The Immunocompromised Patient
نویسنده
چکیده
As increased numbers of immunocompromised persons present to the emergency department (ED), it is essential that emergency physicians possess the knowledge and skills to recognize and to treat infectious complications of cancer, organ transplantation, diabetes, renal failure, cirrhosis, asplenism, human immuno deficiency virus (HIV) infection, and other immunosuppressive conditions. These include infectious complications of immuno suppressive and immunomodulating medications used for a wide variety of disorders. Compared with individuals with an intact immune system, infections in immunocompromised patients are more common, progressive, and severe, and they are caused by a wider variety of microorganisms. Immunocompromised persons who present with acute infections may appear deceptively benign initially, their symptoms and signs often mimicking noninfectious complica tions, only to deteriorate rapidly if they are not aggressively treated. Many interrelated factors cause patients to become immu nocompromised and predispose them to the development of infections with potentially pathogenic microorganisms. These include disruption of the body’s protective surfaces, such as skin and mucosal barriers (oral and respiratory mucosa and intestinal and genitourinary surfaces); disorders that directly impair the function of the body’s immune system (e.g., lymphoma, asplen ism, and myeloma); drugs and irradiation that suppress or alter immune function; alterations in body substances (hyperglycemia) or solid organ function (kidney and liver failure); and malnutri tion, aging, and exposure to antimicrobial agents that inhibit the normal protective resident bacterial flora.
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