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The Proceedings of the American Thoracic Society 2:445-448 (2005)
© 2005 The American Thoracic Society

Breakdown of Pulmonary Host Defense in the Immunocompromised Host

Cancer Chemotherapy

Ladina Joos and Michael Tamm

Pulmonary Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland

Correspondence and requests for reprints should be addressed to Michael Tamm, Pulmonary Medicine and Pulmonary Cell Research, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland. E-mail: mtamm{at}uhbs.ch

ABSTRACT

The number of immunocompromised patients is steadily increasing due to HIV infection, solid organ and stem cell transplantation, intensified chemotherapy, immunosuppression for autoimmune diseases, and a marked increase in the use of monoclonal antibodies. Prevention strategies for pulmonary infections and diagnostic methods have evolved and patient outcome has improved. However, therapies affecting the immune system are also given to older patients and patients with comorbidities. While the rate of pulmonary complications in HIV patients has dramatically decreased under antiretroviral therapy, we are seeing more patients with pulmonary problems after chemotherapy. Neutropenia is still the most important risk factor for bacterial and fungal infection. Flexible bronchoscopy with BAL remains an important diagnostic method with a low morbidity and high diagnostic yield in patients with pulmonary infiltrates following cancer chemotherapy.

Key Words: chemotherapy • immunocompromised hosts • neutropenia • pulmonary infections




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