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Intensive Care Med. 2020 Feb 7. doi: 10.1007/s00134-019-05906-5. [Epub ahead of print]

Diagnosis of severe respiratory infections in immunocompromised patients.

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Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital and Paris University, Paris, France.
Université de Paris, Paris, France.
Department of Intensive Care, Rigshospitalet and Copenhagen Academy for Medical Simulation and Education, University of Copenhagen, Copenhagen, Denmark.
Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA, USA.
Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, NOVA Medical School, New University of Lisbon, Lisbon, Portugal.
Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain.
Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, St James Street, Dublin 8, Ireland.
Department of Medicine and Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada.
Department of Intensive Care, Glasgow Royal Infirmary, Glasgow, UK.
Department of Medicine I, Intensive Care Unit 13i2, Comprehensive Cancer Center, Center of Excellence in Medical Intensive Care (CEMIC), Medical University of Vienna, Vienna, Austria.
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto Salud Carlos III, Madrid, Spain.
CRIPS Department, Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain.
Critical Care Department, Institut Paoli Calmettes, Marseille, France.
Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital and Paris University, Paris, France.
Université de Paris, Paris, France.


An increasing number of critically ill patients are immunocompromised. Acute hypoxemic respiratory failure (ARF), chiefly due to pulmonary infection, is the leading reason for ICU admission. Identifying the cause of ARF increases the chances of survival, but may be extremely challenging, as the underlying disease, treatments, and infection combine to create complex clinical pictures. In addition, there may be more than one infectious agent, and the pulmonary manifestations may be related to both infectious and non-infectious insults. Clinically or microbiologically documented bacterial pneumonia accounts for one-third of cases of ARF in immunocompromised patients. Early antibiotic therapy is recommended but decreases the chances of identifying the causative organism(s) to about 50%. Viruses are the second most common cause of severe respiratory infections. Positive tests for a virus in respiratory samples do not necessarily indicate a role for the virus in the current acute illness. Invasive fungal infections (Aspergillus, Mucorales, and Pneumocystis jirovecii) account for about 15% of severe respiratory infections, whereas parasites rarely cause severe acute infections in immunocompromised patients. This review focuses on the diagnosis of severe respiratory infections in immunocompromised patients. Special attention is given to newly validated diagnostic tests designed to be used on non-invasive samples or bronchoalveolar lavage fluid and capable of increasing the likelihood of an early etiological diagnosis.


Aspergillosis; Cytomegalovirus; Influenza; Mucormycosis; Pneumocystis pneumonia; Toxoplasmosis


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