Pneumonia in immunocompromised individuals

Pneumonia in persons with weakened immunity is often caused by unusual pathogens. Symptoms depend on the microorganism. The diagnosis is based on bacteriological studies of blood and secretion of the respiratory tract, taken during bronchoscopy. Treatment depends on the nature of immunodeficiency and the pathogen of a pathogenic microorganism.

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Causes of the pneumonia in immunocompromised individuals

The causative agents of pneumonia in patients with weakened immunity can be a variety of microorganisms. However, respiratory symptoms and changes in chest radiography in immunodeficient patients can develop not only due to infection, but also due to other processes, for example, pulmonary hemorrhage, pulmonary edema, radiation damage, pulmonary toxicity when taking cytotoxic drugs and tumor infiltrates.

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Symptoms of the pneumonia in immunocompromised individuals

Symptoms may be the same as in community-acquired or hospital pneumonia in immunocompetent patients, although patients with immunodeficiency may not have elevated temperature or respiratory symptoms, and are less likely to excrete purulent sputum against neutropenia. In some patients, the only sign is fever.

Diagnostics of the pneumonia in immunocompromised individuals

Immunodeficient patients with respiratory symptoms, manifestations or fever should be given a chest X-ray. When an infiltrate is detected, diagnostic studies should include sputum smear staining according to Gram, a bacteriological blood test. The optimal diagnosis is established by the study of induced sputum and / or bronchoscopy, especially in patients with chronic pneumonia, atypical manifestations, severe immunity defects and lack of response to broad-spectrum antibiotics.

Probable pathogens can often be predicted based on symptoms, radiological changes and the type of immune deficiency. Probable diagnoses in patients with acute symptoms are bacterial infection, bleeding, pulmonary edema, leukocytagglutinin reaction and pulmonary embolism. Subacute or chronic course is more suspicious of fungal or mycobacterial infection, opportunistic viral infection, pneumonia caused by Pneumocystis jiroveci (formerly P. Carinii), tumor, reaction to cytotoxic drugs or radiation damage.

Radiography revealing limited consolidation usually indicates an infection caused by bacteria, mycobacteria, fungi or Nocardia. Diffuse interstitial changes are more likely to indicate viral infection, P. Jiroveci pneumonia, drug or radiation injury, or pulmonary edema. Common nodular lesions suggest infection with mycobacteria, Nocardia, fungi or a tumor. Cavitric lesions are characteristic of mycobacteria, Nocardia, fungi or bacteria.

In recipients after organ or bone marrow transplantation, a frequent cause of bilateral interstitial pneumonia is cytomegalovirus, or the disease is considered idiopathic. Pleural consolidation is usually caused by aspergillosis. In patients with AIDS, bilateral pneumonia is usually caused by P. Jiroveci infection. Approximately 30% of HIV-positive patients P. Jiroveci pneumonia is the first AIDS-defining diagnosis, and in more than 80% of AIDS patients this infection occurs after a while if prevention is not done. Patients with HIV infection become vulnerable to P. Jiroveci, when the number of CD4 + helpers is reduced to <200 / μL.

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Treatment of the pneumonia in immunocompromised individuals

In patients with neutropenia, the empirical treatment of pneumonia in immunocompromised individuals depends on the immune defect, the radiographic data and the severity of the disease. In general, broad-spectrum drugs are needed that are effective against gram-negative bacteria, Staphylococcus aureus, and anaerobes, as in hospital pneumonia.