Study of Role of Fibreoptic Bronchoscopy to Determine the Aetiology of Non-resolving Pneumonia

Background and Aims: Non-resolving pneumonia (NRP) refers to pneumonia that resolves slowly or incompletely despite appropriate treatment in populations with delayed or disproportionate initiation of therapy, NRP can lead to drug resistance, increased morbidity and ultimately mortality. While the majority of patients respond well to initial antimicrobial therapy, a subset exhibits poor response, resulting in NRP or death. The objective of this study was to identify the underlying causes of NRP by utilising fiberoptic bronchoscopy (FOB) as a diagnostic method. Materials and Methods: This prospective study was conducted in the Department of Pulmonary Medicine at Andhra Medical College, Visakhapatnam and included 50 patients diagnosed with NRP. All patients underwent FOB, during which clinical, radiological and bronchoscopic findings were recorded. Diagnostic techniques such as bronchoalveolar lavage (BAL), brush cytology and transbronchial lung biopsy (TBLB) were employed. Results: A definitive diagnosis was achieved in 94% ( n = 47) of the patients, with most being males over the age of 50. The right lower lobe was most commonly affected. Gross bronchoscopic examination revealed inflamed mucosa with mucopurulent discharge in a large number of cases. Infectious causes accounted for 50% (n-25) of cases, with Gram-negative bacterial infections being most common (32%), followed by tuberculosis (14%) and fungal infections such as mucormycosis (4%). Pseudomonas was the predominant bacterial pathogen, followed by Klebsiella. Malignancies constituted 28% ( n = 14) of cases, with adenocarcinoma being the predominant histological subtype, followed by squamous cell carcinoma. Malignancy was identified in 14%of cases by BAL cytology and in 14% by brush cytology. TBLB was able to diagnose the aetiology in 8,461% (22 out of 28) of the cases where it was performed. Conclusion: Fibreoptic bronchoscopy is a safe and valuable diagnostic tool in the evaluation of NRP, offering high diagnostic yield, especially in detecting infections and malignancies.