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<h3>Background</h3><p>Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Limited evidence is available on the most effective diagnostic approaches, management strategies, and long-term outcomes for CAP in patients who have undergone solid organ transplantation.</p><h3>Research Question</h3><p>What is the acute and long-term morbidity and mortality after CAP in organ transplant recipients?</p><h3>Study Design and Methods</h3><p>We retrospectively...
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Background: The incidence of atypical pneumonia among immunocompromised patients is not well characterized. Establishing a diagnosis of atypical pneumonia is challenging as positive tests must be carefully interpreted. We aimed to assess the test positivity rate and incidence of atypical pneumonia in transplant recipients. Methods: A retrospective cohort study was conducted at the Yale New Haven Health System in Connecticut. Adults with solid organ transplant, hematopoietic stem cell...
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Pulmonary nodules and masses in immunocompromised patients represent a diagnostic challenge due to overlapping radiological and clinical presentations. By integrating clinical context, immune status, and imaging findings, clinicians can more accurately diagnose and manage these lesions, improving patient outcomes. This review presents an algorithmic approach for differentiating between various causes of pulmonary nodules and masses in non-HIV immunocompromised individuals, providing a valuable tool for clinical practice.
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Infectious and noninfectious pulmonary syndromes remain significant contributors to morbidity and mortality after solid organ and hematopoietic stem cell transplantation. Multiple factors increase the risk of pulmonary complications including the surgical trauma related to solid organ transplantation, chemotherapy and radiation prior to hematopoietic stem cell transplant, the degree of immunosuppression, and immune factors contributing to rejection and graft-versus-host disease. The first...
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Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia.Methods: A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations.Results: The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of...
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These guidelines from the AST Infectious Diseases Community of Practice review the diagnosis and management of pneumonia in the post-transplant period. Clinical presentations and differential diagnosis for pneumonia in the solid organ transplant recipient are reviewed. A two-tier approach is proposed based on the net state of immunosuppression and the severity of presentation. With a lower risk of opportunistic, hospital-acquired, or exposure-specific pathogens and a non-severe presentation,...
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Solid organ and hematopoietic stem cell transplant recipients are at increased risk of upper and lower respiratory tract infections. While these infections are frequently encountered in the general population, the spectrum of their clinical presentation including morbidity and mortality is increased in patients undergoing transplantation procedures. Impaired innate and adaptive immunity, potential anatomical abnormalities resulting from extensive surgical procedures, presences of indwelling...
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Abstract. It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended t
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Hematopoietic cell transplant (HCT) and chimeric antigen receptor T-cell (CAR-T) therapy recipients are susceptible to multiple pulmonary complications that are caused by infectious and noninfectious processes. Numerous variables can be associated with specific pulmonary diseases including time from transplantation, presence of graft versus host disease (GVHD), underlying disease, and prolonged neutropenia and lymphocytopenia. Most pulmonary complications are infectious in origin, with...
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