Pneumonia in an Immunocompromised Patient

Pneumonia as a disease was once dreaded, since most of the cases would turn out to be fatal. This was many years ago, and with medical advances, times have changed. However, in some severe cases of pneumonia, especially in people with weakened immune systems, the disease can still be fatal. If the body’s self-defense mechanism does not work well, the person is known to have lesser immunity to diseases. Pneumonia is a serious infection of the lungs. People with compromised immune systems often develop pneumonia as a result of several microscopic organisms, even some that are harmless in healthy bodies.

A patient’s immune system may become compromised for a variety of reasons including cancer, diseased white blood cells, AIDS and other chronic illnesses, and medications such as chemotherapeutic drugs, corticosteroids, and drugs used in treating autoimmune diseases. A person who does not intake sufficient nourishment, good food, clean water and care also may have lesser immunity and is a potential target for viral and bacterial attacks.

What causes pneumonia in immunocompromised patients?

Pneumonia is usually caused when particular germs including viral, bacterial or fungi germs infect the lungs. The flu that develops is an air-borne disease. Normally, the body is able to filter most germs out of the air that you breathe in and stop infections from reaching the lungs. Pneumonia in patients with a weakened immune system can be caused by the same microorganisms that cause common pneumonia, but it is most often caused by organisms that do not affect healthy people.

The most common culprit of pneumonia in a person with a compromised immune system is called pneumocystis jirovecii. Pneumocystis jirovecii is a fungus that typically resides in the lungs of average, healthy individuals. However, if someone's system is weakened for any reason such as cancer, the pneumocystis jirovecii aids in causing pneumonia. Pneumocystis jirovecii pneumonia is often a warning sign that helps doctors diagnose AIDS in an individual who is unaware of his or her condition.

What are the symptoms?

In a pneumonia patient, the normal process of gas exchange in the lungs gets disrupted, and fluid and pus gets filled up in the lungs making the patient gasp for breath. Recurrent bouts of untreated fever, bronchitis, respiratory tract infections, sinusitis, ear and throat infections in children may lead to pneumonia, since the immunity level of the patient would have come down. The symptoms of this form of pneumonia present the same as they would in a healthy person. Patients may develop symptoms like a fever, chills, a productive cough and difficulty breathing. These symptoms may be so severe in some patients that they require ventilators to help them breathe.

How is it diagnosed?

A diagnosis of pneumonia is first found during a physical examination if the symptoms and outward signs are consistent with pneumonia. If pneumonia is suspected, the doctor in question will order further tests, such as a chest X-ray and a microscopic examination of sputum specimen.

In patients suffering from pneumonia, a chest X-ray usually shows patchy infiltrations in the person's lung fields. In immunocompromised patients, a sputum sample will also be collected to find out the exact organism that is causing the symptoms. Sometimes it is difficult to get a sample of sputum from the lungs. In such situations, a sample of sputum can be obtained by inducing natural removal or by bronchoscopy. A vapor is used to stimulate a cough in order to obtain an induced sputum sample in a natural manner. Bronchoscopy is a procedure in which a tube is inserted into a patient's airway, and this is the second way to receive a sample of a person's sputum when under difficult circumstances.

What are the treatment options?

Treatment of this condition depends on several factors including what organism is causing the pneumonia, the severity and progression of the pneumonia, and the status of the specific patient's immune system.

The type of organism responsible for pneumonia in an immunocompromised patient determines what treatment options are best. If it is a bacterial, viral or fungal cause, antibiotics, antivirals or anti-fungal drugs will be prescribed.  

Pneumonia in immunocompromised individuals is more severe and results in a higher risk of fatality as compared to community-acquired pneumonia. This is because the patients with less immune responses tend to become more ill more quickly and are also difficult to treat. For this reason, patients that are taking drugs that suppress their immune systems (chemotherapeutic drugs or corticosteroids) should stop using them temporarily until their pneumonia is completely resolved.

Can you prevent pneumonia in such patients?

Yes, it is possible to prevent pneumonia in those with weakened immune systems. Doctors take various measures to prevent the development of infections when dealing with these patients, because even the tiniest infection could kill them.

People with compromised immune systems should also make sure to get vaccinated against the pneumococcus virus and hemophilus influenza. Avoiding these diseases will help the patients stay healthy and require the least care possible. Immuno deficient patients are often given prophylactic antibiotics to prevent the development of pneumonia, proving that it's an illness that can be avoided, especially in those lacking a proper immune system.

Along with getting these vaccines, care should be taken to provide good nutritious food, clean water, and a hygienic environment for the patient. Sufficient air circulation will also provide relief as well as protect the patient from becoming ill. In case, of chronic diseases, monitoring of the vital statistics and regularly taking any prescribed medication will give a little boost to the immune system. Also, keeping the patient warm during winter and rainy season is another key point to be noted.

Pneumonia can develop in a person who is undergoing treatment in a hospital for another condition or having a surgery as well. Patients in intensive care units who are kept on breathing machines are particularly at risk of developing ventilator associated pneumonia. Now-a-days doctors insist on discharging the patient soon after recovery instead of keeping him or her for few more days in the hospital, fearing the patient might contract an infection while in the hospital.