Skip to main content
SpringerLink
Log in
Book cover

Evidence-Based Critical Care pp 215–220Cite as

Immunocompromised Pneumonia

  • Chapter
  • First Online:

  • 91k Accesses

Abstract

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.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. O’Donnell WJ, Pieciak W, Chertow GM, Sanabria J, Lahive KC. Clearance of Pneumocystis carinii cysts in acute P carinii pneumonia: assessment by serial sputum induction. Chest. 1998;114(5):1264–8.

    Article  PubMed  Google Scholar 

  2. Sickles EA, Greene WH, Wiernik PH. Clinical presentation of infection in granulocytopenic patients. Arch Intern Med. 1975;135(5):715–9.

    Article  CAS  PubMed  Google Scholar 

  3. Dickson RP, Erb-Downward JR, Huffnagle GB. Towards an ecology of the lung: new conceptual models of pulmonary microbiology and pneumonia pathogenesis. Lancet Respir Med. 2014;2(3):238–46. Pubmed Central PMCID: 4004084.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dickson RP, Martinez FJ, Huffnagle GB. The role of the microbiome in exacerbations of chronic lung diseases. Lancet. 2014;384(9944):691–702. Pubmed Central PMCID: 4166502.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Venkataraman A, Bassis CM, Beck JM, Young VB, Curtis JL, Huffnagle GB, et al. Application of a neutral community model to assess structuring of the human lung microbiome. MBio. 2015;6(1). Pubmed Central PMCID: PMC4324308.

    Google Scholar 

  6. Iwai S, Fei M, Huang D, Fong S, Subramanian A, Grieco K, et al. Oral and airway microbiota in HIV-infected pneumonia patients. J Clin Microbiol. 2012;50(9):2995–3002. Pubmed Central PMCID: PMC3421777.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Diaz PI, Hong BY, Frias-Lopez J, Dupuy AK, Angeloni M, Abusleme L, et al. Transplantation-associated long-term immunosuppression promotes oral colonization by potentially opportunistic pathogens without impacting other members of the salivary bacteriome. Clin Vaccine Immunol. 2013;20(6):920–30. Pubmed Central PMCID: PMC3675961.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Wright HL, Moots RJ, Bucknall RC, Edwards SW. Neutrophil function in inflammation and inflammatory diseases. Rheumatology (Oxford). 2010;49(9):1618–31.

    Article  CAS  Google Scholar 

  9. Camps Serra M, Cervera C, Pumarola T, Moreno A, Perello R, Torres A, et al. Virological diagnosis in community-acquired pneumonia in immunocompromised patients. Eur Respir J. 2008;31(3):618–24.

    Article  CAS  PubMed  Google Scholar 

  10. Heussel CP, Kauczor HU, Heussel G, Fischer B, Mildenberger P, Thelen M. Early detection of pneumonia in febrile neutropenic patients: use of thin-section CT. AJR Am J Roentgenol. 1997;169(5):1347–53.

    Article  CAS  PubMed  Google Scholar 

  11. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388–416.

    Google Scholar 

  12. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 Suppl 2:S27–72.

    Article  CAS  PubMed  Google Scholar 

  13. Antonelli M, Conti G, Bufi M, Costa MG, Lappa A, Rocco M, et al. Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA. 2000;283(2):235–41.

    Article  CAS  PubMed  Google Scholar 

  14. Girou E, Schortgen F, Delclaux C, Brun-Buisson C, Blot F, Lefort Y, et al. Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA. 2000;284(18):2361–7.

    Article  CAS  PubMed  Google Scholar 

  15. Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med. 2001;344(7):481–7.

    Article  CAS  PubMed  Google Scholar 

  16. Consensus statement on the use of corticosteroids as adjunctive therapy for pneumocystis pneumonia in the acquired immunodeficiency syndrome. The National Institutes of Health-University of California Expert Panel for Corticosteroids as Adjunctive Therapy for Pneumocystis Pneumonia. N Engl J Med. 1990;323(21):1500–4.

    Google Scholar 

  17. Briel M, Bucher HC, Boscacci R, Furrer H. Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HIV-infection. Cochrane Database Syst Rev. 2006;3, CD006150.

    Google Scholar 

  18. Delclaux C, Zahar JR, Amraoui G, Leleu G, Lebargy F, Brochard L, et al. Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in non-human immunodeficiency virus-infected patients: retrospective study of 31 patients. Clin Infect Dis. 1999;29(3):670–2.

    Article  CAS  PubMed  Google Scholar 

  19. Pareja JG, Garland R, Koziel H. Use of adjunctive corticosteroids in severe adult non-HIV Pneumocystis carinii pneumonia. Chest. 1998;113(5):1215–24.

    Article  CAS  PubMed  Google Scholar 

  20. Tasbakan MS, Gurgun A, Basoglu OK, Ekren PK, Pullukcu H, Bacakoglu F. Comparison of bronchoalveolar lavage and mini-bronchoalveolar lavage in the diagnosis of pneumonia in immunocompromised patients. Respiration. 2011;81(3):229–35.

    Article  PubMed  Google Scholar 

  21. Cazzadori A, Di Perri G, Todeschini G, Luzzati R, Boschiero L, Perona G, et al. Transbronchial biopsy in the diagnosis of pulmonary infiltrates in immunocompromised patients. Chest. 1995;107(1):101–6.

    Article  CAS  PubMed  Google Scholar 

  22. Jain P, Sandur S, Meli Y, Arroliga AC, Stoller JK, Mehta AC. Role of flexible bronchoscopy in immunocompromised patients with lung infiltrates. Chest. 2004;125(2):712–22.

    Article  PubMed  Google Scholar 

  23. Bulpa PA, Dive AM, Mertens L, Delos MA, Jamart J, Evrard PA, et al. Combined bronchoalveolar lavage and transbronchial lung biopsy: safety and yield in ventilated patients. Eur Respir J. 2003;21(3):489–94.

    Article  CAS  PubMed  Google Scholar 

  24. O’Brien JD, Ettinger NA, Shevlin D, Kollef MH. Safety and yield of transbronchial biopsy in mechanically ventilated patients. Crit Care Med. 1997;25(3):440–6.

    Article  PubMed  Google Scholar 

  25. Guo YL, Chen YQ, Wang K, Qin SM, Wu C, Kong JL. Accuracy of BAL galactomannan in diagnosing invasive aspergillosis: a bivariate metaanalysis and systematic review. Chest. 2010;138(4):817–24.

    Article  PubMed  Google Scholar 

  26. White DA, Wong PW, Downey R. The utility of open lung biopsy in patients with hematologic malignancies. Am J Respir Crit Care Med. 2000;161(3 Pt 1):723–9.

    Article  CAS  PubMed  Google Scholar 

  27. Sulahian A, Porcher R, Bergeron A, Touratier S, Raffoux E, Menotti J, et al. Use and limits of (1–3)-beta-d-glucan assay (Fungitell), compared to galactomannan determination (Platelia Aspergillus), for diagnosis of invasive aspergillosis. J Clin Microbiol. 2014;52(7):2328–33. Pubmed Central PMCID: PMC4097729.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bele N, Darmon M, Coquet I, Feugeas JP, Legriel S, Adaoui N, et al. Diagnostic accuracy of procalcitonin in critically ill immunocompromised patients. BMC Infect Dis. 2011;11:224. Pubmed Central PMCID: PMC3170614.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medicine (Pulmonary and Critical Care), University of Michigan Health System, Ann Arbor, MI, USA

    Robert P. Dickson

Authors
  1. Robert P. Dickson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert P. Dickson .

Editor information

Editors and Affiliations

  1. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan, USA

    Robert C. Hyzy

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Dickson, R.P. (2017). Immunocompromised Pneumonia. In: Hyzy, R. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-43341-7_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43341-7_24

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43339-4

  • Online ISBN: 978-3-319-43341-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation