Pulmonary infections in immunosuppressed patients.

Pulmonary infections continue to be a significant problem in patients immunosuppressed by cancer or by drugs given for malignancy, or rheumatologic or dermatologic problems. For the neutropenic patient, single-drug rather than combination antibiotic therapy is being increasingly used. The role of growth factors is also being defined. The availability of the new azoles and of alternative forms of amphotericin B have increased treatment options, particularly for invasive pulmonary aspergillosis. Pneumocystis carinii pneumonia continues to be a problem in this population, and controversy remains about the mode of transmission and the mechanism of disease caused by this infection. Exogenous infection rather than reactivation may play a small role. Appreciation of the role of community and opportunistic viruses in causing respiratory infection or other complications in the immunosuppressed population is also being further detailed.