Non-resolving pneumonia: Difference between revisions
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=== Common Causes === |
=== Common Causes === |
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+ | ==== Infectious Causes ==== |
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+ | * Undertreated bacterial pneumonia |
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− | * |
+ | **[[Streptococcus pneumoniae]] |
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− | * [[Chlamydia pneumoniae]] |
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+ | ** [[Mycoplasma pneumoniae]], though rarely causes severe disease |
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+ | *Unusual bacteria: [[Mycobacterium tuberculosis]], [[non-tuberculous mycobacteria]], [[Nocardia]], [[Actinomyces]] |
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+ | *Fungi: [[Blastomyces]], [[Histoplasma]], [[Coccidioides]] |
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+ | *[[Lung abscess]] |
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+ | ==== Non-Infectious Causes ==== |
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+ | * Acute or chronic [[eosinophilic pneumonia]] |
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+ | * [[Sarcoidosis]] |
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+ | * [[Hypersensitivity pneumonitis]] |
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+ | * [[Cryptogenic organizing pneumonia]] |
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+ | * [[Allergic bronchopulmonary aspergillosis]] |
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+ | * [[Granulomatosis with polyangiitis]] |
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+ | * [[Eosinophilic grenulomatosis with polyangiitis]] |
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+ | * [[Drug-induced pneumonitis]] |
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+ | * [[Pulmonary hemorrhage]] |
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+ | * [[Endogenous lipoid pneumonia|Endogenous]] or [[exogenous lipoid pneumonia]] |
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+ | * Malignancy |
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+ | ** [[Lymphoma]] |
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+ | ** [[Bronchogenic carcinoma]] |
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=== Unusual or Resistant Infections === |
=== Unusual or Resistant Infections === |
Latest revision as of 07:55, 1 February 2022
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