Dr A.J.France. Ninewells Hospital
RESPIRATORY INFECTION IN THE
IMMUNOCOMPROMISED HOST
© A.J.France 2010
Infection in immunocompromised
patients.
 Recognising the immunocompromised
patient is an undergraduate skill
 Treatment is a postgraduate subject
© A.J.France 2010
Who is immunocompromised ?
 Extremes of age
 Patients on immunosuppressant drugs
 Transplant. High dose steroid etc
 Cytotoxic chemotherapy
 Infection: HIV
 Marrow replacement by leukaemia
 Splenectomy
 Rare hereditary disorders
© A.J.France 2010
The very young and the very old
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Splenectomy
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Chemotherapy
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Opportunistic infections
 Symptoms may be mild
 Wider range of pathogens
 Reactivation of dormant organisms
 Exposure to new pathogens
© A.J.France 2010
Opportunistic lung infections
 Pneumocystis
 Cytomegalovirus
 Aspergillus
 Pneumococcus
 Bronchiectasis
HIV
Transplant
Chemotherapy
Splenectomy
Cystic fibrosis
Hypogamma -globulinaemia
© A.J.France 2010
Pneumocystis in HIV infection
 History
 Dry cough for several weeks
 Breathless
 Poor response to first line antibiotics
 Examination
 Very little to find, but……..
 Cyanosis
 Breathless on exertion
 Other features of HIV
© A.J.France 2010
Pneumocystis in HIV infection
 Investigations
 Chest X-ray
 Arterial blood gases
 Making the diagnosis
 Induced sputum
 Bronchoscopy
 Lung biopsy
© A.J.France 2010
Pneumocystis pneumonia
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Pneumocystis
close up
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Pneumocystis in HIV infection
 Treatment
 High dose cotrimoxazole (septrin)
 High dose corticosteroids
 Complications
 Pneumothorax
 Respiratory failure
 Death
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Broncho-alveolar lavage
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Pneumocystis pneumonia.
Lung biopsy, silver stain.
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After treatment
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After treatment
close ups
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Normal pathway
Symptom free
Disease
Treatment
Symptom free
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Without prophylaxis
Symptom free
Disease
Treatment
Relapse
Symptom free
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With prophylaxis
Septrin 480mg daily
Symptom free
Disease
Treatment
Relapse
Symptom free
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Aspergillus
 Lives all over the place
 Ask about building/demolition work
 Ask about gardening hobbies
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Bronchial biopsy. Leukaemia and….
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Bronchial biopsy - aspergillus
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Summary
 First, recognise the immunocompromised
patient
 Second, have a high index of suspicion for
infection – even when there are few abnormal
physical signs
 Third, have a low threshold for admission to
hospital
© A.J.France 2010