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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 reduced.

See also:

• Hospital-acquired pneumonia
• Mycoplasma pneumonia
• Pneumonia - cytomegalovirus
• Pneumonia
• Viral pneumonia
• Walking pneumonia

Alternative Names

Pneumonia in immunodeficient patient

Causes, incidence, and risk factors

People who are immunocompromised have a defective immune response. Because of this, they are susceptible to infections by germs that 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

• Cough - may be dry or produce mucus-like, greenish, or pus-like sputum
• Chills with shaking
• Easy fatigue
• Fever
• General discomfort, uneasiness, or ill feeling (malaise)
• Headache
• Loss of appetite
• Nausea and vomiting
• Sharp or stabbingchest pain that gets worse with deep breathing or coughing
• Shortness of breath

Additional symptoms that may occur:

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

Signs and tests

The doctor may hear crackles or other abnormal breath sounds when listening to the chest with stethoscope. Lack of breath sounds can be an important sign.

Tests may include:

• Chest x-ray
• Sputum gram stain
• Arterial blood gases
• Blood culture
• Complete blood count
• Bronchoscopy
• Chest CT scan, in certain cases
• Lung biopsy, in certain cases

Treatment

Antibiotics or antifungal medicines are used, depending on the specific germ that is causing the infection.

Oxygen andrespiratory treatments to remove fluid and mucus are often needed.

Expectations (prognosis)

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

Complications

• Respiratory failure
• Death

Calling your health care provider

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.

References

Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.

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.

Review Date:8/6/2007
Reviewed By:D. Scott Smith, MD., MSc., DTM., Prof. Medical Microbiology & Immunology, Dept. of Human Biology, Stanford Univ. School of Medicine, Stanford, CA. Review provided by VeriMed Healthcare Network.

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