'When the pneumonia doesn't get better'

A. M. Fein, H. Feinsilver St., M. S. Niederman, Stanley Fiel, P. B. Pai

Research output: Contribution to journalReview article

25 Citations (Scopus)

Abstract

A slowly or nonresolving pneumonia requires careful evaluation. A host defect is likely to be the cause of slow resolution. Nonresolving pneumonia, or deterioration under therapy, is more likely the result of bronchial obstruction or a noninfectious disorder. It is therefore important to determine when a pneumonia resolves inconsistenly with its presumed etiology. Chronic obstructive lung disease, alcoholism, and diabetes are among the most common host defects, especially in patients over age 55. When host defects are present, an observation period may permit the infection to resolve. If these defects are not present, cystic fibrosis, a syndrome of ciliary dysfunction, or acquired hypogammaglobulinemia may, rarely, produce slow resolution, especially in the presence of infertility, sinusitis, diarrhea, or diabetes. Immunoglobulin levels, sweat testing, and nasal biopsy should then be considered. When an infection is not resolving appropriately and there is no systemic host defect, local obstruction to bronchial drainage, an unusual infection, or a noninfectious problem may be suspected. The approach to the diagnosis must be guided by the entire clinical picture. Computed tomography, fiberoptic bronchoscopy, and needle aspiration are useful diagnostic tools, all depending on the specific symptoms and the location on chest roentgenogram. The role of magnetic resonance is yet to be determined. If no diagnosis can be determined, open lung biopsy may be indicated.

Original languageEnglish (US)
Pages (from-to)529-541
Number of pages13
JournalClinics in Chest Medicine
Volume8
Issue number3
StatePublished - Dec 1 1987
Externally publishedYes

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Pneumonia
Infection
Common Variable Immunodeficiency
Biopsy
Sweat
Sinusitis
Bronchoscopy
Nose
Cystic Fibrosis
Chronic Obstructive Pulmonary Disease
Infertility
Alcoholism
Needles
Immunoglobulins
Drainage
Diarrhea
Magnetic Resonance Spectroscopy
Thorax
Tomography
Observation

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine

Cite this

Fein, A. M., Feinsilver St., H., Niederman, M. S., Fiel, S., & Pai, P. B. (1987). 'When the pneumonia doesn't get better'. Clinics in Chest Medicine, 8(3), 529-541.
Fein, A. M. ; Feinsilver St., H. ; Niederman, M. S. ; Fiel, Stanley ; Pai, P. B. / 'When the pneumonia doesn't get better'. In: Clinics in Chest Medicine. 1987 ; Vol. 8, No. 3. pp. 529-541.
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Fein, AM, Feinsilver St., H, Niederman, MS, Fiel, S & Pai, PB 1987, ''When the pneumonia doesn't get better'', Clinics in Chest Medicine, vol. 8, no. 3, pp. 529-541.

'When the pneumonia doesn't get better'. / Fein, A. M.; Feinsilver St., H.; Niederman, M. S.; Fiel, Stanley; Pai, P. B.

In: Clinics in Chest Medicine, Vol. 8, No. 3, 01.12.1987, p. 529-541.

Research output: Contribution to journalReview article

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AB - A slowly or nonresolving pneumonia requires careful evaluation. A host defect is likely to be the cause of slow resolution. Nonresolving pneumonia, or deterioration under therapy, is more likely the result of bronchial obstruction or a noninfectious disorder. It is therefore important to determine when a pneumonia resolves inconsistenly with its presumed etiology. Chronic obstructive lung disease, alcoholism, and diabetes are among the most common host defects, especially in patients over age 55. When host defects are present, an observation period may permit the infection to resolve. If these defects are not present, cystic fibrosis, a syndrome of ciliary dysfunction, or acquired hypogammaglobulinemia may, rarely, produce slow resolution, especially in the presence of infertility, sinusitis, diarrhea, or diabetes. Immunoglobulin levels, sweat testing, and nasal biopsy should then be considered. When an infection is not resolving appropriately and there is no systemic host defect, local obstruction to bronchial drainage, an unusual infection, or a noninfectious problem may be suspected. The approach to the diagnosis must be guided by the entire clinical picture. Computed tomography, fiberoptic bronchoscopy, and needle aspiration are useful diagnostic tools, all depending on the specific symptoms and the location on chest roentgenogram. The role of magnetic resonance is yet to be determined. If no diagnosis can be determined, open lung biopsy may be indicated.

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Fein AM, Feinsilver St. H, Niederman MS, Fiel S, Pai PB. 'When the pneumonia doesn't get better'. Clinics in Chest Medicine. 1987 Dec 1;8(3):529-541.