Diagnosis and treatment of opportunistic infections in immunocompromised surgical patients

The advent of successful therapy for patients who suffer many types of orga n dysfunction and failure, malignancies, and acquired immunodeficiency synd rome has led to the concurrent threat of infection due to a wide array of p athogens, particularly opportunistic microbes that rarely cause disease und er routine circumstances. Among patients who are subjected to extreme degre es of immunosuppression, almost any type of bacterial, fungal, viral, proto zoal, or parasitic organism can exhibit pathogenic potential and lead to de vastating consequences for the host. Immunosuppressive drug therapy for the purpose of organ allograft maintenance, cancer chemotherapy, or the human immunodeficiency virus exerts potent effects upon cellular immunity. Theref ore, although these groups of patients are more susceptible to all types of infectious disease processes, infections due to those pathogens that requi re a component of cellular immunity for their eradication, such as fungi an d viruses, occur at a higher frequency than that observed among normal indi viduals. Of critical importance, all types of infections are associated wit h higher rates of morbidity and mortality in immunosuppressed patients. Cur rently, improved diagnostic techniques and new treatment modalities have re ndered many serious infections, for which suitable therapy previously did n ot exist, amenable to treatment. Because of the large number of immunosuppr essed patients who now lead highly productive lives, it is important for th e surgical practitioner to become familiar with the modalities currently av ailable to precisely diagnose and effectively treat opportunistic infection s in immunocompromised surgical patients.