pulmonary infiltrate in immunocompromised host

Introduction

Also see pulmonary infiltrate in patients with AIDS.

Etiology

• non-infectious
  • malignancy
  • cytotoxic drug reaction
  • radiation pneumonitis
  • pulmonary hemorrhage
  • pulmonary edema
  • pulmonary embolism
• infectious: majority of infiltrates, mortality 50%
  • organ transplantation
    • 1st month post transplantation
      • bacterial infections
      • herpes simplex
    • > 1 month (time when immunosuppression is greatest)
      • Nocardia species
      • fungi (Aspergillosis, Cryptococcus)
      • viruses (cytomegalovirus [CMV], varicella zoster)
      • Pneumocystis carinii
  • severe neutropenia (granulocytes < 500/uL)
    • Pseudomonas aeruginosa
    • Aspergillis species

Laboratory

• sputum & blood cultures
• arterial blood gas (ABG)

Diagnostic procedures

in patients who do not improve within 1-3 days

• fiberoptic bronchoscopy
  • bronchoalveolar lavage
  • transbronchial biopsy
• open lung biopsy (in rapidly deteriorating patients)

Radiology

• chest radiographs

Management

• supportive measures
  • oxygen
  • mechanical ventilation (with respiratory failure)
• Empiric broad spectrum antimicrobial therapy after cultures obtained
  • Initial coverage should include:
    • Staphylococcus
    • Pseudomonas
  • Failure to respond to initial antibiotic therapy, add: amphotericin B

More general terms

• pulmonary infiltrate

More specific terms

• pulmonary infiltrate in patients with AIDS

Additional terms

• pneumonia (PNA)