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Pulmonary Infection in the Immunocompromised Patient: Strategies for Management



Pulmonary Infection in the Immunocompromised Patient: Strategies for Management

Carlos Agusti (Editor), Antoni Torres (Co-Editor)

ISBN: 978-0-470-71418-8 July 2009 456 Pages

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The immuno-compromised patient is more susceptible to a broader range of infections than others, and infections of the respiratory tract are among the first and most common to be encountered.

In this book the authors review current options for management for a group of patients that present unique challenges to the clinician, and for whom the choices of effective therapy are often limited.

  • Most up to date book available dedicated specifically to this topic
  • Major management issue in respiratory medicine for critical care, transplant and cancer patients
  • Reviews important new advances in therapeutics, including drug resistance 

List of Contributors.


1. Lung Immune Defences in the Immunosuppressed Patient (Naimish Patel and Henry Koziel).

1.1 Introduction.

1.2 Host defence function in health.

1.3 Host defence function in select immunocompromised patients.

1.4 Summary and future directions for this field.

2. Microbiological Diagnosis of Respiratory Infections in the Immunocompromised (Margareta Ieven).

2.1 Introduction.

2.2 HIV infection and Mycobacterium tuberculosis.

2.3 HIV infection and Non Tuberculous Mycobacteria.

2.4 HIV and Pneumocystis jirovecii.

2.5 Infections in transplant patients or other immunodeficiencies.

2.6 Concluding remarks.

3. Diagnosis of Pneumonia in Immunocompromised Patients (Robert P. Baughman and Elyse E. Lower).

3.1 Introduction.

3.2 Clinical assessment.

3.3 Blood cultures.

3.4 Sputum.

3.5 Endotracheal aspirate.

3.6 Non bronchoscopic bronchoalveolar lavage.

3.7 Protected brush sample (PBS).

3.8 Bronchoalveolar lavage (BAL).

3.9 Transbronchial biopsy (TBB).

3.10 Surgical lung biopsy (SLB).

3.11 Sample processing.

3.12 Clinical approach to pulmonary infiltrates in immunosuppressed patient.

3.13 Conclusion.

4. Pulmonary Imaging in Immunocompromised Patients (Tom s Franquet).

4.1 Pulmonary infections in immunocompromised patients.

4.2 Respiratory infections.

4.3 Interventional procedures in patients with pneumonia.

4.4 Summary.

5. Pulmonary Infections in HIV Patients in the Highly Active Antiretroviral Therapy Era (Natividad Benito and Asunci¢n Moreno-Camacho).

5.1 Introduction.

5.2 Epidemology and etiology.

5.3 Diagnosis.

5.4 Prognosis.

5.5 Conclusions.

6. Neutropenia (Maria J. Rping, J"rg J. Vehreschild, Santiago Ewig, and Oliver A. Cornely).

6.1 Introduction.

6.2 Management of the neutropenic patient.

6.3 Specific infectious diseases.

7. General Management of Suspected Pneumonia in the Solid Organ Transplant Paitent (Andrew F. Shorr).

7.1 Introduction.

7.2 Epidemiology.

7.3 Differential diagnosis and non-infectious complications.

7.4 Diagnostic approach.

7.5 Conclusion.

8. Respiratory Infections Following Haematopoietic Stem Cell Transplantation (Ayman O. Soubani).

8.1 Immune system recovery after HSCT.

8.2 Bacterial pneumonia.

8.3 Invasive pulmonary aspergillosis.

8.4 Cytomegalovirus.

8.5 Community respiratory viruses.

8.6 Non-infectious pulmonary complications.

8.7 Conclusion.

9. Chronic Non-infectious Pulmonary Complications in Haematopoietic Stem Cell Transplantation (Bekele Afessa and Steve G. Peters).

9.1 Introduction.

9.2 Bronchiolitis Obliterans (BO).

9.3 Bronchiolitis Obliterans organizing pneumonia (BOOP).

9.4 Idiopathic pneumonia syndrome (IPS).

9.5 Diffuse alveolar haemorrhage (DAH).

9.6 Peri-engraftment respiratory distress syndrome (PERDS).

9.7 Delayed pulmonary toxicity syndrome (DPTS).

9.8 Pulmonary cytolytic thrombi (PCT).

9.9 Other non-infectious pulmonary complications.

9.10 Summary.

10. Pulmonary Infections in Patients on Chronic Glucocorticoid Treatment (Ana Ra¤¢ and Carlos Agust¡).

10.1 Introduction.

10.2 Associated inflammatory response in pneumonia.

10.3 Glucocorticoids: mechanisms of action.

10.4 Glucocorticoid therapy in clinical practice.

10.5 Diagnostic approach.

10.6 Empirical treatment of suspected pneumonia in patients receiving chronic GC therapy.

10.7 Prognosis.

10.8 Conclusions.

11. Intensive Care Management in the Immunocompromised Patient with Pulmonary Infiltrates (Gilles Hilbert, Didier Gruson, and Frederic Vargas).

11.1 Introduction.

11.2 Invasive ventilation.

11.3 Rationale for NIV.

11.4 Mechanisms of improvement with NIV in immunocompromised patients with acute respiratory failure.

11.5 Clinical studies.

11.6 Equipment and techniques: particularities in immunocompromised patients.

11.7 Predictive factors of NIV outcome.

11.8 Conclusions.

12. Current Strategies and Future Directions in Antibacterial Treatment (Jan Jelrik Oosterheert and Andy I.M. Hoepelman).

12.1 Introduction.

12.2 Farmacokinetics and farmacodynamics.

12.3 Antibacterial treatment options.

12.4 Resistance.

12.5 HIV related bacterial pulmonary infections.

12.6 Length of treatment.

12.7 Conclusions.

13. Current Strategies in the Treatment of Fungal Infections in the Intensive Care Unit Setting (Mitchell Goldman and George A. Sarosi).

13.1 Introduction.

13.2 Antifungal therapies.

13.3 The endemic fungi in the critical care unit.

13.4 Other yeast infections in the critical care unit.

13.5 Invasive mould infections in the critical care unit.

13.6 Summary.

14. Current Strategies and Future Directions in Cytomegalovirus (CMV) Pneumonitis (Julio C. Medina and Jos‚ M. Aguado).

14.1 Effects of CMV infection in immunocompromised patients.

14.2 Pathophysiology of CMV pneumonitis.

14.3 Risk factors for CMV pneumonitis.

14.4 Pulmonary manifestations of CMV infection.

14.5 Indirect respiratory effects of CMV infection.

14.6 Diagnosis of CMV pneumonitis.

14.7 Antiviral agents against CMV.

14.8 Treatment of CMV pneumonia.

14.9 Prevention of CMV pneumonia.

15. Antiviral Agents against Respiratory Viruses (Michael G. Ison).

15.1 M2 inhibitors.

15.2 Neuraminidase inhibitors.

15.3 Cidofovir.

15.4 Ribavirin.

15.5 Investigational agents.