Evaluation of Non-Resolving and Progressive Pneumonia

  • R. Menéndez
  • A. Torres


The concepts of non-resolving and progressive pneumonia are difficult to define and have led to various reports that have been modified over time. In both cases, these concepts refer to a bad therapeutic response of pneumonia and, in the case of progressive pneumonia, may cause a medical emergency with vital implications for the patient requiring very rapid changes in diagnostic and therapeutic attitude.


Idiopathic Pulmonary Fibrosis Respir Crit Nosocomial Pneumonia Bronchiolitis Obliterans Eosinophilic Pneumonia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kuru T, Lynch JP 3rd (1999) Nonresolving or slowly resolving pneumonia. Clin Chest Med 20: 623–651PubMedCrossRefGoogle Scholar
  2. 2.
    Kirtland SH, Winterbauer RH (1991) Slowly resolving, chronic, and recurrent pneumonia. Clin Chest Med 12: 303–318PubMedGoogle Scholar
  3. 3.
    Niederman MS, Mandell LA, Anzueto A, et al (2001) Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 163: 1730–1754Google Scholar
  4. 4.
    Ortqvist A, Kalin M, Lejdeborn L, Lundberg B (1990) Diagnostic fiberoptic bronchoscopy and protected brush culture in patients with community-acquired pneumonia. Chest 97: 576–582PubMedCrossRefGoogle Scholar
  5. 5.
    Arancibia F, Ewig S, Martinez JA, et al (2000) Antimicrobial treatment failures in patients with community-acquired pneumonia: causes and prognostic implications. Am J Respir Crit Care Med 162: 154–160PubMedCrossRefGoogle Scholar
  6. 6.
    Ruiz M, Ewig S, Marcos MA, et al (1999) Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. Am J Respir Grit Care Med 160: 397–405CrossRefGoogle Scholar
  7. 7.
    Alvarez-Lerma F (1996) Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit. ICU-Acquired Pneumonia Study Group. Intensive Care Med 22: 387–394PubMedCrossRefGoogle Scholar
  8. 8.
    Crouch Brewer S, Wunderink RG, Jones CB, et al (1996) Ventilator-associated pneumonia due to Pseudomonas aeruginosa. Chest 109: 1019–1029CrossRefGoogle Scholar
  9. 9.
    Pereira Gomes JC, Pedreira WL Jr, Araujo EM, et al (2000) Impact of BAL in the management of pneumonia with treatment failure: positivity of BAL culture under antibiotic therapy. Chest 118: 1739–1746CrossRefGoogle Scholar
  10. 10.
    Fein AM, Feinsilver SH, Niederman MS (1993) Nonresolving and slowly resolving pneumonia. Diagnosis and management in the elderly patient. Clin Chest Med 14: 555–569Google Scholar
  11. 11.
    Johnson JL (2000) Slowly resolving and nonresolving pneumonia. Questions to ask when response is delayed. Postgrad Med 108: 115–122PubMedCrossRefGoogle Scholar
  12. 12.
    Fine MJ, Auble TE, Yealy DM, et al (1997) A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 336: 243–250PubMedCrossRefGoogle Scholar
  13. 13.
    Halm EA, Fine MJ, Marrie TJ, et al (1998) Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines. JAMA 279: 1452–1457PubMedCrossRefGoogle Scholar
  14. 14.
    Mittl RL Jr, Schwab RJ, Duchin JS, Goin JE, Albeida SM, Miller WT (1994) Radiographic resolution of community-acquired pneumonia. Am J Respir Crit Care Med 149: 630–635PubMedCrossRefGoogle Scholar
  15. 15.
    Nelson S (2001) Novel nonantibiotic therapies for pneumonia: cytokines and host defense. Chest 119: 419S - 425SPubMedCrossRefGoogle Scholar
  16. 16.
    Skerrett SJ, Park DR (2001) Anti-inflammatory treatment of acute and chronic pneumonia. Semin Respir Infect 16: 76–84PubMedCrossRefGoogle Scholar
  17. 17.
    Bonten MJ, Froon AH, Gaillard CA, et al (1997) The systemic inflammatory response in the development of ventilator-associated pneumonia. Am J Respir Crit Care Med 156: 11051113Google Scholar
  18. 18.
    Monton C, Torres A, EI-Ebiary M, Fillela X, Xaubet A, de la Bellacasa JP (1999) Cytokine expression in severe pneumonia: a bronchoalveolar lavage study. Crit Care Med 27: 17451753Google Scholar
  19. 19.
    Monton C, Ewig S, Torres A, et al (1999) Role of glucocorticoids on inflammatory response in nonimmunosuppressed patients with pneumonia: a pilot study. Eur Respir J 14: 218–220PubMedCrossRefGoogle Scholar
  20. 20.
    Domingo C, Roig J, Planas F, Bechini J, Tenesa M, Morera J (1991) Radiographic appearance of nosocomial legionnaires’ disease after erythromycin treatment. Thorax 46: 663–666PubMedCrossRefGoogle Scholar
  21. 21.
    Muder RR, Yu VL, Parry MF (1987) The radiologic manifestations of Legionella pneumonia. Semin Respir Infect 2: 242–254PubMedGoogle Scholar
  22. 22.
    Kim CK, Chung CY, Kim JS, Kim WS, Park Y, Koh YY (2000) Late abnormal findings on high-resolution computed tomography after Mycoplasma pneumonia. Pediatrics 105: 372378Google Scholar
  23. 23.
    Kauppinen MT, Saikku P, Kujala P, Herva E, Syrjala H (1996) Clinical picture of community-acquired Chlamydia pneumoniae pneumonia requiring hospital treatment: a comparison between chlamydial and pneumococcal pneumonia. Thorax 51: 185–189PubMedCrossRefGoogle Scholar
  24. 24.
    Lieberman D, Livnat S, Schlaeffer F, Porath A, Horowitz S, Levy R (1997) IL-lbeta and IL-6 in community-acquired pneumonia: bacteremic pneumococcal pneumonia versus Mycoplasma pneumoniae pneumonia. Infection 25: 90–94PubMedCrossRefGoogle Scholar
  25. 25.
    Meduri GU, Kanangat S, Stefan J, et al (1999) Cytokines IL-lbeta, IL-6, and TNF-alpha enhance in vitro growth of bacteria. Am J Respir Crit Care Med 160: 961–967PubMedCrossRefGoogle Scholar
  26. 26.
    Chen DK, McGeer A, de Azavedo JC, Low DE (1999) Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. Canadian Bacterial Surveillance Network. N Engl J Med 341: 233–239Google Scholar
  27. 27.
    Ferrer M, Ioanas M, Torres A (2001) The evaluation of the non-responding patients with ventilator-associated pneumonia. Clin Pulm Med 8: 290–295CrossRefGoogle Scholar
  28. 28.
    Menéndez R, Cordero PJ, Santos M, Gobernado M, Marco V (1997) Pulmonary infection with Nocardia species: a report of 10 cases and review. Eur Respir J 10: 1542–1546PubMedCrossRefGoogle Scholar
  29. 29.
    Feinsilver SH, Fein AM, Niederman MS, Schultz DE, Faegenburg DH (1990) Utility of fiber-optic bronchoscopy in nonresolving pneumonia. Chest 98: 1322–1326PubMedCrossRefGoogle Scholar
  30. 30.
    Menéndez R, Cordoba J, de la Cuadra P, et al (1999) Value of the polymerase chain reaction assay in noninvasive respiratory samples for diagnosis of community-acquired pneumonia. Am J Respir Crit Care Med 159: 1868–1873PubMedCrossRefGoogle Scholar
  31. 31.
    Mares DC, Wilkes DS (1998) Bronchoscopy in the diagnosis of respiratory infections. Curr Opin Pulm Med 4: 123–129PubMedGoogle Scholar
  32. 32.
    De Lassence A, Fleury-Feith J, Escudier E, et al (1995) Alveolar hemorrhage. Diagnostic criteria and results in 194 immunocompromised hosts. Am J Respir Crit Care Med 151: 157–163PubMedCrossRefGoogle Scholar
  33. 33.
    Fujimura M, Yasui M, Nishi K, et al (1999) Comparison of bronchoalveolar lavage cell findings in complete-resolution pneumonia and delayed-resolution pneumonia. Am J Med Sci 317: 222–225PubMedCrossRefGoogle Scholar
  34. 34.
    Jacobs JA, De Brauwer EI, Ramsay G, et al (1999) Detection of non-infectious conditions mimicking pneumonia in the intensive care setting: usefulness of bronchoalveolar fluid cytology. Respir Med 93: 571–578PubMedCrossRefGoogle Scholar
  35. 35.
    Luna CM, Vujacich P, Niederman MS, et al (1997) Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest 111: 676–685PubMedCrossRefGoogle Scholar
  36. 36.
    Niederman MS (2000) Bronchoscopy in nonresolving nosocomial pneumonia. Chest 117: 212S - 2185PubMedCrossRefGoogle Scholar
  37. 37.
    Franquet T (2001) Imaging of pneumonia: trends and algorithms. Eur Respir J 18: 196–208PubMedCrossRefGoogle Scholar
  38. 38.
    Tomiyama N, Muller NL, Johkoh T, et al (2000) Acute parenchymal lung disease in immunocompetent patients: diagnostic accuracy of high-resolution CT. Am J Roentgenol 174: 1745–1750CrossRefGoogle Scholar
  39. 39.
    Dunn IJ, Marrie TJ, MacKeen AD, Bhan V, Janigan DT (1994) The value of open lung biopsy in immunocompetent patients with community-acquired pneumonia requiring hospitalization. Chest 106: 23–27PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • R. Menéndez
  • A. Torres

There are no affiliations available

Personalised recommendations