Pneumonia in immunocompromised individuals

Pneumonia in people with weakened immunity is often caused by unusual pathogenic organisms. Symptoms depend on microorganism. The diagnosis is based on bacteriological studies of blood and the secret of the respiratory tract taken in bronchoscopic examination. Treatment depends on the nature of immunodeficiency and pathogen of pathogenic microorganism.

[1], [2], [3], [4], [5 -]

Causes of the pneumonia in immunocompromised individuals

The causative agents of pneumonia in patients with weakened immunity can have a variety of microorganisms. However, respiratory symptoms and changes in the x-ray of the chest in immunodeficiency patients can develop not only due to infection, but also due to other processes, such as pulmonary bleeding, pulmonary edema, radiation, pulmonary toxicity when taking cytotoxic drugs and tumor infiltrates.

[7], [8], [9], [10], [11]

Symptoms of the pneumonia in immunocompromised individuals

Symptoms can be the same as with immunal or hospital pneumonia in immunocompetent patients, although patients with immunodeficiency may not have elevated temperature or respiratory symptoms, and with less probability they will distinguish purulent sputum against the background of neutropenia. In some patients, the only sign is fever.

Diagnostics of the pneumonia in immunocompromised individuals

Immunodeficiency patients with respiratory symptoms, manifestations or fever should be made of chest radiography. If infiltrate is detected, diagnostic studies should include staining with gram sputum, bacteriological blood test. An optimally reliable diagnosis is established in the study of induced sputum and/or bronchoscopy, especially in patients with chronic pneumonia, atypical manifestations, severe immunity defects and the lack of response to a wide spectrum antibiotics.

Probable pathogens can often be predicted on the basis of symptoms, radiological changes and the type of immunodefinity. Probable diagnoses in patients with acute symptoms - bacterial infection, bleeding, pulmonary edema, leukocytagglutinine reaction and pulmonary embolism. Substroy or chronic course is more suspicious of fungal or mycobacterial infection, opportunistic viral infection, pneumonia due to Pneumocystis Jiroveci (previously P. Carinii), tumor, reaction to cytotoxic drugs or radiation lesion.

X-ray, which reveals limited consolidation, usually indicates an infection due to bacteria, mycobacteria, fungi or NoCardia. Diffuse interstitial changes are more likely to indicate a viral infection, P. Jiroveci pneumonia, drug or radiation lesion or pulmonary edema. Common nodule lesions involve infection with mycobacteria, nocardia, fungi or tumor. Cavitarian lesions are characteristic of mycobacteria, nocardia, mushrooms or bacteria.

In recipients, after transplantation of organs or bone marrow, a frequent cause of bilateral interstitial pneumonia is cytomegalovirus, or the disease is recognized as idiopathic. Plateral consolidation usually causes aspergillosis. In patients with AIDS, bilateral pneumonia is usually caused by P. Jiroveci infection. In approximately 30 % of HIV-positive patients, P. Jiroveci is the first AIDS-determining diagnosis, and in more than 80 % of AIDS patients, this infection occurs after a while if prevention is not performed. Patients with HIV infection become vulnerable to P. Jiroveci, when the number of CD4+ Helper is reduced to level & LT; 200/ μl.

[12], [13], [14]

Treatment of the pneumonia in immunocompromised individuals

In patients with neutropenia, empirical treatment of pneumonia in people with weakened immunity depends on the immune defect, radiological data and the severity of the disease. In general, a wide spectrum of action, effective against gram-negative bacteria, golden staphylococcus and anaerobes, as in hospital pneumonia, are needed.