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Pneumonia in immunocompromised patients diagnosis and treatment

Pulmonary infection is common in patients under immunosuppressive drugs and in those with diseases causing defects of cellular or humoral immunity.

Diagnosis  :  As before  +
• Fever, cough, dyspnea.
• The onset of symptoms tends to be less rapid in patients with pneumocystis carinii and mycobarterial infection.
• Some patients who cannot produce sputum for examination can be induced to do so by inhalation of nebulised hypertonic saline.
• Chest x-ray showing lung infiltrates.
• Bronchoscopy, bronchoalveolar lavage fluid examination are helpful for diagnosis.

• Lung biopsy if necessary in certain cases e.g pneumocystis carinii.
Treatment
• It is based on the etiological diagnosis.
• We can start with a third generation cephalosporin or a quinolone plus antistaph antibiotic, or an antipseudomonas penicillin plus an aminoglycoside.
• This treatment is thereafter tailored according to the results of investigations.

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Tamer Mobarak

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