Pneumonia in a Immunocompromised Host

Written by Ann Pietrangelo | Published on June 20, 2012
Medically Reviewed by Brenda B. Spriggs, MD, MPH, FACP

Understanding the Dangers of Pneumonia in an Immunocompromised Person

Pneumonia is a condition where your lungs become infected due to bacteria, viruses, fungi, or other germs. When a person with an already weakened immune system gets pneumonia, it is called “pneumonia in an immunocompromised host.”

Having a weakened immune system means it is harder for you to fight off the germs that cause pneumonia (and other infections). Immediate medical intervention and careful monitoring are necessary to lower the risk of serious complications.

If you have a compromised immune system and have symptoms of pneumonia, contact your health care professional immediately.

A Weakened Immune System: What Does it Mean to be an “Immunocompromised Host?”

People with a weakened immune system have difficulty in fighting off the viruses, bacteria, and fungi that cause pneumonia.

A major risk factor for pneumonia is chronic obstructive lung disease (COPD). Patients who are treated for COPD with corticosteroid medications over a long period of time are even more susceptible. Underlying lung disease also increases the risk of complications of pneumonia.

You might also have a weakened immune system if you:

  • had a bone marrow transplant
  • had an organ transplant
  • have an HIV infection or AIDS
  • have leukemia lymphoma, or another condition that affects your bone marrow
  • have a chronic lung disease
  • have heart disease
  • have diabetes
  • take steroids, had chemotherapy, or take other medications that suppress the immune system (like those that are used for cancer and some autoimmune diseases)

Other Risk Factors

Infants, young children, and people over age 65 also have increased risk of pneumonia. Other risks include:

  • smoking
  • a hospital stay, especially if a respirator is used
  • air pollution
  • exposure to agricultural, construction, or industrial chemicals and fumes

Recognizing the Symptoms of Pneumonia

The following symptoms are common signs of pneumonia:

  • coughing (with or without mucus)
  • fever, chills, shivering, night sweats
  • fatigue
  • headache
  • nausea, vomiting
  • loss of appetite
  • chest pain that is aggravated by coughing or deep breathing
  • shortness of breath
  • swollen glands

In rare cases, joint and muscle stiffness can occur.

Diagnosing Pneumonia

Using a stethoscope, your doctor will probably notice abnormal sounds in your chest. There may be a crackling sound when you breathe. Diminished noise, or the absence of the normal sounds of breathing can indicate a fluid buildup between your lungs and your chest wall (pleural effusion).

Tests that can help diagnose pneumonia include:

  • chest X-ray
  • blood tests
  • sputum Gram stain (to detect bacteria in mucus from your air passages)
  • sputum direct fluorescent antibody (to examine mucus coughed up from your lungs)

In some cases, bronchoscopy (test used to view the airways), chest CT scan (scan that creates more detailed X-rays), or lung biopsy (test performed to examine a sample of lung tissue) may be used.

Treating Pneumonia

Depending on what type of bacteria is causing your pneumonia, you will be treated with antibiotics or antifungal medications.

Many people can be safely treated at home. Children generally begin to improve within a day or two, and adults take two to three days.

If you have a weakened immune system, symptoms may be more severe and recovery could take longer. You may need to stay in the hospital for a few days, where you will receive intravenous fluids and can be safely monitored.

If there is a build up of fluid in the lining of your lungs, it can be removed by performing a thoracentesis. This is a minimally-invasive technique where the doctor will insert a needle (guided by X-ray, if necessary) to take fluid from the pleural space surrounding the lungs. The fluid extracted with this procedure is sent to the laboratory for analysis (cell counts, bacteria, viral, fungal testing) and can be very helpful in the diagnosing your condition.

Some symptoms can last for weeks. Even when you begin to feel better, the infection may still be present, so it is important that you continue following your doctor’s treatment plan. Be sure to:

  • get lots of rest
  • drink plenty of fluids
  • take all prescribed medications, even if when you start to feel better (if you stop taking antibiotics too soon, the infection may return)
  • arrange a follow-up physical examination

Complications of Pneumonia

According to the Centers for Disease Control, pneumonia and influenza are the eighth leading causes of death in the United States (CDC, 2012). In people with a severely weakened immune system, complications are more common and can include:

  • spread of infection
  • sepsis (high levels of bacteria in the bloodstream)
  • respiratory failure (assisted breathing will be necessary)
  • death (a very wide mortality range, depending on the type of organism, the severity of the pneumonia as well as the cause of the underlying compromised immune system)

Preventing Pneumonia in Immunocompromised Patients

Ask your doctor if you should receive the yearly immunization for pneumonia. This is the pneumococcal vaccine, and is usually given at the same time as the flu vaccine.

If you need to stay in a hospital for any reason, you are at increased risk of hospital-acquired pneumonia. This is more common for people on a respirator. Health care workers can also pass it from patient to patient.

This kind of pneumonia is very dangerous and can even be fatal. Your doctor may order antibiotics as a preventative measure.

During cold and flu season, avoid crowds and people who are coughing or sneezing, and wash your hands often.

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