Vulnerable Patients:
Secondary Immunodeficiency

Up to half of solid organ transplant or HSCT recipients and patients receiving chemotherapy who develop an RVI progress to lower respiratory tract infection.1,2
90%

RVIs can lead to prolonged ICU admissions and mechanical ventilation.3

Recurrent infections
Risk Factors
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    Comorbidities: diabetes,4,5 GVHD,6 leukemia,4 lymphoma,4 hematologic malignancies,6 metabolic disease4,5

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    Procedures: apheresis/ablation(CAR-T),7 inpatient/ outpatient surgery,5 hematologic transplant (HSCT/BMT),8 solid organ transplant,6 anesthesia,4 splenectomy4

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    Treatment: chemotherapy,8 glucocorticoids,4,5 immunosuppressants,4,5 immunotherapy and immunomodulatory agents4,5

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    Chronic and co-infection: COVID-19,9 HIV,4,5 viral hepatitis,10 influenza,10 pertussis,11 cytomegalovirus,4 Epstein-Barr virus,4 herpes zoster,10 bacterial infection12

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    Malnutrition4,5

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    Environmental conditions: UV light,4,5 radiation5

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    Trauma: severe burns4,5

25%

Patients requiring ventilation, intubation, or ICU admission3

78%

Potential duration of ICU admission3

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Failure to recognize and address these high-risk populations can result in long-term respiratory complications, increased hospitalizations, and mortality for patients.2,8

What next steps would you take for this patient?

61-year-old female lung transplant recipient
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    Former smoker (1 pack/day for >25 years) with a history of COPD and emphysema

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    Received lung transplant and is receiving long-term immunosuppressants

Patient
REVIEW CASE HISTORY
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    Physical Exam

    Presented to the ER with respiratory distress and severe confusion 3 months after receiving lung transplant

    Physical examination results:
    Chart
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    Hospital Course

    Admitted to the ICU, with initiation of IV fluids and broad-spectrum antibiotics, and was placed on mechanical ventilation

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    On day 3, all cultures were NGTD except NP swab, which was positive for RSV.

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    Labs/Imaging

    CT images show peribronchiolar nodular consolidations and ground glass opacifications

    Significant laboratory values:
    • WBC: 3000 cells/μL
    • Platelets: 85,000/μL
CLICK HERE TO LEARN MORE ABOUT RVI TREATMENT GOALS AND STRATEGIES
Clinical Challenges

Immunocompromised patients face a number of clinical challenges associated with RVI, including co-infections, progression to lower respiratory tract infection, and potentially death.

LEARN MORE
Addressing RVI

Learn about the advantages and limitations of RVI management strategies in immunocompromised patients.

LEARN MORE

Cases are hypothetical. Images and descriptions are for illustrative purposes only


BMT, bone marrow transplant; COPD, chronic obstructive pulmonary disease; ER, emergency room; GVHD, graft-versus-host disease; HIV, human immunodeficiency virus; HSCT, hematopoietic stem cell transplant; ICU, intensive care unit; IV, intravenous; NGTD, no growth to date NP, nasopharyngeal; RSV, respiratory syncytial virus; RVI, respiratory viral infection; UV, ultraviolet; WBC, white blood cell.

References

1. Abbas S, et al. Int J Infect Dis. 2017;62:86-93. 2. Chatzis O, et al. BMC Infect Dis. 2018;18(1):111. 3. Schmidt H, et al. Influenza Other Respir Viruses. 2019;13(4):331-338. 4. Raje N, Dinakar C. Immunol Allergy Clin North Am. 2015;35(4):599-623. 5. Chinen J, Shearer WT. J Allergy Clin Immunol. 2010;125(2 Suppl 2):S195-S203. 6. Paulsen GC, Danziger-Isakov L. Clin Chest Med. 2017;38(4):707-726. 7. Buitrago J, et al. Clin J Oncol Nurs. 2019;23(2):42-48. 8. Hirsch HH, et al. Clin Infect Dis. 2013;56(2):258-266. 9. Shields AM, et al. J Allergy Clin Immunol. 2020; S0091-6749(20)32406-4. 10. Ruffner MA, et al. Front Immunol. 2017;8:665. 11. Solans L, Locht C. Front Immunol. 2019;9:3068. 12. Wiegers HMG, et al. BMC Infect Dis. 2019;19(1):938. 13. Cinetto F, et al. Eur Respir Rev. 2018;27(149):180019. 14. Baumann U, et al. Front Immunol. 2018;9:1837.

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