Guideline
Ramirez JA, Musher DM, Evans SE, et al. Treatment of community-acquired pneumonia in immunocompromised adults: a consensus statement regarding initial strategies. Chest. 2020; 158:1896-1911. Immunocompromised patients have been excluded from previous guidelines on CAP management. This guideline was developed independent of academic societies by 45 clinicians with relevant expertise using Delphi survey methodology. The group defines various degrees of immunocompromise and provides guidance on the corresponding likely pathogens, appropriate evaluation, and empiric treatment. Given the paucity of evidence, most recommendations are based on expert opinion.
Diagnostic Strategies
The following reviews nicely outline infectious and non-infectious complications of solid organ and hematopoietic stem cell transplantation.
Azoulay E, Russell L, Van de Louw A, et al. Nine-I Investigators. Diagnosis of severe respiratory infections in immunocompromised patients. Intensive Care Med. 2020;46(2):298-314. Review of diagnostic strategies with special attention to newly validated diagnostic tests.
Chi AK, Soubani AO, White AC, et al. An update on pulmonary complications of hematopoietic stem cell transplantation. Chest. 2013; 144:1913-1922.
Azoulay E, Mokart D, Lambert J, et al. Diagnostic strategy for hematology and oncology patients with acute respiratory failure: randomized controlled trial. Am J Respir Crit Care Med 2010;182:1038-46. In this prospective, randomized study of 216 cancer patients with acute respiratory failure, most of whom had hematologic malignancies and one-fourth of whom had undergone hematopoietic stem cell transplantation, early bronchoscopy with BAL did not lead to an increased risk of intubation, but was not diagnostically superior to an initial noninvasive diagnostic approach, with the exception of diagnosis of Pneumocystis.
HIV and Pulmonary Disease
Gagnon S, Boota AM, Fischl MA, et al. Corticosteroids as adjunctive therapy for severe PCP in AIDS. N Engl J Med 1990;323:1444-50. One of three studies published in the same year establishing the efficacy of steroids in severe PCP in patients with AIDS.
Fitzpatrick ME, Kunisaki KM, Morris A. Pulmonary disease in HIV-infected adults in the era of antiretroviral therapy. AIDS. 2018;32:277-292. Review of respiratory symptoms and disease in HIV patients including infectious and non-infectious pulmonary disease with specific attention to COPD, Asthma, and Pulmonary Hypertension.
PMID: 29194119
