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Common pulmonary infections in immunocompromised patients
Author
Jay A Fishman, MD
Section Editor
Kieren A Marr, MD
Deputy Editor
Anna R Thorner, MD

Disclosures

Last literature review version 19.2: Maio 2011 | This topic last updated: Dezembro 9, 2009 (More)

INTRODUCTION — The spectrum of potential pathogens known to cause pulmonary infections in immunocompromised individuals has grown as a result of intensified immunosuppression, prolonged patient survival, the emergence of antimicrobial-resistant pathogens, and improved diagnostic assays. Immunocompromised hosts are defined by susceptibility to infection with organisms of little native virulence in normal individuals. Each group (eg, AIDS, solid organ transplantation, or hematopoietic cell transplantation) has enhanced susceptibility to a subset of pathogens.

Survival has improved with the availability of newer antimicrobial agents, including azole antifungals, macrolides, antivirals, and antiretroviral drugs. Despite these advances, pulmonary infection remains the most common form of documented tissue invasive infection observed in these hosts [1-5].

Common pulmonary infections in the immunocompromised host will be reviewed here. The risk of pneumonia and approaches to the evaluation and diagnosis of pulmonary infiltrates in the immunocompromised individual and the treatment of specific disease entities are discussed separately. (See "Approach to the immunocompromised patient with fever and pulmonary infiltrates".)

GENERAL CONSIDERATIONS — A number of general considerations apply in the immunocompromised patient with a pulmonary infection:

• Multiple simultaneous processes are common. These may include dual infection with Pneumocystis jirovecii (also known as P. carinii) and cytomegalovirus, or superimposition of another process (lung injury or drug toxicity). Sequential infection (eg, viral infection preceding bacterial or fungal infection) is also common. • Early