The initial pulmonary evaluation of the immunocompromised patient.

摘要: Practical approaches to the initial evaluation of solid organ transplant patients, BMT and HIV-infected patients with pulmonary disease are summarized in Figures 2, 3, 4. These algorithms meant be used as guidelines for clinician. The clinical setting will ultimately determine extent speed evaluation. Patients who recipients transplants have symptoms may focal or diffuse changes normal chest radiographs. In all these groups, sputum is obtained by expectation. If a pathogen found any it treated. When no on examination disease, empiric antibiotic therapy given. do not improve antibiotics, then bronchoscopy performed. Some centers proceed directly before antibiotics started hope directing therapy. CXR infiltrates identified undergo bronchoscopy, protocol followed until diagnosis made (see Fig. 2). received present treated shown Figure 3. reveal if infiltrate diffuse. Those broad-spectrum 48 72 hours. signs show some resolution, usually effect depends large how far along recovery from patient when they develop infiltrates. During first 30 days posttransplant, edema commonly occurs, resolve diuresis. clinically fluid overloaded respond diuretic therapy, BAL indicated. Finally, many symptoms. They pattern (Fig. 4). All subjected induction identify pathogen. one identified, Should treatment adequately found, BAL, protected specimen brush, transbronchial biopsy attempted. above schema general guideline disorders ICP. respiratory abnormality most cases closely followed. does deteriorates further, additional diagnostic procedures such video-assisted thorascopic lung CT-directed transthoracic needle needed.