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OVERVIEW

Immunocompromised host is a term encompassing a growing group of individuals with a variety of immunocompromising conditions and varying degrees of immunodeficiency.1 The group includes persons with human immunodeficiency virus (HIV), solid organ transplant (SOT) recipients, hematopoietic stem cell transplant (HSCT) recipients, those on chemotherapy for malignancies, those receiving medications for autoimmune conditions, those with primary immune deficiencies, and those with acquired or intrinsic immune deficiencies.

This large and diverse group is expanding as medical therapies improve and evolve. Similarly, the medical complexity of the immunocompromised host is rising with new therapeutic agents, use of immunosuppressive agents later in life as immunosenescence occurs,2 and prolonged survival of immunocompromised individuals. This prolonged survival is frequently due to improved management of infectious complications of immunodeficiency.3

Pulmonary infections encompass a major category of infectious complications affecting these individuals.4–8 Pulmonary infections in immunocompromised hosts have a spectrum beyond that of immunocompetent hosts, with greater variety of presentations and the potential for both multiple infections and noninfectious processes to occur simultaneously. Opportunistic infections (those infections that do not usually occur in immunocompetent individuals, or that do so with increased virulence) are an important group of infections in immunocompromised hosts, but common or “typical” infections continue to constitute the majority of infections occurring in immunocompromised hosts, albeit often with more severe or prolonged manifestations.

While some infections are more common with specific immune deficits (Table 123-1), this is not always the case. Similarly, many patients have multiple simultaneous immune deficits, making an immune deficit approach alone inadequate for clinical management.

TABLE 123-1Infections Associated with Specific Immune Defects

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