Infections in the Secondary Immunocompromised Host

Susan Elizabeth Snape, Nottingham University Hospital, City Campus, Nottingham, UK
Pradhib Venkatesan, Nottingham University Hospital, City Campus, Nottingham, UK

Published online: December 2009

DOI: 10.1002/9780470015902.a0002224.pub2

Deficiency in host defences allows infections to occur with greater frequency. Their nature and presentation may be unusual and hence diagnosis may be difficult. The type, severity and duration of immunocompromise determine the infections to which the host is vulnerable. Unlike in primary immunocompromised patients, the susceptibility of secondary immunocompromised patients to infection often changes during the course of their illness as their immune function may vary with the use of immunosuppressive drugs or highly active antiretroviral agents prescribed for those with human immunodeficiency virus. This article highlights the timing of host susceptibility to specific infections in relation to the course of their illness and treatment. Growing numbers of immunocompromised patients make this a key area for those involved in managing infections. A number of strategies are employed to combat the infectious threat ranging from prophylaxis to pre-emptive, empirical and definitive treatment regimens.

Key concepts:

Immunocompromised patients are susceptible to a range of opportunistic infections due to deficiencies in their immune defences. Approaches to diagnosis, investigation and management in the secondary immunocompromised host are explored.

Keywords: immunocompromised host; opportunistic infection; neutropaenia; transplantation; malignancy; human immunodeficiency virus (HIV)

Figure 1. Relationship between post-stem cell transplant course and susceptibility to specific infections. Risk of infection is based on typical prophylaxis strategies, including co-trimoxazole for PCP, filtered and screened blood products and ganciclovir for CMV, aciclovir for HSV and fluconazole for candidaemia. Infections and risks are stated in boxes with the potential duration of susceptibility shown with arrows.
Figure 2. Relationship between susceptibility to specific infections and time post-solid organ transplantation. CMV, cytomegalovirus; EBV, Epstein–Barr virus; PTLD, posttransplant lymphoproliferative disease and VZV, varicella zoster virus.
Figure 3. Chest radiograph of a bone marrow transplant recipient who developed fever and hypoxia. There is an indistinct hazy bilateral lower zone shadowing. A bronchoalveolar lavage revealed cytomegalovirus.
Figure 4. Cerebral computed tomographic scans showing multiple abscesses due to nocardia in a heart transplant recipient.
Figure 5. Abdominal ultrasonogram showing multiple abscesses in the liver in a patient with acute myeloid leukaemia. Biopsy revealed Candida albicans.
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Related Sub-Topics:

Immunodeficiency | Virus Diseases
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Article Title: Infections in the Secondary Immunocompromised Host
 
How to Cite close
Elizabeth Snape, Susan, and Venkatesan, Pradhib(Dec 2009) Infections in the Secondary Immunocompromised Host. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0002224.pub2]