureus, Gram-negative aerobes defective intracellular killing Chronic granulomatosis S. aureus defective alternative ways sickle cell anemia, Streptococcus pneumoniae, Haemophilus influenzae C5-deficient congenital disorder S. pneumoniae, S. aureus, gram-negative bacterial cell regulated immune defense (T-cell deficiency or dysfunction) Hodgkin’s lymphoma, cancer chemotherapy, treatment with corticosteroids mycobacteria, viruses (eg. As herpes simplex virus, cytomegalovirus), Strongyloides sp., Opportunistic fungi (eg., Aspergillus, Mucor, Cryptococcus spp.), Nocardia sp., Toxoplasma sp. AIDS Pneumocystis jirovecii, Toxoplasma sp., Cytomegalovirus, herpes simplex virus, opportunistic fungi (for. Example, Aspergillus, Mucor, Cryptococcus spp.), Mycobacteria Humoral immune deficiency B-cell deficiency or dysfunction multiple myeloma, agammaglobulinemia S. pneumoniae, H . influenzae, Neisseria meningitidis Selective deficiency: IgA, IgG, IgM S. pneumoniae, H. influenzae hypogammaglobulinaemia P. jirovecii, cytomegalovirus, S. pneumoniae, H. influenzae * Examples Many diseases can cause multiple defects. PMN = polymorphonuclear leukocytes symptoms and discomfort symptoms and complaints may be the same as those that occur in community-acquired pneumonia (Community-acquired pneumonia: Symptoms and complaints) or hospital-acquired pneumonia (hospital-acquired pneumonia: Symptoms and complaints) in immunocompetent patients. The symptoms may include malaise, chills, fever, rigors, cough, dyspnea and chest pain. However, fever or respiratory symptoms may be absent and the Sputumist neutropenia probably rare purulent In immunosuppressed patients. In some patients, fever is the only symptom. Tips and risks In immunocompromised patients m ust be examined with great attention to pneumonia because the symptoms can be atypical or altered. Diagnostic chest X-ray assessment of oxygen supply induction or bronchoscopy to obtain sputum blood cultures pathogens are based on the symptoms, changes in chest X-ray and the type of immunodeficiency predicted chest x-ray and assessment of oxygenation (usually by pulse oximetry) are in immunocompromised patients with respiratory symptoms, complaints or fever carried out. If an infiltrate or hypoxemia are present, diagnostic tests should be performed. Chest x-ray may be normal in pneumonia with Pneumocystis jirovecii, but hypoxia is usually available. Sputum tests and blood cultures are performed. Sputum tests should the Gram staining, mycobacterial and fungal include stains and cultures and sometimes tests for viruses (eg., PCR for cytomegalovirus in a transplant patients or in patients with AIDS). If discomfort, symptoms or risk factors for Aspergillus infection are present (aspergillosis: Pathophysiology), a serum galactomannan test should be performed. In the ideal case, the diagnosis with induced sputum can be supported both by bronchoscopy or, especially in patients with mild pneumonia, severe immunodeficiencies and lack of response to broad-spectrum antibiotics. The pathogens most likely underlying can often be predicted from the symptoms, the chest x-ray findings and the type of immune defect. Differential diagnoses in patients with acute symptoms include bacterial infections, bleeding, pulmonary edema, a leukocyte agglutination reaction on blood transfusion and pulmonary embolism. An indolent disease course can be rather close to an infection caused by fungi or mycobacteria, an opportunistic viral infection, P. jirovecii pneumonia, tumor response to immunosuppressive or an underlying radiation damage. Localized consolidation in the chest X-ray usually indicates an infection by bacteria, mycobacteria, fungi or Nocardia sp. at. A diffuse interstitial pattern of distribution rather speaks for a viral infection, P. jirovecii- pneumonia, medication side effects, radiation damage or pulmonary edema. Diffusely distributed nodular lesions can mycobacteria, Nocardia sp., Fungi or suspected tumors. Caverns are suggestive of mycobacteria, Nocardia sp., Fungi or bacteria, particularly S. aureus. In organ or bone marrow transplant recipients with bilateral interstitial pneumonia often CMV infection is based, or the disease is idiopathic. A pleuranahe consolidation usually corresponds to a aspergillosis. In AIDS patients, bilateral pneumonia usually P. jirovecii pneumonia are. Approximately 30% of HIV patients P. jirovecii pneumonia occurs as the first AIDS-defining diagnosis, and without prophylaxis develop> 80% of AIDS patients sooner or later this infection (human immunodeficiency virus infection (HIV infection): prevention of opportunistic infections). Patients with HIV infection are susceptible to P. jirovecii pneumonia when the CD4 + -Helferzahl <200 / ul is (Pneumocystis jirovecii conjunctivitis and pneumonia). Treatment broad-spectrum antimicrobial therapy Antimicrobial therapy depends and the risk factors for specific pathogens from the defect of the immune system. The consultation of an expert in infectious diseases is usually recommended. In patients with neutropenia empirical treatment depends on the defect of the immune system, X-ray findings and the severity of the disease. In general, broad-spectrum antibiotics are needed that are effective against gram-negative rods, Staphylococcus aureus and anaerobes, as with hospital-acquired pneumonia (hospital-acquired pneumonia: Treatment). If the condition of the patient does not improve with conditions other than HIV infection after 5 days of antibiotic therapy, antifungal therapy is often added taken empirically. Therapies that improve the function of the immune system (pneumonia in immunocompromised patients: Prevention) are an important tool for the treatment of pneumonia in immunocompromised patients. Prevention therapies enhance the immune function indicated for the prevention of pneumonia in immunocompromised patients. For example, patients should receive (G-CSF or Filgrastim) and patients with hypogammaglobulinemia due to congenital or acquired disorders (eg. As multiple myeloma, leukemia) IV immunoglobulin with chemotherapy-induced neutropenia granulocyte colony-stimulating factor. Patients with HIV and CD4 + helper cells <200 / ul should receive prophylactic therapy with trimethoprim / sulfamethoxazole or other appropriate therapy daily. Vaccination is also important in these patients. Thus, should. B. patients at risk of pneumonia with encapsulated bacteria (eg. B., hypogammaglobulinemia, asplenia) received vaccinations against pneumococcal and H. influenzae. Important points Typical and unusual pathogens should be considered in immunocompromised patients who have pneumonia. If patients have hypoxemia, or abnormne chest x-ray, followed by further tests including sputum tests, ideally with induced or bronchoscopy preserved sample. Beginning with broad-spectrum antimicrobial therapy