The immunocompromised patient: guidelines for the clinical approach
Ramírez-Ronda, C.H.; Fuxench-Chiesa, Z.
Boletin de la Asociacion Medica de Puerto Rico 74(2): 24-30
1982
ISSN/ISBN: 0004-4849 PMID: 6958276 Document Number: 701456
The clinical, diagnostic, and therapeutic approach to infections in immunocompromised patients is complicated by the fact that these patients are critically immunosuppressed and have rapidly progressive clinical courses. The multiple physicians involved in their care are not always in communication, which unfortunately delays major decisions regarding management. For this reason, the Infectious Disease specialists at Stanford University and our own program try to insure that one physician is ultimately responsible for, and coordinates the care of these critically ill patients. In addition, we consider the team approach to be optimal, but recognize that certain members of the team may not always be available. In his event, alternate physicians must be available. The necessity of having the appropriate technical and medical-surgical facilities had led a number of authors to recommend that these patients be cared for solely in major medical centers whenever possible. This necessity has unfortunately altered the quality of life for many patients in an untoward manner, especially where they have had to move themselves and their families to such centers. The team may be rather extensive but most often consists of the patient's personal physician, housestaff, hematologist-oncologist, radiologist, infections disease consultant, thoracic surgeon, laboratory microbiologist and pathologist. Coordination of such a team effort is not only a major responsibility but a necessity if these patients are to be cared for appropriately. We will attempt to provide certain guidelines which we hope will be helpful for physicians caring for such patients. For this reason the reader is referred to the bibliography for critical articles related to the subjects covered. What follows then will be a discussion, dealing with selected clinical, diagnostic and therapeutic considerations which the practicing physician may use in dealing with infections in high risk patients, primarily those with hematologic malignancy receiving high dose immunosuppressive drugs, including corticosteroids.
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