Occasional reviews A persistent challenge: the diagnosis of respiratory disease in the non-AIDS immunocompromised host

The diagnostic and therapeutic approach to respiratory disease in the immunocompromised host remains a challenge for several reasons: (1) the current increase in both the number of immunocompromised hosts and their length of survival; (2) the high frequency of lung disease in these patients, and (3) the severity of these lung diseases. A good example is given in a recent review by Paterson et al of the epidemiology of invasive aspergillosis in transplant recipients. The incidence of this opportunistic infection, which mainly aVects the lung, varies from 1% in kidney recipients to 9% in lung recipients (with 2% in liver recipients and 7% in bone marrow recipients). In this population it has a mortality rate of 55–92% and accounts for 10–15% of deaths of all transplant recipients.