Non-resolving pneumonia
From IDWiki
Differential Diagnosis
Common Causes
Infectious Causes
- Undertreated bacterial pneumonia
- Streptococcus pneumoniae
- Legionella (legionellosis)
- Mycoplasma pneumoniae, though rarely causes severe disease
- Chlamydia pneumoniae
- Haemophilus influenzae
- Resistant forms of usual infectious causes
- Unusual bacteria: Mycobacterium tuberculosis, non-tuberculous mycobacteria, Nocardia, Actinomyces
- Fungi: Blastomyces, Histoplasma, Coccidioides
- Lung abscess
Non-Infectious Causes
- Acute or chronic eosinophilic pneumonia
- Sarcoidosis
- Hypersensitivity pneumonitis
- Cryptogenic organizing pneumonia
- Allergic bronchopulmonary aspergillosis
- Granulomatosis with polyangiitis
- Eosinophilic grenulomatosis with polyangiitis
- Drug-induced pneumonitis
- Pulmonary hemorrhage
- Endogenous or exogenous lipoid pneumonia
- Malignancy
Unusual or Resistant Infections
| Organism | Clinical Clues |
|---|---|
| Mycobacterium tuberculosis (tuberculosis) | older age, residence in endemic country, HIV |
| Non-tuberculous mycobacteria | COPD, HIV |
| Nocardia (nocardiosis) | immunocompromised host |
| Actinomyces (actinomycosis) | aspiration, chest wall involvement |
| Aspergillus (aspergillosis) | immunocompromised host, vascular invasion |
| Histoplasma capsulatum (histoplasmosis) | exposure to Mississippi River Valley |
| Coccidioides immitis (Coccidiomycosis) | exposure to southwestern US |
| Blastomyces dermatitidis (blastomycosis) | exposure to southeast and midwest US |
| Coxiella burnetii (Q fever) | exposure to sheep, cattle, or cats |
| Francisella tularensis (tularemia) | exposure to rabbits or ticks |
| Chlamydia psittaci (psittacosis) | exposure to birds |
| Yersinia pestis (plague) | exposure to rats |
| Leptospira (leptospirosis) | exposure to rats or urine-contaminated water |
| Burkholderia pseudomallei (melioidosis) | rodent exposure in Southeast Asia, similar presentation to TB |
| Paragonimus westermani (paragonimiasis) | travel to Asia, Africa, or Central and South America |
| Hantavirus | mouse exposure in southwestern US |
| Bacillus anthracis (anthrax) | contact with infected animal carcasses or hides, and more common in Asia, Iran, Turkey, Greece, and South Africa |
Non-Infectious Causes
| Disease | Clinical Clues |
|---|---|
| Neoplastic Disorders | |
| Bronchogenic carcinoma | |
| Lymphoma | |
| Immunologic Disorders | |
| Granulomatosis with polyangiitis | |
| Diffuse alveolar hemorrhage | |
| Cryptogenic organising pneumonia | |
| Acute eosinophilic pneumonia | |
| Chronic eosinophilic pneumonia | |
| Acute interstitial pneumonia | |
| Pulmonary alveolar proteinosis | |
| Sarcoidosis | |
| Rheumatic Diseases | |
| Systemic lupus erythematosus | |
| Rheumatoid arthritis | |
| Polymyositis | |
| Dermatomyositis | |
| Vascular Abnormalities | |
| Heart failure | |
| Pulmonary embolism | |
| Miscellaneous | |
| Drug toxicity | |
Investigations
- CT chest
- Consider bronchoalveolar lavage or biopsy
