Immunocompromised Patients

Chapter

Abstract

In this chapter, we will review the principles of caring for an immunocompromised patient in the surgical intensive care unit (ICU), focusing on those in which infection is suspected. We will review in detail the management of patients who have undergone solid organ transplantation (SOT), stem cell transplantation (SCT), chemotherapy, radiation, chronic corticosteroid therapy, and tumor necrosis factor-alpha (TNF-α (alpha)) inhibitor therapy and those with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), chronic hepatitis B virus (HBV), or chronic hepatitis C virus (HCV) infection. We will review risk factors for viral, bacterial, and fungal infections in these patients, as well as an approach to their initial diagnostic evaluation and treatment.

In general, clinicians should maintain a high degree of suspicion for infection in these patient populations, as such patients often will not present with classic symptoms due to their inability to mount an inflammatory response. Because infections may remain occult for a more prolonged period of time, and infection can progress rapidly in these patients, when an immunocompromised patient is admitted to the surgical ICU, aggressive diagnostic and therapeutic measures may be necessary.

Keywords

Immunocompromised host Solid organ transplantation Stem cell transplantation Chemotherapy Corticosteroids Tumor necrosis factor-alpha inhibitors Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) Hepatitis B Hepatitis C 

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Authors and Affiliations

  1. 1.Department of MedicineHospital of the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA

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