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Scott D. Halpern, MD, PhD, MBioethics

JAMA. 2005;294:734-737.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Consider the following 3 newly admitted patients. The first patient has marked hypoxemia requiring mechanical ventilation and is found to have nonspecific, bilateral, alveolar infiltrates on chest radiography. The second patient has had a severe change in mental status and on brain imaging has an enhancing lesion exerting a mass effect. The third patient has high fevers, ventilator-dependent respiratory failure, and diffuse nodular infiltrates on chest radiography, with negative blood, urine, and sputum cultures after 48 hours.

In each of these cases, the next steps in physicians’ diagnostic and therapeutic algorithms could be usefully informed by knowledge of the patients’ immunocompetency. Knowing that these patients had recently used immunosuppressive therapies, or were infected with the human immunodeficiency virus (HIV), would substantially increase the probabilities of Pneumocystis jiroveci pneumonia in the first patient, toxoplasmosis in the second patient, and disseminated fungal or mycobacterial infections in . . . [Full Text of this Article]

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Author Affiliations: Department of Medicine, Center for Clinical Epidemiology and Biostatistics, Center for Education and Research on Therapeutics, and Center for Bioethics, University of Pennsylvania School of Medicine, Philadelphia.

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