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Pneumonia in Immunocompromised Patients

Overview

Pneumonia in the immunocompromised host is a complex infection and inflammation of the lower respiratory tract, complicated by widespread multi-drug antibiotic resistance, and aided by medical advances such as improvements in diagnostic measures and immunosuppressive agents. Though overall patient survival has increased, pneumonia is both the most common invasive infection in immunocompromised patients and continues to carry a high mortality and morbidity rate.

The major immunocompromised host groups are those with:

HIV/AIDS

Solid organ and hematopoietic cell transplants

Malignancy on chemotherapy or radiation therapy

Primary immunodeficiencies and autoimmune diseases

Acquired immunodeficiencies: asplenia, long-term steroid use

Chest radiograph of HIV-infected patient with PJP

Chest radiograph of HIV-infected patient with PJP shows diffuse patchy infiltrates with predominantly perihilar and interstitial prominence, as well as a few pneumatocoeles up to 1cm in size. Courtesy of Radiopaedia (https://radiopaedia.org/), case of Dr Andrew Dixon, rID 9613.

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Chest CT of HIV-infected patient with PJP shows ea

Chest CT of HIV-infected patient with PJP shows early findings of diffuse ground glass opacities, and chronic findings of linear opacities and thickening of interlobular septa. Courtesy of Radiopaedia (https://radiopaedia.org/), case of Dr Yune Kwong, rID 26697.

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Complications

Pneumonia in immunocompromised is often complicated by superinfection, drug toxicity, empyema, sepsis, pneumothorax, and acute respiratory distress syndrome (ARDS).

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