Pneumonia in immunocompromised host

Alternative names
Pneumonia in immunodeficient patient

Definition
Pneumonia in an immunocompromised host describes a lung infection that occurs in a person whose infection-fighting mechanisms are significantly impaired.

Causes, incidence, and risk factors

People who are immunocompromised have a defective immune response. Because of this, they are susceptible to infections by microorganisms that are present everywhere, but do not normally cause disease in healthy people. They are also more susceptible 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
  o nonproductive (dry cough) or with mucus-like, greenish, or pus-like sputum
  
• chills with shaking
  
• fever
  
• easy fatigue
  
• chest pain
  o sharp or stabbing
  o increased by deep breathing
  o 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:
  o joint stiffness (rare)
  o muscular stiffness (rare)
  o swollen glands
  o excessive sweating or night sweats

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

The goal of treatment is to eliminate the infection with antimicrobial therapy (antibiotics or antifungal agents, usually). The specific agent used will depend on the sensitivity of the organism causing the problem as determined by a culture or special stains.

Respiratory treatments to remove secretions and oxygen therapy are often indicated.

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

Prevention

Limit exposure of immunocompromised people to others who are ill.

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