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Chapter 21 : Lower Respiratory Tract Infections

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Abstract:

Decades of advances in cancer treatments and transplantation immunology have expanded the population of severely immunocompromised patients. In addition, new therapies for the management of rheumatologic, autoimmune, and acquired immune diseases have reduced mortality among these patient groups. Pulmonary infections are the most common syndromes contributing to morbidity and mortality among immunosuppressed patients ( ). Virtually any potential pathogen can result in significant illness, and pulmonary infiltrates may be caused by a variety of noninfectious syndromes as well. Management of pulmonary syndromes in these vulnerable populations is a challenge for both clinicians and microbiologists, as prompt diagnosis can prevent irreversible pulmonary complications and/or allow withdrawal of potentially toxic empiric therapies. Diagnostic approaches should consider the tempo of the pulmonary process, the extent of immunosuppression, and the radiographic patterns. In addition, the likelihood of a specific infection may be affected by recently administered prophylaxis or empiric therapies.

Citation: Carroll K, Adams L. 2016. Lower Respiratory Tract Infections, p 539-568. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0029-2016
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Figure 1

A proposed infection timeline based on the use of common prophylaxis in solid organ transplant recipients. The dotted lines indicate onset of infection that would occur without prophylaxis. Solid lines indicate the most common times to onset of infection for each pathogen. On the x-axis, 0 indicates the time of transplantation. CAP, community acquired; CMV, Cytomegalovirus; EBV, Epstein-Barr virus; HSV, herpes simplex virus; Mtb, . Modified with permission from reference .

Citation: Carroll K, Adams L. 2016. Lower Respiratory Tract Infections, p 539-568. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0029-2016
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Image of Figure 2
Figure 2

Proposed infection timeline based on the use of common prophylaxis in human stem cell transplant recipients. The dotted lines indicate onset of infection that would occur without prophylaxis. Solid lines indicate the most common times to onset of infection for each pathogen. On the x-axis, 0 indicates the time of transplantation, and each number following indicates months posttransplantation. CAP, community acquired; CMV, Cytomegalovirus; GVHD, graft-versus-host disease; EBV, Epstein-Barr virus; HSV, herpes simplex virus;HHV-6, human herpesvirus-6; Mtb, . Modified with permission from reference .

Citation: Carroll K, Adams L. 2016. Lower Respiratory Tract Infections, p 539-568. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0029-2016
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Image of Figure 3
Figure 3

Clinical approach to pulmonary infiltrates in immunocompromised patients. BAL, bronchoalveolar lavage; CMV, cytomegalovirus; CT, computed tomography; CXR, chest X-ray; MRSA, methicillin-resistant ; PJP, pneumonia; SLB, surgical lung biopsy. Reprinted with permission from reference .

Citation: Carroll K, Adams L. 2016. Lower Respiratory Tract Infections, p 539-568. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0029-2016
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Tables

Generic image for table
Table 1

Radiographic appearances of pulmonary infiltrates in the immunocompromised host and the likely etiologic agents

Citation: Carroll K, Adams L. 2016. Lower Respiratory Tract Infections, p 539-568. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0029-2016
Generic image for table
Table 2

Recommended diagnostic studies to be performed on BAL, TBB, and SLB specimens

Citation: Carroll K, Adams L. 2016. Lower Respiratory Tract Infections, p 539-568. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0029-2016

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