A persistent challenge: the diagnosis of respiratory disease in the non-AIDS immunocompromised host
- Service de Pneumologie et de Réanimation Respiratoire, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France
- Professor C Mayaud
The diagnostic and therapeutic approach to respiratory disease in the immunocompromised host remains a challenge for several reasons: (1) the current increase in both the number of immunocompromised hosts and their length of survival; (2) the high frequency of lung disease in these patients,1-3 and (3) the severity of these lung diseases.3-5 A good example is given in a recent review by Paterson et alof the epidemiology of invasive aspergillosis in transplant recipients.5 The incidence of this opportunistic infection, which mainly affects the lung, varies from 1% in kidney recipients to 9% in lung recipients (with 2% in liver recipients and 7% in bone marrow recipients). In this population it has a mortality rate of 55–92% and accounts for 10–15% of deaths of all transplant recipients.
In fact, the diagnostic challenge is continuously evolving in the immunocompromised host and the following three questions need to be considered: (1) What new data are available on the diagnostic and therapeutic approach? (2) What current changes are there in the diagnostic and therapeutic approach in neutropenic patients? (3) What current changes are there in the diagnostic and therapeutic approach in the immunocompromised host without neutropenia?
What new data are available on the diagnostic and therapeutic approach?
IS THERE AN EVOLUTION IN THE TYPE AND SEVERITY OF THE UNDERLYING IMMUNODEFICIENCIES?
The data from the literature clearly show the continuous changes both in the indications for immunosuppressive treatment and in the nature and dosages of the immunosuppressive drugs used. For example, steroids are increasingly used in patients with chronic lung disease such as lung cancer, chronic obstructive lung disease, idiopathic pulmonary fibrosis, or sarcoidosis6; the use of combined treatment for solid tumours—for example, chemotherapy and thoracic radiotherapy for lung cancer7 or intensive chemotherapy combined with total body irradiation, transplantation of autologous bone marrow, and 13-cis-retinoic acid for neuroblastoma8; and the performance of solid organ transplantations for lung, liver, cardiac or …