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

  • Comorbidities: diabetes,4,5 GVHD,6 leukemia,4 lymphoma,4hematologic malignancies,6 metabolic disease4,5

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

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

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

  • Malnutrition4,5

  • Environmental conditions: UV light,4,5 radiation5

  • 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

  • Former smoker (1 pack/day for >25 years) with a history of COPD and emphysema

  • Received lung transplant and is receiving long-term immunosuppressants

Patient
REVIEW CASE HISTORY

  • Physical Exam

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

    Physical examination results:
    Chart

  • Hospital Course

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

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

  • 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.

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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.