Table 113-1 Infections Associated with Selected Defects in Immunity Host Defect NONSPECIFIC I Impaired cough !

oss of gastric acidity !oss of cutaneous integrity Disease or Therapy Associated with Defect !NIT" Rib fracture, neuromuscular dysfunction Achlorhydria, histamine bloc"ade $enetrating trauma, athlete%s foot urn Intra&enous catheter acteria causing pneumonia, aerobic and anaerobic oral flora Salmonella spp#, enteric pathogens Staphylococcus spp#, Streptococcus spp# Pseudomonas aeruginosa Staphylococcus spp#, Streptococcus spp#, gram-negati&e rods, coagulase-negati&e staphylococci Streptococcus spp#, coagulasenegati&e staphylococci, Staphylococcus aureus Staphylococcus spp#, Streptococcus spp#, gram-negati&e rods Clostridium difficile, Candida spp# Escherichia coli *hronic pulmonary infection with P. aeruginosa Common Etiologic Agent of Infection

Implantable de&ice

'eart &al&e

Artificial (oint

!oss of normal bacterial Antibiotic use flora Impaired clearance $oor drainage Abnormal secretions INF#A +eutropenia )rinary tract infection *ystic fibrosis

ATO$" $ESPONSE 'ematologic malignancy, .ram-negati&e enteric bacilli, cytoto,ic chemotherapy, Pseudomonas spp#, aplastic anemia, 'I- infection Staphylococcus spp#, Candida spp# *h/dia"-'igashi syndrome, S. aureus, Streptococcus 0ob%s syndrome, protein-calorie pyogenes, Haemophilus malnutrition influenzae, gram-negati&e bacilli !eu"ocyte adhesion defects 1 and 1 acteria causing s"in and systemic infections, gingi&itis

*hemota,is

$hagocytosis 2cellular3

Systemic lupus erythematosus Streptococcus pneumoniae, H. 2S!43, chronic myelogenous influenzae leu"emia, megaloblastic anemia 5 H. influenzae, S. pneumoniae,

Splenectomy

Host Defect

Disease or Therapy Associated with Defect

Common Etiologic Agent of Infection other streptococci, Capnocytophaga spp#, Babesia microti, Salmonella spp#

6icrobicidal defect

*hronic granulomatous disease *atalase-positi&e bacteria and fungi7 staphylococci, E. coli, Klebsiella spp#, P. aeruginosa, Aspergillus spp#, Nocardia spp# *h/dia"-'igashi syndrome S. aureus, S. pyogenes ycobacterium spp#, Salmonella Interferon receptor defect, spp# interleu"in 11 deficiency, interleu"in 11 receptor defect

INNATE I *3 *8 *9, *:, *;

!NIT" *ongenital li&er disease, S!4, S. aureus, S. pneumoniae, nephrotic syndrome Pseudomonas spp#, Proteus spp# *ongenital *ongenital, S!4 Sic"le cell disease *ongenital *ongenital Neisseria spp#, gram-negati&e rods Neisseria meningitidis, N. gonorrhoeae S. pneumoniae, Salmonella spp# .ram-negati&e bacilli S. pneumoniae, S. aureus, other bacteria N. meningitidis, other bacteria

*omplement system

Alternati&e pathway Toll-li"e receptor < Interleu"in 1 receptor= associated "inase 2IRA>3 < 6annan-binding lectin ADAPTI%E I T lymphocyte deficiency?dysfunction

*ongenital

!NIT" Thymic aplasia, thymic !isteria monocytogenes, hypoplasia, 'odg"in%s disease, ycobacterium spp#, Candida sarcoidosis, lepromatous spp#, Aspergillus spp#, leprosy Cryptococcus neoformans, herpes simple, &irus, &aricella-@oster &irus AIDS Pneumocystis, cytomegalo&irus, herpes simple, &irus, ycobacterium a"ium# intracellulare, C. neoformans, Candida spp# Candida spp# Aungi, &iruses S. pneumoniae, other streptococci

6ucocutaneous candidiasis $urine nucleoside phosphorylase deficiency cell ruton%s B-lin"ed

Host Defect deficiency?dysfunction

Disease or Therapy Associated with Defect agammaglobulinemia Agammaglobulinemia, chronic lymphocytic leu"emia, multiple myeloma, dysglobulinemia Selecti&e Ig6 deficiency Selecti&e IgA deficiency

Common Etiologic Agent of Infection H. influenzae, N. meningitidis, S. aureus, Klebsiella pneumoniae, E. coli, $iardia lamblia% Pneumocystis, entero&iruses S. pneumoniae, H. influenzae, E. coli $. lamblia, hepatitis &irus, S. pneumoniae, H. influenzae Pneumocystis, cytomegalo&irus, S. pneumoniae, H. influenzae, &arious other bacteria S. pneumoniae, H. influenzae, S. aureus, rubella &irus, $. lamblia S. aureus, S. pneumoniae, H. influenzae, Candida albicans, Pneumocystis, &aricella-@oster &irus, rubella &irus, cytomegalo&irus Agents of infections associated with T and cell abnormalities

6i,ed T and cell deficiency?dysfunction

*ommon &ariable hypogammaglobulinemia Ata,ia-telangiectasia Se&ere combined immunodeficiency

Cis"ott-Aldrich syndrome

B-lin"ed hyper-Ig6 syndrome Pneumocystis, cytomegalo&irus, Cryptosporidium par"um