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Pneumonia on the background of immunodeficiency states: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025
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In patients with immunodeficiency conditions, pneumonia can be caused by various pathogens. In cases of humoral immunity impairment (for example, in myeloma disease), pneumonia is most often caused by pneumococcus, Haemophilus influenzae, and Neisseria. In AIDS patients, the main etiologic factors of pneumonia are pneumocystis, toxoplasma, cytomegalovirus, herpes virus, opportunistic fungi aspergillus, and cryptococci.
Pneumocystis carinii pneumonia
Pneumocystis carinii is considered a fungus by modern standards and is a conditionally pathogenic pathogen. In healthy individuals, the pathogen may be inactive in the lungs, but if the cellular immune function is impaired, it causes severe pneumonia.
Pneumocystis pneumonia is extremely common in AIDS patients and is often the cause of their death. It can also develop in patients with leukemia.
Symptoms of Pneumocystis pneumonia
In most patients, Pneumocystis pneumonia begins gradually. Patients are bothered by general weakness, fever, cough with difficult to separate sputum (possibly hemoptysis), shortness of breath. An objective examination reveals cyanosis, enlarged liver and spleen, auscultation of the lungs reveals dry and fine-bubble rales in various parts of the lungs, and percussion reveals dilation of the roots of the lungs. Quite often, Pneumocystis pneumonia can acquire a severe course (pronounced intoxication syndrome, significant shortness of breath).
Diagnosis of Pneumocystis pneumonia
At first, moderate pulmonary infiltration is determined in the area of both roots of the lungs, subsequently focal infiltrative shadows appear, which can merge into fairly large areas of compaction and alternate with areas of pulmonary emphysema. The disease can be complicated by rupture of emphysematous areas and the development of pneumothorax.
Laboratory data: moderate leukocytosis and a decrease in the number of T-helper lymphocytes (CD4) in the blood to a level below 200 in 1 μl are noted.
To confirm the diagnosis of Pneumocystis pneumonia, Pneumocysts are identified in sputum, transtracheal aspirate, and bronchial washings. Pneumocysts are detected by staining preparations with megenamine silver or by the Giemsa method. In recent years, monoclonal antibodies have been used.
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Treatment of Pneumocystis pneumonia
| Preparation | Dosage, scheme | Possible side effect |
| Baktrmm, biseptop (Trimethoprim - sulfamethoxazole) | Daily dose 15 mg/kg orally or intravenously. Course of treatment 14-21 days | Nausea, vomiting, drug rash, anemia, neutropenia, hepatitis, Stevens-Johnson syndrome |
| Trimethoprim + Dapsone | Daily dose: trimetholrim 15 mg/kg orally, dalsone -100 mg orally. Course of treatment 14-21 days | Nausea, drug rash, hemolytic anemia, methemoglobinemia |
| Pentamidine (Pentamidinum) | Daily dose 3-4 mg/kg intravenously, course of treatment 14-21 days | Hypotension, hypoglycemia, anemia, pancreatitis, hepatitis |
| Primaqine + Clindamycin | Daily dose: Primakin 15-30 mg orally, clindamycin 1800 mg (in three doses) orally. The course of treatment is 14-21 days. | Hemolytic anemia, methemoglobinemia, neutropenia, colitis |
| Atovaquone | Single dose 750 mg orally 3 times a day. Course of treatment 14-21 days | Drug rash, aminotransferase elevation, anemia, neutropenia |
| Trimetrexate | Used in case of ineffectiveness of all other drugs. Daily dose 45 mg/ m2 intravenously together with calcium leucovorin. Course of treatment 21 days | Leukopenia, drug rash |
Cytomegalovirus pneumonia
Cytomegalovirus infection can cause purely viral pneumonia. The course of pneumonia is severe, with pronounced intoxication and high body temperature. Respiratory failure rapidly increases, manifested by severe dyspnea and cyanosis. Auscultation of the lungs reveals harsh breathing, scattered dry wheezing, and fine bubbling wheezing. X-ray examination of the lungs reveals significant and widespread damage to the interstitium. Cytomegalovirus pneumonia is characterized by high mortality.
To confirm the diagnosis of cytomegalovirus pneumonia, a cytological study of sputum, saliva, urine, and cerebrospinal fluid sediment is performed. In this case, "cytomegalo" cells are detected. The diameter of these cells ranges from 25 to 40 µm, they have an oval or round shape, and an inclusion surrounded by a light rim ("owl's" eye) is noted in the nucleus.
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Treatment of pneumonia in the presence of neutropenia
The most common causative agents of pneumonia are Staphylococcus aureus, Escherichia coli, and Pseudomonas.
It is advisable to prescribe ticarcitin in combination with aminoglycosides (amikacin); it is recommended to add vancomycin to this combination.
If the therapy is effective, it is continued for 2 weeks, and in case of persistent neutropenia, even longer.
If there is no effect within 24-48 hours, it is justified to prescribe amphotericin B in combination with erythromycin. In recent years, cephalosporins and aminoglycosides have been most frequently used.
Treatment of pneumonia due to T-lymphocyte deficiency
Requires the administration of cephalosporins in combination with aminoglycosides and parenteral administration of biseptol. Further actions are the same as for pneumonia against the background of neutropenia.
Treatment of pneumonia in the context of AIDS
Pneumonia against the background of AIDS is most often caused by fungi, legionella, viruses (cytomegaloviruses, herpes viruses), and pneumocystis.
Depending on the type of pathogen, the following medications are prescribed:
- candidiasis: amphotericin B at a daily dose of 0.3-0.6 mg/kg;
- cryptococcosis: amphotericin B at a daily dose of 0.3-0.5 mg/kg in combination with flucytosine orally 150 mg/kg per day;
- pneumocystis;
- herpes viruses: acyclovir 5-10 mg/kg intravenously 3 times a day for 7-14 days.