Пневмонія у імунокомпрометованих хворих
Immune System Defect | Examples of Disorders Or Therapy With Defect* | Likely Pathogens |
|---|---|---|
Defective polymorphonuclear leukocytes | ||
Neutropenia | Acute leukemia, aplastic anemia, cancer chemotherapy | Gram-negative bacteria Staphylococcus aureus Aspergillus Candida |
Defective chemotaxis | S. aureus Gram-negative aerobic bacteria | |
Defective intracellular killing | Chronic granulomatous disease | S. aureus |
Defective alternative pathway | Streptococcus pneumoniae Haemophilus influenzae | |
C5 deficiency | Congenital disorder | S. pneumoniae S. aureus Gram-negative bacteria |
Cell-mediated immunity | ||
T-cell deficiency or dysfunction | Hodgkin lymphoma, cancer chemotherapy, corticosteroid therapy | Mycobacteria Viruses (eg, herpes simplex virus, cytomegalovirus) Strongyloides species Opportunistic fungi (eg, Aspergillus, Mucor, Cryptococcus species Nocardia species Toxoplasma species |
Pneumocystis jirovecii Toxoplasma species Cytomegalovirus Herpes simplex virus Opportunistic fungi (eg, Aspergillus, Mucor, Cryptococcus species) Mycobacteria | ||
Humoral immunodeficiency | ||
B-cell deficiency or dysfunction | Agammaglobulinemia, hematologic malignancies, HIV infection, nephrotic syndrome, impaired splenic function, congenital disorders such as common variable immune deficiency Chemotherapy, biologic therapy, or chimeric antigen receptor-modified T (CAR-T) cell therapy, organ transplantation | S. pneumoniae H. influenzae Neisseria meningitidis |
Selective deficiency: IgA, IgG, IgM | S. pneumoniae H. influenzae | |
Hypogammaglobulinemia | P. jirovecii Cytomegalovirus S. pneumoniae H. influenzae | |
* Examples. Many disorders cause multiple defects. | ||