Pulmonary Infection in the Immunocompromised Patient Strategies for Management

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ISBN: 9780470319574 | 0470319577
Cover: Hardcover
Copyright: 3/2/2009

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With recent improvements in solid organ and hematopoietic stem cell transplantation techniques, the expanded use of chemotherapy and glucocorticoids, and the appearance of new immunomodulatory therapies, the number of immunocompromised patients has not only increased over the past decade, but continues to grow rapidly. The immunocompromised patient is extremely susceptible to a broad range of infections, and infections of the respiratory tract are among the first and most common to be encountered.

Preface	p. ix
List of Contributors	p. xi
Lung Immune Defences in the Immunosuppressed Patient	p. 1
Introduction	p. 1
Host defence function in health	p. 1
Host defence function in select immunocompromised patients	p. 7
Summary and future directions for this field	p. 17
Microbiological Diagnosis of Respiratory Infections in the Immunocompromised	p. 29
Introduction	p. 29
HIV infection and Mycobacterium tuberculosis	p. 30
HIV infection and non tuberculous mycobacteria (NTM)	p. 33
HIV and Pneumocystis jirovecii	p. 34
Infections in transplant patients or other immunodeficiencies	p. 35
Concluding remarks	p. 45
Diagnosis of Pneumonia in Immunocompromised Patient	p. 53
Introduction	p. 53
Clinical assessment	p. 55
Blood cultures	p. 60
Sputum	p. 60
Endotracheal aspirate	p. 61
Non bronchoscopic bronchoalveolar lavage	p. 63
Protected brush sample (PBS)	p. 64
Bronchoalveolar lavage (BAL)	p. 65
Transbronchial biopsy (TBB)	p. 71
Surgical lung biopsy (SLB)	p. 73
Sample processing	p. 74
Clinical approach to pulmonary infiltrates in immunosuppressed patient	p. 76
Conclusion	p. 80
Pulmonary Imaging in Immunocompromised Patients	p. 95
Pulmonary infections in immunocompromised patient	p. 95
Respiratory infections	p. 100
Interventional procedures in patients with pneumonia	p. 111
Summary	p. 113
Pulmonary Infections in HIV Patients in the Highly Active Antiretroviral Therapy Era	p. 117
Introduction	p. 117
Epidemology and etiology	p. 118
Diagnosis	p. 128
Prognosis	p. 131
Conclusions	p. 132
Neutropenia	p. 143
Introduction	p. 143
Management of the neutropenic patient	p. 149
Specific infectious diseases	p. 160
General Management of Suspected Pneumonia in the Solid Organ Transplant Patient	p. 197
Introduction	p. 197
Epidemiology	p. 197
Differential diagnosis and non-infectious complications	p. 199
Diagnostic approach	p. 201
Conclusion	p. 210
Respiratory Infections Following Haematopoietic Stem Cell Transplantation	p. 213
Immune system recovery after HSCT	p. 215
Bacterial pneumonia	p. 217
Invasive pulmonary aspergillosis	p. 222
Cytomegalovirus	p. 232
Community respiratory viruses	p. 235
Non-infectious pulmonary complications	p. 239
Conclusion	p. 241
Chronic Non-infectious Pulmonary Complications in Haematopoietic Stem Cell Transplantation	p. 257
Introduction	p. 257
Bronchiolitis Obliterans (BO)	p. 260
Bronchiolitis Obliterans organizing pneumonia (BOOP)	p. 263
Idiopathic pneumonia syndrome (IPS)	p. 265
Diffuse alveolar haemorrhage (DAH)	p. 267
Peri-engraftment respiratory distress syndrome (PERDS)	p. 269
Delayed pulmonary toxicity syndrome (DPTS)	p. 270
Pulmonary cytolytic thrombi (PCT)	p. 271
Other non-infectious pulmonary complications	p. 272
Summary	p. 274
Pulmonary Infections in Patients on Chronic Glucocorticoid Treatment	p. 283
Introduction	p. 283
Associated inflammatory response in pneumonia	p. 283
Glucocorticoids: Mechanisms of action	p. 284
Glucocorticoid therapy in clinical practice	p. 286
Diagnostic approach	p. 296
Empirical treatment of suspected pneumonia in patients receiving chronic GC therapy	p. 298
Prognosis	p. 298
Conclusions	p. 299
Intensive Care Management in the Immunocompromised Patient with Pulmonary Infiltrates	p. 305
Introduction	p. 305
Invasive ventilation	p. 306
Rationale for NIV	p. 307
Mechanisms of improvement with NIV in immunocompromised patients with acute respiratory failure	p. 308
Clinical studies	p. 309
Equipment and techniques: particularities in immunocompromised patients	p. 316
Predictive factors of NIV outcome	p. 319
Conclusions	p. 320
Current Strategies and Future Directions in Antibacterial Treatment	p. 325
Introduction	p. 325
Farmacokinetics and farmacodynamics	p. 325
Antibacterial treatment options	p. 331
Resistance	p. 336
HIV related bacterial pulmonary infections	p. 339
Length of treatment	p. 342
Conclusions	p. 343
Current Strategies in the Treatment of Fungal Infections in the Intensive Care Unit Setting	p. 349
Introduction	p. 349
Antifungal therapies	p. 350
The endemic fungi in the critical care unit	p. 351
Other yeast infections in the critical care unit	p. 358
Invasive mould infections in the critical care unit	p. 363
Summary	p. 375
Current Strategies and Future Directions in Cytomegalovirus (CMV) Pneumonitis	p. 383
Effects of CMV infection in immunocompromised patients	p. 383
Pathophysiology of CMV pneumonitis	p. 384
Risk factors for CMV pneumonitis	p. 385
Pulmonary manifestations of CMV infection	p. 386
Indirect respiratory effects of CMV infection	p. 387
Diagnosis of CMV pneumonitis	p. 387
Antiviral agents against CMV	p. 388
Treatment of CMV pneumonia	p. 390
Prevention of CMV pneumonia	p. 393
Antiviral Agents against Respiratory Viruses	p. 401
M2 inhibitors	p. 402
Neuraminidase inhibitors	p. 407
Cidofovir	p. 412
Ribavirin	p. 414
Investigational agents	p. 417
Index	p. 429
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Pulmonary Infection in the Immunocompromised Patient Strategies for Management

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Pulmonary Infection in the Immunocompromised Patient Strategies for Management

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