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Respiratory Infections in Immunocompromised Patients

Yavor Kyumyurdzhiyski, Kaloyan Dobrev, Sibel Yuzeirova, Kolyo Karahristov, Valentina Dimitrova

Abstract

Introduction: Immunosuppressive treatment of patients undergoing organ transplantation, which is administered as a supportive therapy, often leads to severe, potentially life-threatening infections, which can be difficult to treat. Pneumocystis jirovecii and Cytomegalovirus (CMV) are some of the most common pathogens which cause pulmonary opportunistic infections in such patients.

Materials and Methods:A 40-year-old man, who had undergone a kidney transplantation in May 2013 was subsequently treated with immunosuppressive drugs like tacrolimus, cellcept and corticosteroids for almost a year. The patient was then admitted to the Clinic of Pulmonology at the St. Marina University Hospital, Varna with complaints of fatigue, shortness of breath, high temperature and a hacking cough. 

Results: Diagnostic imaging showed infiltrative shades in both lungs. Sputum and blood culture tests yielded no isolated microbiological agents. Antibacterial therapy with Tienam, Targocid and Sumamed was initiated, however, there were persistent fatigue, febrility and a deteriorating respiratory insufficiency, which required the use of non-invasive ventilation. CT of the thorax showed changes, specific for a pneumocystic pneumonia. Consequently, Biseptol was added to the therapy. Serological tests confirmed the presence of CMV and a course of treatment with Cymevene was conducted. The patient improved substantially and was discharged and prescribed a home oxygen treatment for 3 months. His condition was influenced favourably by broad-spectrum antibiotics, antiviral therapy and non-invasive ventilation.  A CT scan was performed in February 2017 and it showed a residual emphysematous bulla in the third segment of the lung.

Conclusion: Treatment with immunosuppressive drugs can be a risk factor for the development of serious opportunistic infections in patients who have undergone an organ transplantation. Such infections are not uncommon and they can be a determining factor for the following therapeutic behaviour.


Keywords

pulmonology, immunosuppressive therapy, kidney transplant, opportunistic infection


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