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Pneumonia is a common and morbid complication of immunosuppression and requires unique diagnostic and therapeutic considerations. This chapter reviews the presentation, microbial etiology, diagnosis, empiric management and supportive care of pneumonia in immunocompromised patients. The presentation of pneumonia is often clinically and radiographically atypical among immunocompromised patients, and warrants a more aggressive diagnostic approach than is recommended for immunocompetent patients. The breadth of potential pathogens is broad in immunocompromised patients and corresponds to each patient’s specific immune defects. Empiric antimicrobial therapy should be tailored to each patient’s profile of potential pathogens, and revisited frequently in the context of clinical response and microbiological data. Non-infectious pulmonary pathology is common in immunocompromised patients and should be included in differential diagnoses. Invasive testing of the lower respiratory tract (via flexible bronchoscopy, miniature bronchoalveolar lavage or open lung biopsy) is more commonly indicated for immunocompromised patients than among the immunocompetent. Evidence supporting delivery of intensive care in the immunocompromised population is reviewed, and current controversies are discussed.
KeywordsPneumonia Immunocompromised Immunosuppressed Immunosuppression Respiratory infection Bacteria Fungi Virus Opportunistic infection Infectious disease Pulmonary
Acquired Immunodeficiency Syndrome
Human Immunodeficiency Virus
Intensive care unit
Noninvasive positive pressure ventilation
Polymerase chain reaction
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