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Respiratory Disease in the Immunosuppressed Patient
- James H. Shelhamer, MD;
- Galen B. Toews, MD;
- Henry Masur, MD;
- Anthony F. Suffredini, MD;
- Philip A. Pizzo, MD;
- Thomas J. Walsh, MD; and
- David K. Henderson, MD
Abstract
▪ Pulmonary complications, both infectious and non-infectious, are an important cause of morbidity in patients with various types of immunosuppression. The appropriate response to these clinical problems requires an understanding of pulmonary host defense and of the various types of systemic immunosuppression. Infectious and noninfectious pulmonary complications may vary according to the type of immunosuppression as well as to the degree and duration of immunosuppression. Appropriate clinical management also requires an understanding of the clinical problems commonly seen in specific groups of immunosuppressed patients and an understanding of the sensitivity, specificity, and potential complications associated with the available diagnostic approaches to those patients. Because respiratory disease in these patient groups may progress rapidly to respiratory failure, an expeditious evaluation based on the knowledge of likely causes of respiratory disease and prompt specific or empiric therapy are indicated. Specific sets of algorithms for the evaluation of both focal and diffuse pulmonary disease may facilitate such an evaluation. In addition, an aggressive approach to the prevention of pulmonary disease including immunization, prophylaxis, and immunomodulation (for example, colony stimulating factors) may be warranted in specific subgroups at risk.
Article and Author Information
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An edited summary of a Combined Clinical Staff Conference held 29 November 1990 at the National Institutes of Health, Bethesda, Maryland.
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Authors who wish to cite a section of the conference and specifically indicate its author may use this example for the form of reference:
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Toews GB. Predisposition to respiratory disease: immunologic and nonimmunologic factors, pp 415-8. In: Shelhamer JH, moderator. Respiratory disease in the immunocompromised patient. Ann Intern Med. 1992;117:415-31.
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Requests for Reprints: James H. Shelhamer, MD, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892.
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Current Author Addresses: Drs. Shelhamer, Masur, and Suffredini: Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892.
Dr. Toews: Division of Pulmonary and Critical Care Medicine, University of Michigan Hospital, Ann Arbor, MI 48109-0360.
Drs. Pizzo and Walsh: National Cancer Institute, Building 10, Room 13-N-240, NIH, Bethesda, MD 20892.
Dr. Henderson: Associate Director, Clinical Center, NIH, Bethesda, MD 20892.
