11th January 2024

Infections

Chest infections are commoner in patients with ILD. They are important to avoid, and if they do occur, they should be treated swiftly as they are linked to ILD progression.
All infections are more common in ILD (bacterial, viral, fungal); incidence of tuberculosis, in particular, was shown to be up to 4-5 times higher than in patients without ILD.
Impaired defence mechanisms due to lung injury and scarring, as well as immunosuppressive medications with which ILD is often treated, both predispose this cohort of patients to chest infections.
Fibrotic conditions such as IPF are not treated with immunosuppression; thus, patients with exacerbation should always be covered with broad-spectrum antibiotics for a potential infective cause.
In non-IPF ILD, however, acute deterioration might present a clinical dilemma. It is important to distinguish between non-infective and infective exacerbation, as it might call for either increase in immunosuppression or reduction of it in combination with antibiotic treatment. BAL and/or sputum culture are key investigations to make this distinction in unclear cases.

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