Respiratory infection in an immunocompromised person: Difference between revisions

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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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|-
  
|-
 
|Steroids and solid organ transplantation
  
|Steroids and solid organ transplantation
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| rowspan="3" |opportunistic infections, systemic viruses, [[Pneumocystis]], [[Cryptococcus]], [[Mycobacteria]], [[Toxoplasma]]
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| rowspan="4" |opportunistic infections, systemic viruses, [[Pneumocystis]], [[Cryptococcus]], [[Mycobacteria]], [[Toxoplasma]]
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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
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| 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
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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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|-
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|[[HIV]]
 
|-
  
|-
 
! colspan="3" |Humoural Immunodeficiency
  
! colspan="3" |Humoural Immunodeficiency
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|Complement deficiency
  
|Complement deficiency
 
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|-
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|Common variable immunodeficiency
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|[[Common variable immunodeficiency]]
 
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|-
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|Rituximab and other anti-CD20 therapy
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|[[Rituximab]] and other anti-CD20 therapy
 
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|-
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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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|Steroids and solid organ transplantation
  
|Steroids and solid organ transplantation
 
| 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
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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
 
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|-
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|Neutropenia
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|[[Neutropenia]]
 
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|-
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|Myelodysplastic syndrome
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|[[Myelodysplastic syndrome]]
 
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|-
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|Acute myelogenous leukemia
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|[[Acute myelogenous leukemia]]
 
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|-
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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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|nodular lesions
  
|nodular lesions
 
|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
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|sputum and blood cultures, antigenuria, sputum with fungal culture, [[Aspergillus]]/[[Mucorales]] PCR, [[galactomannan]] and [[β-D glucan]], bronchoalveolar lavage
 
|-
  
|-
 
|septal thickening
  
|septal thickening
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|cavitations
  
|cavitations
 
|[[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
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|sputum and blood cultures, mycobacterial culture, [[Histoplasma]] PCR
 
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|-
 
|excavated nodules
  
|excavated nodules
 
|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]]
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|sputum and blood cultures, [[Aspergillus]]/[[Nocardia]]/[[Mucorales]] PCR, [[galactomannan]] and [[β-D glucan]]
 
|-
  
|-
 
|consolidation
  
|consolidation
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|ground glass opacities
  
|ground glass opacities
 
|[[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
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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
 
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|}
   
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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]]

Latest revision as of 13:40, 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
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