Respiratory infection in an immunocompromised person
From IDWiki
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 | ||
| 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
