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Treatment of Difficult Lung Infections

written by: AngelicaMD • edited by: lrohner • updated: 12/18/2010

A number of lung infections that are difficult to get rid of do not respond readily to usual treatment with antibiotics. They can be chronic or recurrent despite treatment and cost a lot in health care. Learn what these difficult lung infections are and what treatment options are available.

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    The lungs are the organs of respiration where thousands of liters of gases are exchanged everyday to deliver oxygen to the body and eliminate carbon dioxide. In this process, many dust particles, pollen, bacteria, viruses, fungi and other materials may be inhaled. Fortunately for most healthy people, the body’s inherent self-defense mechanisms can fight off infections through its filtering and immune systems. However, many factors can cause a breakdown in these defenses and allow an individual to be susceptible to infections. Some of these factors are old age, poor general health, chronic use of antibiotics, immune deficiency states like AIDS, cancer, and others. Using certain drugs to suppress the immune system like steroids and chemotherapy can also decrease one’s defenses against infections.

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    Difficult Lung Infections

    Many lung diseases caused by bacterial and viral infections respond to antibiotics and antivirals. However, there are infections that are a number of lung infections that are difficult to get rid of, which may be because of the nature of the infecting agent itself, or may be influenced by other patient factors such as poor health and immune deficiency.

    Pulmonary tuberculosis is a type of lung infection that is sometimes not easy to diagnose because it develops slowly and can mimic other diseases. When diagnosed treatment usually consists of several antibiotics and needs several months to resolve. These drugs include isoniazid, rifampin, pyrazinamide, and ethambutol. Patients usually respond to initial treatment, but once they feel better, they stop taking the drugs and the infection recurs. For this reason patients are usually treated in health centers where the drugs are regularly dispensed and patients’ conditions are monitored.

    Fungal lung infections are often slow to develop but may be aggressive when one’s immunity is compromised, such as in AIDS patients. They are often difficult to diagnose and may need several months to treat. Common fungal infections are histoplasmosis and coccidioidomycosis, while less common are blastomycosis and paracoccidioidomycosis. Treatment consists of oral or intravenous drugs such as Amphotericin B, Anidulafungin, and Ketoconazole.

    Immune deficiency syndromes like HIV infections can affect the lungs and allow bacterial, viral and fungal and other opportunistic infections to develop. Acquired immunodeficiency syndrome (AIDS) is the worst HIV form of infection, and the lungs, which are exposed to all elements in the air are easily affected. Because of the nature of the disease, lung infections associated with this syndrome are difficult to treat. Therefore these patients are often given drugs to prevent the infections. For bacteria, they are given trimethoprim-sulfamethoxazole, pentamidine or dapsone. Azithromycin, clarithromycin or rifabutin may be given for fungal infections. Children with recurring infections may be given immune globulin injections to increase their immune defense.

    Hyperimmunoglobulinemia E syndrome or Buckley syndrome is a hereditary immunodeficiency disorder where recurring infections with staphylococcal bacteria can affect the skin, joints and lungs. The disorder starts at infancy and antibiotics like dicloxacillin or cephalexin are given continuously to prevent infections. Lifespan of these children depends on the severity of lung infections.

    Lung infections caused by parasites are uncommon and therefore difficult to diagnose and treat. Some of these are visceral larva migrans caused by toxocara, psittacosis (from birds) and paragonimiasis. Infection results in pneumonia, and if severe, hospitalization and intravenous antibiotic therapy are required.

    Legionnaires' disease is a disease caused by Legionella bacteria that can cause pneumonia, many in patients confined in a hospital. It can be severe and fatal. Drug therapy consists of antibiotics like fluoroquinolones, erythromycin or azythromycin. Treatment may be difficult in immunocompromised patients, and as much as 20 percent of these patients may succumb to the disease.

    Repeated lung infections can lead to a condition called bronchiectasis, where the airways are widened and lung tissues are destroyed. Its treatment consists of proper antibiotic treatment, bronchodilators, respiratory and physical therapy. To prevent recurring lung infections, immune globulins and vaccinations may be given to susceptible patients. For those with severe bronchiectasis and no medical treatment is effective, lung transplantation is an option.

    Treatment of difficult lung infections are dependent on proper and accurate diagnosis, management of the patient’s general health condition and patient cooperation. Many of these are amenable to treatment but may incur a lot of cost because of the chronicity of the problem.


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