Pneumonia in immunocompromised host

Definition

Pneumonia in an immunocompromised host describes a lung infection that occurs in a person whose ability to fight infection is greatly impaired.

Alternative Names

Causes

People who are immunocompromised have a defective immune response. Because of this, they are susceptible to infections by germs (microorganisms) that are everywhere, but do not cause disease in healthy people. They are also more vulnerable to the usual causes of pneumonia, which can affect anyone.

Immunosuppression can be caused by HIV infection, leukemia, organ transplantation, bone marrow transplant, and medications to treat cancer.

Symptoms

• Nonproductive (dry) cough or cough with mucus-like, greenish, or pus-like sputum
• Chills with shaking
• Fever
• Easy fatigue
• Chest pain that is:
  • Sharp or stabbing
  • Increased by deep breathing
  • Increased by coughing
• Headache
• Loss of appetite
• Nausea and vomiting
• General discomfort, uneasiness, or ill feeling (malaise)
• Shortness of breath

  Additional symptoms that may occur:

  • Joint stiffness (rare)
  • Muscle stiffness (rare)
  • Swollen glands
  • Excessive sweating or night sweats

Exams and Tests

Crackles or other abnormal breath sounds may be heard when listening to the chest with stethoscope (auscultation). Lack of breath sounds can be an important sign.

Tests include:

• Chest x-ray
• Sputum gram stain, other special stains, and culture
• CBC
• Arterial blood gases
• Bronchoscopy
• Chest CT scan, in certain cases
• Lung biopsy, in certain cases

Treatment

The goal of treatment is to get rid of the infection with antibiotics or antifungal agents. The specific drug used will depend on what kind of organism is causing the problem. One drug may kill one type of organism, but not another.

Respiratory treatments (to remove fluid and mucus) and oxygen therapy are often needed.

Outlook (Prognosis)

The outcome may be poor if the pneumonia is caused by a virus or fungus, or if the patient is severely immunosuppressed.

Possible Complications

• Respiratory failure
• Death

When to Contact a Medical Professional

Call your health care provider if you are immunosuppressed and you have symptoms of pneumonia.

Prevention

Limit exposure of immunocompromised people to others who are ill.

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Cohen J, Powderly WG. Infectious Diseases. 2nd ed. New York, NY: Elsevier, 2004.

Mandell, GL, Bennett JE, Dolin R, eds. Principles of Infectious Diseases. 5th ed. New York, NY: Churchill Livingstone, 2000.

Mandell LA, Wunderink RG, Anzueto A, 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 Mar 1;44 Suppl 2:S27-72.

American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416.

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