Pneumonia in the background of immunodeficient conditions: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
In patients with immunodeficiency conditions, pneumonia can be caused by various pathogens. If there is a violation of humoral immunity (for example, in myeloma), pneumonia is most commonly caused by pneumococcus, hemophilic rod, Neisseria. In patients with AIDS, the main etiological factors of pneumonia are pneumocysts, toxoplasma, cytomegalovirus, herpes virus, opportunistic fungi of aspergillus, cryptococci.
Pneumonia caused by Pneumocystis carinii
Pneumocystis carinii is a modern concept of fungi and is a conditionally pathogenic agent. In healthy individuals, the causative agent may be in an inactive state in the lungs, but if the function of cellular immunity is impaired, it causes the development of severe pneumonia.
Pneumocystis pneumonia is extremely characteristic of 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 concerned about general weakness, fever, cough with hard-to-recover sputum (possibly hemoptysis), dyspnea. In an objective study, cyanosis, enlarged liver and spleen are found, with auscultation of the lungs - dry and small bubbling rales in different parts of the lungs, while percussion - expansion of the roots of the lungs. Quite often, pneumocystic pneumonia can acquire a severe course (pronounced intoxication syndrome, significant shortness of breath).
Diagnosis of PCP
First, moderate pulmonary infiltration is determined in the region of both lung roots, followed by focal infiltrative shadows that can merge into sufficiently large compartments and alternate with the areas of emphysema. The disease can be complicated by rupture of emphysematous areas and the development of pneumothorax.
Laboratory data - there is a moderate leukocytosis and a decrease in the amount of T-lymphocyte-helper (CD4) in the blood to below 200 in 1 μl.
To confirm the diagnosis of pneumocystis pneumonia, pneumocysts are determined in sputum, transtracheal aspirate, bronchial flushes. Pneumocysts are detected when the preparations are stained with megenamine silver or by the method of Giemsa. In recent years, monoclonal antibodies have been used.
[6], [7], [8], [9], [10], [11], [12], [13]
Treatment of PCP
| A drug | Dosage regimen | Possible side effect |
| Bactrum, biseptop (Trimethoprim - sulfamethoxazole) | The daily dose is 15 mg / kg. Inside or intravenously. The course of treatment is 14-21 days | Nausea, vomiting, drug rash, anemia, neutropenia, hepatitis, Stephen-Johnson syndrome |
| Trimethoprim + Dapsone | Daily dose; trimetholim 15 mg / kg orally, dalsone -100 mg orally. The course of treatment is 14-21 days | Nausea, drug rash, hemolytic anemia, methemoglobinemia |
| Pentamidine (Pentamidinum) | The daily dose of 3-4 mg / kg intravenously, the course of treatment 14-21 days | Hypotension, hypoglycemia, anemia, pancreatitis, hepatitis |
| Primakin (Primaqine) + clindamycin (Clindamycinum) | Daily dose: primakine 15-30 mg orally, clindamycin 1800 mg (three times) inside. Baking course 14-21 days | Hemolytic anemia, methemoglobinemia, neutropenia, colitis |
| Atovaquone (Atovaquone) | A single dose of 750 mg orally once a day. The course of treatment is 14-21 days | Drug rash, elevation of aminotransferase, anemia, neutropenia |
| Trimetrexate | It is used in case of ineffectiveness of all other drugs. A daily dose of 45 mg / m 2 is administered intravenously together with calcium leucovorin. Baking course 21 days | Leukopenia, drug rash |
Cytomegalovirus pneumonia
Cytomegalovirus infection can cause pure viral pneumonia. The course of pneumonia is severe, with pronounced intoxication, high body temperature. Rapidly increasing respiratory failure, it manifests itself marked shortness of breath, cyanosis. With auscultation of the lungs, hard breathing is detected, scattered dry wheezes, small bubbling rales. Radiographic examination of the lungs reveals a significant and widespread lesion of interstitium. Cytomegalovirus pneumonia is characterized by high lethality.
To confirm the diagnosis of cytomegalovirus pneumonia, a cytological study is made of sputum, saliva, urine, cerebrospinal fluid. In this case, cells "cytomegaly" are found. The diameter of these cells varies from 25 to 40 microns, they have an oval or round shape, the nucleus is marked inclusion, surrounded by a bright rim ("owl" eye).
Where does it hurt?
What's bothering you?
What do need to examine?
Treatment of pneumonia with neutropenia
Most often, the causative agents of pneumonia are Staphylococcus aureus, E. Coli, pseudomonas.
It is advisable the appointment of ticarcithin in combination with aminoglycosides (amikacin), it is recommended to add vancomycin to this combination.
With the effectiveness of therapy it continues for 2 weeks, and in case of persistence of neutropenia - and more.
If there is no effect within 24-48 h, the use of amphotericin B in combination with erythromycin is justified. In recent years, the most commonly used are cephalosporins and aminoglycosides.
Treatment of pneumonia against a background of deficiency of T-lymphocytes
Requires the appointment of cephalosporins in combination with aminoglycosides and parenteral use of biseptol. Further actions are the same as for pneumonia against a background of neutropenia.
Treatment of pneumonia in the background of AIDS
Pneumonia against AIDS is often caused by fungi, legionella, viruses (cytomegaloviruses, herpes viruses), pneumocysts.
Depending on the type of pathogen, the following drugs are prescribed:
- candidamycosis: amphotericin B in a daily dose of 0.3-0.6 mg / kg;
- cryptococcosis: amphotericin B in a daily dose of 0.3-0.5 mg / kg in combination with flucytosine orally 150 mg / kg per day;
- pneumocyst;
- herpes viruses: acyclovir 5-10 mg / kg intravenously 3 times a day for 7-14 days.