Infections in the Immunocompromised

OVERVIEW

  • immunosuppression is increasingly common in the ICU and in the community
  • due to conditions such as chemotherapy and stem cell transplantation for cancer, solid organ transplantation, and therapies for autoimmune and rheumatological diseases
  • such patients are susceptible to the common pathogens seen as well as opportunistic pathogens

DIAGNOSIS

Inflammatory responses are impaired

  • patients may lack fever
  • may lack localising signs of infection
  • may lack typical radiographic changes e.g. CXR for pneumonia
  • invasive diagnostic tests may be required
  • infection may be difficult to distinguish from rejection and graft-versus-host disease

MANAGEMENT

  • early use of appropriate antibiotics is critical
  • drug interactions and side effects are common
  • patients from endemic areas may have parasitic diseases
  • many viral infections lack effective treatments
  • resistance to antimicrobials is a common problem

References and Links

  • Fishman JA. Infections in immunocompromised hosts and organ transplant recipients: essentials. Liver Transpl. 2011 Nov;17 Suppl 3:S34-7. doi: 10.1002/lt.22378 PMID: 21748845.

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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