Pulmonary Infection in the Immunocompromised Patient (eBook)

Carlos Agusti and Antoni Torres are the authors of Pulmonary Infection in the Immunocompromised Patient: Strategies for Management, published by Wiley.

PULMONARY INFECTION IN THE IMMUNOCOMPROMISED PATIENT STRATEGIES FOR MANAGEMENT 1
Contents 7
Preface 11
List of Contributors 13
1 Lung Immune Defences in the Immunosuppressed Patient 17
1.1 Introduction 17
1.2 Host defence function in health 17
1.3 Host defence function in select immunocompromised patients 23
1.4 Summary and future directions for this field 33
2 Microbiological Diagnosis of Respiratory Infections in the Immunocompromised 45
2.1 Introduction 45
2.2 HIV infection and Mycobacterium tuberculosis 46
2.3 HIV infection and non tuberculous mycobacteria (NTM) 49
2.4 HIV and Pneumocystis jirovecii 50
2.5 Infections in transplant patients or other immunodeficiencies 51
2.6 Concluding remarks 61
3 Diagnosis of Pneumonia in Immunocompromised Patient 69
3.1 Introduction 69
3.2 Clinical assessment 71
3.3 Blood cultures 76
3.4 Sputum 76
3.5 Endotracheal aspirate 77
3.6 Non bronchoscopic bronchoalveolar lavage 79
3.7 Protected brush sample (PBS) 80
3.8 Bronchoalveolar lavage (BAL) 81
3.9 Transbronchial biopsy (TBB) 87
3.10 Surgical lung biopsy (SLB) 89
3.11 Sample processing 90
3.12 Clinical approach to pulmonary infiltrates in immunosuppressed patient 92
3.13 Conclusion 96
4 Pulmonary Imaging in Immunocompromised Patients 111
4.1 Pulmonary infections in immunocompromised patient 111
4.2 Respiratory infections 116
4.3 Interventional procedures in patients with pneumonia 127
4.4 Summary 129
5 Pulmonary Infections in HIV Patients in the Highly Active Antiretroviral Therapy Era 133
5.1 Introduction 133
5.2 Epidemology and etiology 134
5.3 Diagnosis 144
5.4 Prognosis 147
5.5 Conclusions 148
6 Neutropenia 159
6.1 Introduction 159
6.2 Management of the neutropenic patient 165
6.3 Specific infectious diseases 176
7 General Management of Suspected Pneumonia in the Solid Organ Transplant Patient 213
7.1 Introduction 213
7.2 Epidemiology 213
7.3 Differential diagnosis and non-infectious complications 215
7.4 Diagnostic approach 217
7.5 Conclusion 226
8 Respiratory Infections Following Haematopoietic Stem Cell Transplantation 229
8.1 Immune system recovery after HSCT 231
8.2 Bacterial pneumonia 233
8.3 Invasive pulmonary aspergillosis 238
8.4 Cytomegalovirus 248
8.5 Community respiratory viruses 251
8.6 Non-infectious pulmonary complications 255
8.7 Conclusion 257
9 Chronic Non-infectious Pulmonary Complications in Haematopoietic Stem Cell Transplantation 273
9.1 Introduction 273
9.2 Bronchiolitis Obliterans (BO) 276
9.3 Bronchiolitis Obliterans organizing pneumonia (BOOP) 279
9.4 Idiopathic pneumonia syndrome (IPS) 281
9.5 Diffuse alveolar haemorrhage (DAH) 283
9.6 Peri-engraftment respiratory distress syndrome (PERDS) 285
9.7 Delayed pulmonary toxicity syndrome (DPTS) 286
9.8 Pulmonary cytolytic thrombi (PCT) 287
9.9 Other non-infectious pulmonary complications 288
9.10 Summary 290
10 Pulmonary Infections in Patients on Chronic Glucocorticoid Treatment 299
10.1 Introduction 299
10.2 Associated inflammatory response in pneumonia 299
10.3 Glucocorticoids: Mechanisms of action 300
10.4 Glucocorticoid therapy in clinical practice 302
10.5 Diagnostic approach 312
10.6 Empirical treatment of suspected pneumonia in patients receiving chronic GC therapy 314
10.7 Prognosis 314
10.8 Conclusions 315
11 Intensive Care Management in the Immunocompromised Patient with Pulmonary Infiltrates 321
11.1 Introduction 321
11.2 Invasive ventilation 322
11.3 Rationale for NIV 323
11.4 Mechanisms of improvement with NIV in immunocompromised patients with acute respiratory failure 324
11.5 Clinical studies 325
11.6 Equipment and techniques: particularities in immunocompromised patients 332
11.7 Predictive factors of NIV outcome 335
11.8 Conclusions 336
12 Current Strategies and Future Directions in Antibacterial Treatment 341
12.1 Introduction 341
12.2 Farmacokinetics and farmacodynamics 341
12.3 Antibacterial treatment options 347
12.4 Resistance 352
12.5 HIV related bacterial pulmonary infections 355
12.6 Length of treatment 358
12.7 Conclusions 359
13 Current Strategies in the Treatment of Fungal Infections in the Intensive Care Unit Setting 365
13.1 Introduction 365
13.2 Antifungal therapies 366
13.3 The endemic fungi in the critical care unit 367
13.4 Other yeast infections in the critical care unit 374
13.5 Invasive mould infections in the critical care unit 379
13.6 Summary 391
14 Current Strategies and Future Directions in Cytomegalovirus (CMV) Pneumonitis 399
14.1 Effects of CMV infection in immunocompromised patients 399
14.2 Pathophysiology of CMV pneumonitis 400
14.3 Risk factors for CMV pneumonitis 401
14.4 Pulmonary manifestations of CMV infection 402
14.5 Indirect respiratory effects of CMV infection 403
14.6 Diagnosis of CMV pneumonitis 403
14.7 Antiviral agents against CMV 404
14.8 Treatment of CMV pneumonia 406
14.9 Prevention of CMV pneumonia 409
15 Antiviral Agents against Respiratory Viruses 417
15.1 M2 inhibitors 418
15.2 Neuraminidase inhibitors 423
15.3 Cidofovir 428
15.4 Ribavirin 430
15.5 Investigational agents 433
Index 445