Etiology and Management of the Compromised Patient with Fever and Pulmonary Infiltrates

  • Robert H. Rubin
  • Reginald Greene


The immunocompromised patient in whom fever and pneumonitis develop presents a formidable challenge to the clinician. A legion of microbial invaders ranging from common viral and bacterial pathogens to exotic fungal and protozoan agents have been reported to cause pulmonary infection in these patients. Given the array of infectious etiologies, it is little wonder that pneumonia is the most frequent cause of fatal infection in the compromised host.1–8 For example, in one large series of 227 renal transplant patients, inflammatory disease of the lung occurred in 20% of patients and was associated with 50% of fatalities.6 Patients with acute leukemia in relapse develop an episode of pneumonia approximately once every 60 days at risk.9 In patients with hematologic malignancy who developed fever and pulmonary infiltrates, the mortality rate (45%) was five times that for such patients with fever alone.10 In a similar study of pneumonia in patients with cancer, the mortality rate (76%) for patients with pulmonary infection was many time greater than the mortality associated with infection at other sites.10 In most patients with acquired immunodeficiency syndrome (AIDS) pneumonia develops, and in virtually all these patients pneumonia is an important factor in their demise.


Invasive Aspergillosis Pulmonary Infection Renal Transplant Patient Pulmonary Infiltrate Radiation Pneumonitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer Science+Business Media New York 1988

Authors and Affiliations

  • Robert H. Rubin
    • 1
    • 2
  • Reginald Greene
    • 3
    • 4
  1. 1.Infectious Disease and Transplantation UnitsMassachusetts General HospitalBostonUSA
  2. 2.Department of MedicineHarvard Medical SchoolBostonUSA
  3. 3.Chest Division, Radiology ServiceMassachusetts General HospitalBostonUSA
  4. 4.Department of RadiologyHarvard Medical SchoolBostonUSA

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