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Lower Respiratory Tract Infections

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  • Authors: Karen C. Carroll1, La’tonzia L. Adams2
  • Editors: Randall T. Hayden3, Donna M. Wolk4, Karen C. Carroll5, Yi-Wei Tang6
    Affiliations: 1: Division of Medical Microbiology, Johns Hopkins Hospital, Baltimore, MD 21287; 2: Pathology & Lab Medicine, VA Portland Health Care System, Portland, OR 97239; 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 July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0029-2016
  • Received 18 April 2016 Accepted 25 April 2016 Published 15 July 2016
  • Karen C. Carroll, [email protected]
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  • Abstract:

    This review will focus on the infectious etiologies and more common noninfectious causes of lower respiratory tract syndromes among major immunosuppressed populations. The changing epidemiology of infections in the era of highly active antiretroviral therapy (HAART) in the case of HIV-positive patients and the impacts of both newer immune-suppressant therapies and anti-infective prophylaxis for other immunocompromised hosts will be discussed, with emphasis on diagnostic approaches and practice algorithms.

  • Citation: Carroll K, Adams L. 2016. Lower Respiratory Tract Infections. Microbiol Spectrum 4(4):DMIH2-0029-2016. doi:10.1128/microbiolspec.DMIH2-0029-2016.


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This review will focus on the infectious etiologies and more common noninfectious causes of lower respiratory tract syndromes among major immunosuppressed populations. The changing epidemiology of infections in the era of highly active antiretroviral therapy (HAART) in the case of HIV-positive patients and the impacts of both newer immune-suppressant therapies and anti-infective prophylaxis for other immunocompromised hosts will be discussed, with emphasis on diagnostic approaches and practice algorithms.

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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 35 .

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0029-2016
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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 35 .

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0029-2016
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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 15 .

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0029-2016
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Radiographic appearances of pulmonary infiltrates in the immunocompromised host and the likely etiologic agents

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0029-2016
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Recommended diagnostic studies to be performed on BAL, TBB, and SLB specimens

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0029-2016

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