Nonleukopenic compromised hosts frequently have life-threatening infectious diseases
that result in admission to the critical care unit (CCU). Nonleukopenic compromised
hosts are those whose impaired host defenses are not related to a defect in the number
of circulating lymphocytes. The commonest diseases associated with impaired host defenses
not related to leukopenia are diabetes mellitus and systemic lupus erythematosus (SLE);
the group also includes patients on corticosteroid therapy or those with absent or
impaired splenic function. A wide variety of other disorders associated with immune
defects, such as multiple myeloma, often are complicated by infection, but such infections
are less likely to result in admission to the CCU than are infections in the aforementioned
categories.
Infections in diabetes, lupus, or impaired splenic function often are severe and may
be life-threatening. Intraabdominal infections, urinary tract infections (UTIs), and
skin and soft tissue infections are the most common, resulting in severe infections
in diabetics. Patients with lupus are subject to a wide variety of infections, usually
involving the skin and soft tissues, central nervous system (CNS), urinary tract,
or lungs. Long-term, high-dose steroid therapy primarily diminishes T-lymphocyte-dependent
immunity, predisposing such patients to intracellular pathogens. Patients on chronic
steroid therapy are predisposed to CNS infections, pulmonary infections, and disseminated
infections due to intracellular bacteria, viruses, and systemic fungi.
The main diagnostic difficulty in the patient with SLE is to differentiate a lupus
flare from infection. In patients with impaired or absent splenic function, overwhelming
infection is the most dreaded complication, often having a fatal outcome. This article
discusses the differential diagnostic approach of serious infections in these patients
from the infectious disease perspective.
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Article info
Footnotes
Address reprint requests to Burke A. Cunha, MD, Chief, Infectious Disease Division, Winthrop-University Hospital, Mineola, NY 11501
Identification
Copyright
© 1998 W. B. Saunders Company. Published by Elsevier Inc. All rights reserved.
