Respiratory infection in an immunocompromised person: Difference between revisions

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(Created page with "== Differential Diagnosis == === By Defect === {| class="wikitable" !Risk Factor !Differential Diagnosis !Investigations |- ! colspan="3" |Cell-Mediated Immunodeficiency |- |...")
 
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== Differential Diagnosis ==
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==Differential Diagnosis==
   
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=== By Defect ===
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===By Defect===
 
{| class="wikitable"
  
{| class="wikitable"
 
!Risk Factor
  
!Risk Factor
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| rowspan="3" |sputum and blood culture, antigenuria, multiplex viral PCR, CMV/HSV/VZV PCR, bronchoalveolar lavage, Toxoplasma/Cryptococcus PCR, induced sputum, beta-D glucan
  
| rowspan="3" |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
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|[[Hairy cell leukemia]], [[acute T-cell leukemia]], [[T-cell lymphoma]]
 
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|Fludarabine, ibrutinib, alemtuzumab
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|[[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
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|[[Common variable immunodeficiency]]
 
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|Rituximab and other anti-CD20 therapy
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|[[Rituximab]] and other anti-CD20 therapy
 
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|Multiple myeloma and CLL
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|[[Multiple myeloma]] and [[CLL]]
 
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! colspan="3" |Phagocyte Defects
  
! colspan="3" |Phagocyte Defects
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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
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|[[Neutropenia]]
 
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|Myelodysplastic syndrome
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|[[Myelodysplastic syndrome]]
 
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|Acute myelogenous leukemia
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|[[Acute myelogenous leukemia]]
 
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|Allogeneic hematopoietic stem cell transplantation
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|[[Allogeneic hematopoietic stem cell transplantation]]
 
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=== By CT Pattern ===
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===By CT Pattern===
 
{| class="wikitable"
  
{| class="wikitable"
 
!Pattern
  
!Pattern
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== Further Reading ==
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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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*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]
   
 
[[Category:Immunocompromised hosts]]
  
[[Category:Immunocompromised hosts]]

Revision as of 21:45, 15 February 2021

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
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