Diagnosis of severe respiratory infections in immunocompromised patients

Elie Azoulay, Lene Russell, Andry Van de Louw, Victoria Metaxa, Philippe Bauer, Pedro Povoa, José Garnacho Montero, Ignacio Martin Loeches, Sangeeta Mehta, Kathryn Puxty, Peter Schellongowski, Jordi Rello, Djamel Mokart, Virginie Lemiale, Adrien Mirouse

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

An increasing number of critically ill patients are immunocompromised. Acute hypoxemic respiratory failure (ARF), chiefly due to pulmonary infection, is the leading reason for ICU admission. Identifying the cause of ARF increases the chances of survival, but may be extremely challenging, as the underlying disease, treatments, and infection combine to create complex clinical pictures. In addition, there may be more than one infectious agent, and the pulmonary manifestations may be related to both infectious and non-infectious insults. Clinically or microbiologically documented bacterial pneumonia accounts for one-third of cases of ARF in immunocompromised patients. Early antibiotic therapy is recommended but decreases the chances of identifying the causative organism(s) to about 50%. Viruses are the second most common cause of severe respiratory infections. Positive tests for a virus in respiratory samples do not necessarily indicate a role for the virus in the current acute illness. Invasive fungal infections (Aspergillus, Mucorales, and Pneumocystis jirovecii) account for about 15% of severe respiratory infections, whereas parasites rarely cause severe acute infections in immunocompromised patients. This review focuses on the diagnosis of severe respiratory infections in immunocompromised patients. Special attention is given to newly validated diagnostic tests designed to be used on non-invasive samples or bronchoalveolar lavage fluid and capable of increasing the likelihood of an early etiological diagnosis.

Original languageEnglish
Pages (from-to)298-314
JournalIntensive Care Medicine
Volume46
Issue number2
Early online date2020
DOIs
Publication statusPublished - Feb 2020

Keywords

  • Aspergillosis
  • Cytomegalovirus
  • Influenza
  • Mucormycosis
  • Pneumocystis pneumonia
  • Toxoplasmosis

Fingerprint Dive into the research topics of 'Diagnosis of severe respiratory infections in immunocompromised patients'. Together they form a unique fingerprint.

  • Cite this

    Azoulay, E., Russell, L., Van de Louw, A., Metaxa, V., Bauer, P., Povoa, P., ... Mirouse, A. (2020). Diagnosis of severe respiratory infections in immunocompromised patients. Intensive Care Medicine, 46(2), 298-314. https://doi.org/10.1007/s00134-019-05906-5