Respiratory infection in an immunocompromised person: Difference between revisions
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==Differential Diagnosis== |
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===By Defect=== |
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{| class="wikitable" |
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!Risk Factor |
!Risk Factor |
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|Steroids and solid organ transplantation |
|Steroids and solid organ transplantation |
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| rowspan=" |
| rowspan="4" |opportunistic infections, systemic viruses, [[Pneumocystis]], [[Cryptococcus]], [[Mycobacteria]], [[Toxoplasma]] |
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| rowspan=" |
| rowspan="4" |sputum and blood culture, antigenuria, multiplex viral PCR, [[CMV]]/[[HSV]]/[[VZV]] PCR, bronchoalveolar lavage, [[Toxoplasma]]/[[Cryptococcus]] PCR, induced sputum, beta-D glucan |
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|Hairy cell leukemia, acute T-cell leukemia, T-cell lymphoma |
|[[Hairy cell leukemia]], [[acute T-cell leukemia]], [[T-cell lymphoma]] |
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|Fludarabine, ibrutinib, alemtuzumab |
|[[Fludarabine]], [[ibrutinib]], [[alemtuzumab]] |
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|[[HIV]] |
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! colspan="3" |Humoural Immunodeficiency |
! colspan="3" |Humoural Immunodeficiency |
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|Complement deficiency |
|Complement deficiency |
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|Common variable immunodeficiency |
|[[Common variable immunodeficiency]] |
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|Rituximab and other anti-CD20 therapy |
|[[Rituximab]] and other anti-CD20 therapy |
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|Multiple myeloma and CLL |
|[[Multiple myeloma]] and [[CLL]] |
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! colspan="3" |Phagocyte Defects |
! colspan="3" |Phagocyte Defects |
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|Steroids and solid organ transplantation |
|Steroids and solid organ transplantation |
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| rowspan="5" |systemic viruses, [[Aspergillus]], [[Mycobacteria]], [[Nocardia]], [[Mucorales]], [[Toxoplasma]] |
| rowspan="5" |systemic viruses, [[Aspergillus]], [[Mycobacteria]], [[Nocardia]], [[Mucorales]], [[Toxoplasma]] |
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| rowspan="5" |sputum and blood cultures, antigenuria, multiplex viral PCR, CMV/HSV/VZV PCR, induced sputum, bronchoalveolar lavage, fungal culture of sputum, [[β-D glucan]] and [[galactomannan]], Aspergillus PCR, Toxoplasma/Cryptococcus PCR |
| rowspan="5" |sputum and blood cultures, antigenuria, multiplex viral PCR, [[CMV]]/[[HSV]]/[[VZV]] PCR, induced sputum, bronchoalveolar lavage, fungal culture of sputum, [[β-D glucan]] and [[galactomannan]], Aspergillus PCR, Toxoplasma/Cryptococcus PCR |
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|Neutropenia |
|[[Neutropenia]] |
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|Myelodysplastic syndrome |
|[[Myelodysplastic syndrome]] |
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|Acute myelogenous leukemia |
|[[Acute myelogenous leukemia]] |
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|Allogeneic hematopoietic stem cell transplantation |
|[[Allogeneic hematopoietic stem cell transplantation]] |
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===By CT Pattern=== |
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{| class="wikitable" |
{| class="wikitable" |
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!Pattern |
!Pattern |
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|nodular lesions |
|nodular lesions |
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|bacterial pneumonia, [[Aspergillus]], [[Nocardia]], [[Mucorales]] |
|bacterial pneumonia, [[Aspergillus]], [[Nocardia]], [[Mucorales]] |
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|sputum and blood cultures, antigenuria, sputum with fungal culture, Aspergillus/Mucorales PCR, [[galactomannan]] and [[β-D glucan]], bronchoalveolar lavage |
|sputum and blood cultures, antigenuria, sputum with fungal culture, [[Aspergillus]]/[[Mucorales]] PCR, [[galactomannan]] and [[β-D glucan]], bronchoalveolar lavage |
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|septal thickening |
|septal thickening |
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|cavitations |
|cavitations |
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|[[Mycobacteria]], [[Histoplasma]], bacterial pneumonia including [[Staphylococcus aureus]] |
|[[Mycobacteria]], [[Histoplasma]], bacterial pneumonia including [[Staphylococcus aureus]] |
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|sputum and blood cultures, mycobacterial culture, Histoplasma PCR |
|sputum and blood cultures, mycobacterial culture, [[Histoplasma]] PCR |
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|excavated nodules |
|excavated nodules |
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|bacterial pneumonia, [[Mucorales]], [[Nocardia]], [[Actinomyces]], [[Aspergillus]] |
|bacterial pneumonia, [[Mucorales]], [[Nocardia]], [[Actinomyces]], [[Aspergillus]] |
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|sputum and blood cultures, Aspergillus/Nocardia/Mucorales PCR, [[galactomannan]] and [[β-D glucan]] |
|sputum and blood cultures, [[Aspergillus]]/[[Nocardia]]/[[Mucorales]] PCR, [[galactomannan]] and [[β-D glucan]] |
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|consolidation |
|consolidation |
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|ground glass opacities |
|ground glass opacities |
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|[[Pneumocystis]], viral pneumonia, atypical bacterial pneumonia |
|[[Pneumocystis]], viral pneumonia, atypical bacterial pneumonia |
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|sputum and blood culture, Legionella antigenuria, sputum for Pneumocystis, β-D glucan, multiplex viral PCR, CMV/VZV/HSV blood PCR, bronchoalveolar lavage |
|sputum and blood culture, [[Legionella]] antigenuria, sputum for [[Pneumocystis]], β-D glucan, multiplex viral PCR, [[CMV]]/[[VZV]]/[[HSV]] blood PCR, bronchoalveolar lavage |
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==Further Reading== |
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* |
*Diagnosis of severe respiratory infections in immunocompromised patients. ''Intensive Care Med''. 2020;46:298-314. doi: [https://doi.org/10.1007/s00134-019-05906-5 10.1007/s00134-019-05906-5] |
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[[Category:Immunocompromised hosts]] |
[[Category:Immunocompromised hosts]] |
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Latest revision as of 17:40, 10 March 2022
Differential Diagnosis
By Defect
| Risk Factor | Differential Diagnosis | Investigations |
|---|---|---|
| Cell-Mediated Immunodeficiency | ||
| Steroids and solid organ transplantation | opportunistic infections, systemic viruses, Pneumocystis, Cryptococcus, Mycobacteria, Toxoplasma | sputum and blood culture, antigenuria, multiplex viral PCR, CMV/HSV/VZV PCR, bronchoalveolar lavage, Toxoplasma/Cryptococcus PCR, induced sputum, beta-D glucan |
| Hairy cell leukemia, acute T-cell leukemia, T-cell lymphoma | ||
| Fludarabine, ibrutinib, alemtuzumab | ||
| HIV | ||
| Humoural Immunodeficiency | ||
| Splenectomy and asplenism | bacterial pneumonia (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae) | sputum and blood cultures, antigenuria, multiplex viral PCR |
| Complement deficiency | ||
| Common variable immunodeficiency | ||
| Rituximab and other anti-CD20 therapy | ||
| Multiple myeloma and CLL | ||
| Phagocyte Defects | ||
| Steroids and solid organ transplantation | systemic viruses, Aspergillus, Mycobacteria, Nocardia, Mucorales, Toxoplasma | sputum and blood cultures, antigenuria, multiplex viral PCR, CMV/HSV/VZV PCR, induced sputum, bronchoalveolar lavage, fungal culture of sputum, β-D glucan and galactomannan, Aspergillus PCR, Toxoplasma/Cryptococcus PCR |
| Neutropenia | ||
| Myelodysplastic syndrome | ||
| Acute myelogenous leukemia | ||
| Allogeneic hematopoietic stem cell transplantation | ||
By CT Pattern
| Pattern | Differential Diagnosis | Investigations |
|---|---|---|
| nodular lesions | bacterial pneumonia, Aspergillus, Nocardia, Mucorales | sputum and blood cultures, antigenuria, sputum with fungal culture, Aspergillus/Mucorales PCR, galactomannan and β-D glucan, bronchoalveolar lavage |
| septal thickening | atypical bacterial pneumonia | sputum and blood cultures, antigenuria, bronchoalveolar lavage |
| cavitations | Mycobacteria, Histoplasma, bacterial pneumonia including Staphylococcus aureus | sputum and blood cultures, mycobacterial culture, Histoplasma PCR |
| excavated nodules | bacterial pneumonia, Mucorales, Nocardia, Actinomyces, Aspergillus | sputum and blood cultures, Aspergillus/Nocardia/Mucorales PCR, galactomannan and β-D glucan |
| consolidation | bacterial pneumonia, Aspergillus | sputum and blood cultures, antigenuria, sputum for fungal culture, galactomannan and β-D glucan |
| pleural effusion | bacterial pneumonia, tuberculosis | sputum and blood cultures, antigenuria, mycobacterial blood culture, pleural aspiration and culture |
| ground glass opacities | Pneumocystis, viral pneumonia, atypical bacterial pneumonia | sputum and blood culture, Legionella antigenuria, sputum for Pneumocystis, β-D glucan, multiplex viral PCR, CMV/VZV/HSV blood PCR, bronchoalveolar lavage |
Further Reading
- Diagnosis of severe respiratory infections in immunocompromised patients. Intensive Care Med. 2020;46:298-314. doi: 10.1007/s00134-019-05906-5
