Glucocorticoid-Induced Immunosuppression and Immunocompromised Host Pneumonia

Mira Yulianti,
Department of Internal Medicine, Division of Respirology and Critical Illness, Faculty of Medicine Universitas Indonesia Dr. Cipto Mangunkusumo General Hospital
Dwitya Wilasarti, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia Dr. Cipto Mangunkusumo General Hospital

Abstract

Glucocorticoid is still a mainstay therapy in numerous diseases despite advances in novel chemotherapy and biologic immunomodulators. Estimated prevalence of glucocorticoid exposure is 1% in the general population. Glucocorticoid affect the immune system through various pathways, rendering those exposed to glucocorticoid immunocompromised. Studies have found that even at lower doses and short-term prescription, infection risk is increased in this population. Pneumonia is one of the leading causes of infection in the immunocompromised population, and based on the latest ATS/IDSA workshop report regarding immunocompromised-host pneumonia (ICHP), diagnosis and the etiologic workup differs compared to the community acquired pneumonia in immunocompetent patients. Approach to admission to inpatient care also differs due to the higher possibility of rapid deterioration of initially stable patients. Empirical treatment targets core respiratory pathogens but must be followed up to an attempt to determine causative pathogen according to clinical predisposition and imaging findings.
Keywords: immunocompromised host pneumonia, glucocorticoid