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Pneumonia - weakened immune system

Pneumonia in immunodeficient patient; Pneumonia - immunocompromised host

 

Pneumonia is a lung infection. It can be caused by many different germs, including bacteria, viruses, and fungi.

This article discusses pneumonia that occurs in a person who has a hard time fighting off infection because of problems with the immune system. This type of disease is called "pneumonia in an immunocompromised host."

Related conditions include:

  • Hospital-acquired pneumonia
  • Pneumocystis jirovecii (previously called Pneumocystis carinii) pneumonia
  • Pneumonia - cytomegalovirus
  • Pneumonia
  • Viral pneumonia
  • Walking pneumonia

Causes

 

People whose immune system is not working well are less able to fight off germs. This makes them prone to infections from germs that do not often cause disease in healthy people. They are also more vulnerable to regular causes of pneumonia, which can affect anyone.

Your immune system may be weakened or not work well because of:

  • Bone marrow transplant
  • Chemotherapy
  • HIV infection
  • Leukemia, lymphoma, and other conditions that harm your bone marrow
  • Autoimmune disorders
  • Medicines (including steroids, and those used to treat cancer and control autoimmune diseases)
  • Organ transplant (including kidney, heart, and lung)

 

Symptoms

 

Symptoms may include:

  • Cough (may be dry or produce mucus-like, greenish, or pus-like sputum)
  • Chills with shaking
  • Easy fatigue
  • Fever
  • General discomfort, uneasiness, or ill feeling (malaise)
  • Headache
  • Loss of appetite
  • Nausea and vomiting
  • Sharp or stabbing chest pain that gets worse with deep breathing or coughing
  • Shortness of breath

Other symptoms that may occur:

  • Heavy sweating or night sweats
  • Stiff joints (rare)
  • Stiff muscles (rare)

 

Exams and Tests

 

Your health care provider may hear crackles or other abnormal breath sounds when listening to your chest with a stethoscope. Decreased volume of breath sounds is a key sign. This finding may mean there is a buildup of fluid between the chest wall and lung (pleural effusion).

Tests may include:

  • Arterial blood gases
  • Blood chemistries
  • Blood culture
  • Bronchoscopy (in certain cases)
  • Chest CT scan (in certain cases)
  • Chest x-ray
  • Complete blood count
  • Lung biopsy (in certain cases)
  • Serum Cryptococcus antigen test
  • Serum galactomannan test
  • Sputum culture
  • Sputum Gram stain
  • Sputum immunofluorescence tests (or other immune tests)
  • Urine tests (to diagnose Legionnaire disease or Histoplasmosis)

 

Treatment

 

Antibiotics or antifungal medicines may be used, depending on the type of germ that is causing the infection. Antibiotics are not helpful for viral infections. You may need to stay in the hospital during the early stages of the illness.

Oxygen and treatments to remove fluid and mucus from the respiratory system are often needed.

 

Outlook (Prognosis)

 

Factors that may lead to a worse outcome include:

  • The pneumonia that is caused by a fungus.
  • The person has a very weak immune system.

 

Possible Complications

 

Complications may include:

  • Respiratory failure (the person needs machines to assist breathing)
  • Sepsis
  • Spread of the infection
  • Death

 

When to Contact a Medical Professional

 

Call your health care provider if you have a weakened immune system and you have symptoms of pneumonia.

 

Prevention

 

If you have a weakened immune system, you may receive daily antibiotics to prevent some types of pneumonia.

Ask your provider if you should receive the influenza (flu) and pneumococcal (pneumonia) vaccines.

Practice good hygiene. Thoroughly wash your hands with soap and water:

  • After being outdoors
  • After changing a diaper
  • After doing housework
  • After going to the bathroom
  • After touching body fluids, such as mucus or blood
  • After using the telephone
  • Before handling food or eating

Other things you can do to reduce your exposure to germs include:

  • Keep your house clean.
  • Stay away from crowds.
  • Ask visitors who have a cold to wear a mask or not to visit.
  • DO NOT do yard work or handle plants or flowers (they can carry germs).

 

 

References

Donnelly JP, Blijlevens NMA, van der Velden WJFM. Infections in the immunocompromised host. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 309.

Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72. PMID: 17278083 www.ncbi.nlm.nih.gov/pubmed/17278083.

Marr KA. Approach to fever and suspected infection in the compromised host. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 281.

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      Review Date: 5/1/2015

      Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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