Key Points

• I understand that some of our patients are immunosuppressed and may develop pulmonary infections as a result of that, but the chapter is not surgical. It is comprehensive however irrelevant to many of the practicing thoracic surgeons. Most of the diagnosis and treatment in such situations are primarily done by pulmonologists, transplant physicians or intensivists. thoracic surgeons are consulted if there is a significant lung destruction or complications needing some level of surgical intervention. Thus I am not sure we should have a such a long chapter for this topic.
• One of the lacking topics is injury to the lung secondary to chemotherapy, immunotherapy or radiation which would be susceptible to infection and important to manage after surgery. How will we manage the preoperative infection in terms of monitoring, diagnosis and prevention? How to manage a pulmonary infection postoperatively which is most likely covered in the postoperative complications chapter?
• Tables 1 and 2 are very helpful.
• I would suggest a significant rewrite of this chapter and make it more surgeon relevant.
• Lower respiratory tract infections, especially pneumonia, are the first cause of mortality worldwide.
• Pneumonia in an immunocompromised host is difficult to diagnose.
• A high degree of suspicion and controlling the immunosuppressive state is key to the outcome.
• Microbiologic diagnosis is slow, but new rapid DNA-based tests are coming.
• Pathogenesis and clinical radiographic manifestations are different in normal and immunocompromised hosts.
• Recent therapeutic guidelines are useful.