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Overview of Infections in the Immunocompromised Host

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  • Authors: Lesia K. Dropulic1, Howard M. Lederman2
  • Editors: Randall T. Hayden3, Donna M. Wolk4, Karen C. Carroll5, Yi-Wei Tang6
    Affiliations: 1: The National Institutes of Health, National Institute of Allergy and Infectious Diseases, Division of Intramural Research, Bethesda, MD 20892; 2: Departments of Pediatrics, Medicine, and Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287; 3: St. Jude Children’s Research Hospital, Memphis, TN; 4: Geisinger Clinic, Danville, PA; 5: Johns Hopkins University Hospital, Baltimore, MD; 6: Memorial Sloan-Kettering Institute, New York, NY
  • Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0026-2016
  • Received 11 February 2016 Accepted 19 April 2016 Published 12 August 2016
  • Lesia K. Dropulic, [email protected]
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  • Abstract:

    Understanding the components of the immune system that contribute to host defense against infection is key to recognizing infections that are more likely to occur in an immunocompromised patient. In this review, we discuss the integrated system of physical barriers and of innate and adaptive immunity that contributes to host defense. Specific defects in the components of this system that predispose to particular infections are presented. This is followed by a review of primary immunodeficiency diseases and secondary immunodeficiencies, the latter of which develop because of a specific illness or condition or are treatment-related. The effects of treatment for neoplasia, autoimmune diseases, solid organ and stem cell transplants on host defenses are reviewed and associated with susceptibility to particular infections. In conclusion, an approach to laboratory screening for a suspected immunodeficiency is presented. Knowledge of which host defects predispose to specific infections allows clinicians to prevent, diagnose, and manage infections in their immunocompromised patients most effectively.

  • Citation: Dropulic L, Lederman H. 2016. Overview of Infections in the Immunocompromised Host. Microbiol Spectrum 4(4):DMIH2-0026-2016. doi:10.1128/microbiolspec.DMIH2-0026-2016.


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Understanding the components of the immune system that contribute to host defense against infection is key to recognizing infections that are more likely to occur in an immunocompromised patient. In this review, we discuss the integrated system of physical barriers and of innate and adaptive immunity that contributes to host defense. Specific defects in the components of this system that predispose to particular infections are presented. This is followed by a review of primary immunodeficiency diseases and secondary immunodeficiencies, the latter of which develop because of a specific illness or condition or are treatment-related. The effects of treatment for neoplasia, autoimmune diseases, solid organ and stem cell transplants on host defenses are reviewed and associated with susceptibility to particular infections. In conclusion, an approach to laboratory screening for a suspected immunodeficiency is presented. Knowledge of which host defects predispose to specific infections allows clinicians to prevent, diagnose, and manage infections in their immunocompromised patients most effectively.

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Timeline of infections after solid organ transplantation. Alterations in the timeline occur as a result of antimicrobial prophylaxis or in the presence of excessive immunosuppression or intense epidemiologic exposure to a potential pathogen. HSV, herpes simplex virus; EBV, Epstein-Barr virus; VZV, varicella-zoster virus; RSV, respiratory syncytial virus.

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0026-2016
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Timeline of infections after autologous hematopoietic cell transplantation.

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0026-2016
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Timeline of opportunistic infections after allogeneic hematopoietic cell transplantation. PTLD, posttransplant lymphoproliferative disease; TB, tuberculosis; NTM, nontuberculous mycobacteria; GVHD, graft-versus-host disease; RES, reticuloendothelial system.

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0026-2016
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Components of the immune system

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0026-2016
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Patterns of illness associated with primary immunodeficiency diseases

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0026-2016
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Illustrative primary immunodeficiency diseases

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0026-2016
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Host immune deficits and infections associated with immunosuppressive and chemotherapeutic agents

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0026-2016
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Biologic immune response modulators targeting lymphocytes

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0026-2016
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Biologic immune response modulators targeting cytokines and other immune mediators

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0026-2016

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