Conces D J
Department of Radiology, Indiana University School of Medicine, Indianapolis, USA.
J Thorac Imaging. 1998 Oct;13(4):234-46. doi: 10.1097/00005382-199810000-00004.
Immunocompromised patients are susceptible to infections by organisms that infect individuals with normal immunity and by organisms that affect only those with abnormalities in their immune system. Using the radiographic findings and incorporating clinical information allows for the creation of a useful list differential diagnoses. The nature of the immune defect must be defined because defects in the different parts of the immune system are associated with infections by specific organisms. The time interval since transplantation provides a diagnostic clue because infections tend to occur at certain time intervals after transplantation. An epidemiologic history provides a history of exposure to organisms that may produce pneumonia. Consideration of the therapy the patient has received provides additional clues to the cause of the pneumonia. The physical examination and laboratory studies may provide an indication of the cause of the infection. Organisms tend to produce infections that have a typical rate of clinical development. Classifying the presentation as acute, subacute, or chronic provides additional etiologic clues. Correlating the clinical information with the radiographic findings generates a list of the most likely causative organisms. The list is useful in deciding on additional diagnostic tests and guiding therapy.
免疫功能低下的患者易受感染，这些感染源包括可感染免疫功能正常个体的病原体，以及仅侵袭免疫系统存在异常的个体的病原体。利用影像学检查结果并结合临床信息，有助于列出一份实用的鉴别诊断清单。必须明确免疫缺陷的性质，因为免疫系统不同部位的缺陷与特定病原体感染相关。移植后的时间间隔可提供诊断线索，因为感染往往在移植后的特定时间间隔内发生。流行病学史能提供接触可能引发肺炎的病原体的情况。考虑患者接受的治疗方法可为肺炎病因提供更多线索。体格检查和实验室检查可能提示感染的病因。病原体往往会引发具有典型临床发展速度的感染。将临床表现分类为急性、亚急性或慢性可提供更多病因线索。将临床信息与影像学检查结果相关联，可得出最可能的致病病原体清单。该清单有助于决定进一步的诊断检查并指导治疗。
