Surapaneni Vineela, Alla Bhagyaraj, Yelkoti Sushma Laxmi, Rachakonda Ramakrishna, Talatam Aruna
BACKGROUND Slow resolution of pneumonia despite treatment is a common clinical problem. Delay in diagnosis results in increased morbidity. We wanted to establish the aetiology, assess the associated risk factors and study the role of fiberoptic bronchoscopy and CTguided biopsy. METHODS This is a prospective observational study where in 50 patients presenting with an initial diagnosis of pneumonia, who had persistent symptoms and showed less than 50% clearance of chest radiograph at 2 weeks and less than complete clearance at four weeks despite appropriate antibiotic therapy for 10 days were included. All the patients were investigated thoroughly. CTguided biopsy and fiberoptic bronchoscopy were done in selected cases. Obtained results were analyzed. RESULTS Mean age was 53.4 years. Male:female ratio= 1.8:1. Most common aetiology was due to infection seen in 31 (62%) patients. Common organisms isolated were Mycobacterium tuberculosis 18 (58%), fungi 5 (16%), organisms resistant to empirical antibiotic therapy 4 (13%), mixed pathogens 2 (6.5%), non-tuberculous mycobacteria (6.5%). The next common cause observed was malignancy, seen in 12 patients (24%). Adenocarcinoma (67%) was the most common histological type followed by squamous cell carcinoma (25%) and atypical adenomatous hyperplasia (8%). Other causes were cryptogenic organizing pneumonia, pulmonary sequestration and aspirated foreign body. Aetiology was unknown in 2 cases. Diabetes was the most common risk factor among the study group. CONCLUSIONS A thorough evaluation with timely utilization of the available investigations helps us in proper management of non-resolving pneumonias
