Etiological Evaluation of Non-resolving Pneumonia: Our Experience in a Tertiary Care Center of Telangana

Introduction: Non-resolving or slowly resolving pneumonia is not uncommon, affecting 10–20% of patients admitted withcommunity-acquired pneumonia (CAP). Non-resolving pneumonia is a challenging clinical problem. Incidence of non-resolvingpneumonia was found to be 10–15% among hospitalized patients with CAP and of them 6% developed progressive pneumonia.This study aims to evaluate the patients of non-resolving or slowly resolving pneumonias to establish the cause of it.Methodology: It is a prospective, observational study taken up by the Department of Pulmonary Medicine of SVS MedicalCollege and Hospital, Mahabubnagar, Telangana. All the enrolled cases of non-resolving or slowly resolving pneumonia whichsatisfy the inclusive criteria were taken into the study from June 2017 to December 2018. A total of 28 patients were satisfyingthe inclusion criteria and were further studied for evaluating the causative factors. The study was started after taking the approvalof the Institutional Ethics Committee, SVS Medical College and Hospital, Mahabubnagar, Telangana.Observation and Results: The mean age of the patients was 48.2 years. Of 28 patients, 18 (64.2%) were male and 10 (35.7%)were female with a male:female ratio – 1.8:1. Fever (81%) and cough (86%) were the most common symptoms. Smoking wasthe most common comorbidity noted (60.7%) followed by alcoholism (46.6%), diabetes (39.28%), hypertension (25%), andchronic obstructive pulmonary disease (21.4%). The most common cause of non-resolution of pneumonia in this study wastuberculosis 11 (39.28%) followed by bacterial pneumonias 9 (32.1%) which were caused by drug-resistant organisms. Othercauses were malignancy 6 (21.4%), foreign body 1 (3.57%), and fungal pneumonia 1 (3.57%).

A clinical study on non-resolving pneumonia in tertiary care centre

Background: Non-resolving pneumonia is a problem not only for the patient but also to the treating physician because establishing the cause for the non-resolution of pneumonia takes time and requires invasive investigations. The present study was done with the aim to evaluate the etiology and clinical outcome of non-resolving pneumonia by using fibre-optic bronchoscopy (FOB).Methods: This prospective study was done on 45 patients with symptoms and signs of non-resolving pneumonia attending the Govt. Thiruvotteeswarar Hospital of Thoracic Medicine, Otteri, Chennai, a tertiary care teaching centre, during the period January 2016 to December 2016. All the patients were investigated systematically to find out the etiological factors for non-resolution pneumoniaResults: Males preponderance was seen in the study (80%). Patients of age group 51-60 years are more affected (26.6%). Bacterial pneumonia not responding to empirical antibiotics (42.2%) was the most common cause followed by pulmonary tuberculosis (28.8%) and malignancy (24.4%). On FOB, inflammation with secretions was noticed in most of the patients (66.6%).Conclusion: The findings of the study concluded that apart from bacterial pneumonia not responding to empirical antibiotics, tuberculosis and malignancy were found to be the major causes of non-resolving pneumonia. Hence, it is necessary to observe every patients for the adequate response to treatment and to utilize other modalities of investigations like FOB,CT guided FNAC/biopsy whenever required to offer exact management to the patients.

A 12-year-old girl with hodgkin’s disease presenting as a non-resolving pneumonia and an endobronchial nodule.

The presence of a non-resolving pneumonia warrants the suspicion of a possible malignancy. While pulmonary involvement in Hodgkin’s disease can present as a non-resolving pneumonia, the clinical clues of dyspnoea, stridor and wheeze point to a possible endobronchial involvement. A bronchoscopy in such a situation can be valuable for diagnosis, and can aid in staging of the disease. The true incidence of endobronchial involvement in Hodgkin’s disease is not known, but when diagnosed early and treated appropriately, the prognosis is usually good, and a complete cure is possible.

Consolidative Bronchioloalveolar Carcinoma Presenting as Pneumonia, and This Led to a Late Diagnosis due to the Improvement after Antibiotic Therapy / 결핵및호흡기질환

Non-resolving or slowly resolving pulmonary infiltrates in spite of administering adequate antimicrobial therapy are a clinical diagnostic challenge for physicians. The rate of radiographic resolution varies with the patients' age, the underlying comorbidities, the extent of radiographic involvement, the functional status and the causal pathogens. It is important to differentiate non-resolving or slowly resolving bacterial pneumonia from other uncommon infectious pneumonias or malignancies that require invasive diagnostic techniques to confirm the diagnosis. Bronchioloalveolar carcinoma can present with various clinical and radiographic features. Unfortunately, the radiographic similarity of consolidative BAC to pneumonia often leads to an incorrect diagnosis of pneumonia and possibly significant delays in obtaining appropriate diagnostic studies. We describe here a case of a mixed adenocarcinoma and bronchioloalveolar carcinoma that was initially diagnosed as pneumonia due to the consolidation pattern on the radiography and the patient's initial improvement with antibiotic treatment.