Infections in the immunocompromised host
Work out the immune defect, recognise the syndromes (pulmonary infiltrates, CNS infection, disseminated rash), go early for tissue and BAL, know first-line drugs for aspergillus, mucor, cryptococcus, CMV, nocardia and listeria, and handle biologics during infection.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Start every assessment by naming the immune defect: neutropenia, T-cell, B-cell or antibody, splenic, complement, or TNF blockade. The organism follows from it. The table is in immunosuppression complications.
- Signs are muted. Fever may be absent on steroids, consolidation may not form without neutrophils, and CRP can be blunted by IL-6 blockade (tocilizumab).
- Treat empirically and investigate invasively, at the same time. BAL, biopsy and CT happen early, because the differential is long and several organisms can coexist.
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Sources
- Therapeutic Guidelines: Antibiotic (infections in immunocompromised patients, febrile neutropenia, fungal infections)AU/NZTherapeutic Guidelines Limited (eTG complete), 2025 to 2026 staged update; guideline-wide changes March 2025 (topic version not verified)
- Australian Immunisation Handbook: Vaccination for people who are immunocompromisedAU/NZAustralian Technical Advisory Group on Immunisation (ATAGI), Australian Government Department of Health, Disability and Ageing, online, updated 2026
- Recommendations for the use of biologic and targeted synthetic DMARDsAU/NZAustralian Rheumatology Association, November 2025
- Bass AR et al. 2022 American College of Rheumatology guideline for vaccinations in patients with rheumatic and musculoskeletal diseases. Arthritis Care Res 2023;75:449-64American College of Rheumatology, 2022 (published 2023)
- Patterson TF et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the IDSA. Clin Infect Dis 2016;63:e1-60Infectious Diseases Society of America, 2016
- Rubin LG et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014;58:e44-100Infectious Diseases Society of America, 2013
- Jarvis JN et al. Single-dose liposomal amphotericin B treatment for cryptococcal meningitis (AMBITION-cm). N Engl J Med 2022;386:1109-20New England Journal of Medicine, 2022
- Last updated
- 14 November 2026
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