NONRESOLVING OR SLOWLY RESOLVING PNEUMONIA - 08/09/11
Résumé |
Physicians are often confronted with the dilemma of nonresolving or slowly resolving pulmonary infiltrates in patients receiving antibiotics for suspected community-acquired pneumonia (CAP). Nonresolution or slow resolution of pneumonia may reflect inadequate antibiotic therapy, resistant or highly virulent organisms, impaired host defenses, nonbacterial causes, obstructing endobronchial lesions (including neoplasms), and a host of noninfectious causes. When should these alternative causes be considered in patients with nonresolving or slowly resolving infiltrates? How long should one wait before embarking on a costly investigation to evaluate reasons for nonresolution? What is the normal or expected rate of resolution for pneumonia? What is the “safe” time interval for expectant observation? These decisions should be guided by the natural history of pneumonias (with knowledge of specific pathogens) and various host factors. Although a staggering array of diseases and clinical syndromes can masquerade as CAP, 43, 85, 151, 194 these are far outnumbered by true cases of pneumonia. In this article the authors discuss the patterns of radiographic resolution for CAP and host factors that influence natural history. They also review diverse noninfectious disorders that can mimic CAP, and present an approach to diagnosis and treatment.
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| Address reprint requests to Joseph P. Lynch, III, MD, Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, 3916 Taubman Center, Box 0360, Ann Arbor, MI 48109-0360 Supported in part by National Institutes of Health Grant 1P50HL46487. |
Vol 20 - N° 3
P. 623-651 - septembre 1999 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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