Immunocompromised Host

Diagnostic Strategies

The following reviews nicely outline infectious and non-infectious complications of solid organ and hematopoietic stem cell transplantation. Harris et al. advocate for early bronchoscopy in these populations, although the study by Azoulay et al. below suggests the yield may be lower in hematology and oncology patients.

Harris B, Lowy FD, Stover DE, et al. Diagnostic bronchoscopy in solid-organ and hematopoietic stem cell transplantation. Ann Am Thorac Soc. 2013; 10:39-49.

PMID: 23509331

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Chi AK, Soubani AO, White AC, et al. An update on pulmonary complications of hematopoietic stem cell transplantation. Chest. 2013; 144:1913-1922.

PMID: 24297123

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Azoulay E, Mokart D, Lambert J, et al. Diagnostic strategy for hematology and oncology patients with acute respiratory failure: randomized controlled trial. Am J Respir Crit Care Med 2010;182:1038-46. In this prospective, randomized study of 216 cancer patients with acute respiratory failure, most of whom had hematologic malignancies and one-fourth of whom had undergone hematopoietic stem cell transplantation, early bronchoscopy with BAL did not lead to an increased risk of intubation, but was not diagnostically superior to an initial noninvasive diagnostic approach, with the exception of diagnosis of Pneumocystis.

PMID: 20581167

HIV and Pulmonary Disease

Gagnon S, Boota AM, Fischl MA, et al. Corticosteroids as adjunctive therapy for severe PCP in AIDS. N Engl J Med 1990;323:1444-50. One of three studies published in the same year establishing the efficacy of steroids in severe PCP in patients with AIDS.

PMID: 2233916

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