The Diagnosis and Treatment of Respiratory Infections in Autoimmune Disease, Excluding Tuberculosis

摘要: Respiratory infections play an important role in the morbidity and mortality associated with autoimmune disease. A patient disease who presents a fever, cough breathlessness or pleuritic pain may have respiratory infection, but these symptoms can also occur if there is exacerbation of process adverse reaction to medication. general approach such outlined as algorithm Figure 1. complete drug history essential. Empirical treatment antibiotics for common (e.g. penicillin macrolide), while awaiting results blood cultures, sputum examination serology, will cover majority episodes. Patients low numbers circulating neutrophils lymphocytes require special consideration. High-resolution computed tomography (CT) reveal parenchymal lesions where chest radiograph appears normal, ground-glass shadowing Pneumocystis carinii pneumonia (PCP), nodules Aspergillus early reaction, be diagnostic, e.g. “halo sign” infection. more invasive dictated by lack response treatment, again CT valuable planning procedure anatomical site sampled. The choice bronchoscopy, thoracoscopy open-lung biopsy determined patient’s condition: rapid worsening clinical state hypoxia recommend biopsy. Transbronchial biopsies are frequently too small provide adequate material make diagnosis, greater risk approaching failure from pneumothorax haemorrhage.