PNEUMONIA

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PNEUMONIA

• BY
• DR.SOHEIR SAAD

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Pneumonia

• Pneumonia is a term which describes inflammation
  of the lung parenchyma characterised by exudation
  and consolidation into the alveoli.
• Pneumonia can occur in any individual who is
  seriously ill, both in adults and in children. It
  also occurs especially
• at the extremes of life - neonates, the elderly
• in patients with pre-existing lung disease -
  chronic bronchitis, bronchiectasis, fibrosis,
  carcinoma
• after abdominal operations
• in the compromised host, including patients with
  AIDS

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Pulmonary Defence Mechanism

• pneumonia can result whenever these defense
  mechanisms are impaired or whenever the
  resistance of the host in general is lowered.
• Factors that affect resistance in general include
  chronic diseases, immunologic deficiency, and
  treatment with immunosuppressive agents,
  leukopenia, and unusually virulent infections.
• The clearing mechanisms can be interfered with by
  many factors, such as the following

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• Loss or suppression of the cough reflex, as a
  result of coma, anesthesia, neuromuscular
  disorders, drugs, or chest pain.
• Injury to the mucociliary apparatus
• Interference with the phagocytic or bactericidal
  action of alveolar macrophages by alcohol,
  tobacco smoke, anoxia, or oxygen intoxication
• Pulmonary congestion and edema
• Accumulation of secretions in conditions such as
  cystic fibrosis and bronchial obstruction

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Pneumonia types

• Pneumonia is divided into six broad clinical
  syndromes
• 1-community acquired Acute pneumonia
• 2-community acquired Atypical pneumonia
• 3-hospital acquired pneumonia (Nosocomial)
• 4-aspiration pneumonia
• 5-Chronic pneumonia
• 6-Necrotizing Pneumonia and Lung Abscess

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Symptoms and signs

• Common symptoms and signs of pneumonia include
• cough
• fever
• pleuritic chest pain
• Features which indicate the severity of the
  pneumonia include
• confusion
• respiratory distress
• cyanosis

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The classical physical signs of pneumonic lung
consolidation are reduced percussion note
bronchial breathing crackles whispering
pectoriloquy pleural friction rub Septicaemia
should be suspected if the patient is cold,
clammy and hypotensive. Sputum production may not
be a feature in the acute phase
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Community acquired pneumonia

• -Community acquired pneumonia is a common disease
  with a reducing incidence. It usually occurs in
  children or the elderly, or in people with an
  underlying pathology.
• -This type of pneumonia is often a complication
  of viral respiratory disease such as influenza.
• It is particularly common in winter in countries
  with temperate climates.

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Eighty percent of community acquired pneumonia is
pneumococcal pneumonia. Other causes of
community acquired pneumonias include haemophilus
influenzae, staphylococcal aureus, atypical
pneumonias (e.g. due to mycoplasma pneumoniae),
mycobacterium tuberculosis, and viruses.
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Lobar Pneumonia-Pathogenesis

• In lobar pneumonia, four stages of the
  inflammatory response have classically been
  described
• 1.congestion,
• 2.red hepatization,
• 3.gray hepatization, and
• 4 resolution.

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Lobar pneumonia-gray hepatization, gross
photograph. The lower lobe is uniformly
consolidated.
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A closer view of the lobar pneumonia demonstrates
the distinct difference between the upper lobe
and the consolidated lower lobe.
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This is a lobar pneumonia in which consolidation
of the entire left upper lobe has occurred.
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Patchy area of alveoli that are filled with
inflammatory cells
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(lobular pneumonia) is characterized by patchy
areas of pulmonary consolidation.
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A bronchopneumonia is classically a "hospital
acquired" pneumonia seen in persons already ill
from another disease process. Typical bacterial
organisms include Staphylococcus aureus,
Klebsiella, E. coli, and Pseudomonas.
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LOBAR
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OTHER TYPE OF PNUOMONIA
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Hospital acquired pneumonia (Nosocomial)

• -Gram-negative rods belonging to
  Enterobacteriaceae
• (Klebsiella., Serratia marcescens, Escherichia
  coli) and pseudomnas
• -Staphylococcus aureus
• (usually penicillin-resistant)

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Aspiration pneumonia

• -Anaerobic oral flora (Bacteroides, Prevotella,
  Fusobacterium, Peptostreptococcus),
• admixed with aerobic bacteria like
  (Streptococcus pneumoniae, Staphylococcus aureus,
  Haemophilas influenzae, and Pseudomonas
  aeruginosa

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Aspiration pneumonia is a lung infection
resulting from the aspiration of organisms into
the lower respiratory tract. This contrasts with
inhalation pneumonia which refers to the
consequences of inhaling non-infected particulate
matter, fluids and irritant gases.
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The usual site for an aspiration pneumonia is the
right lung. Aspirated material will enter the
lower lobes when the patient is standing. If the
patient is supine then the aspirated material
will enter the apical segment of the lower lobes
or the posterior segment of the upper lobes
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There is a localized foreign body giant cell
response to the aspirated material seen here at
high magnification. Aspirated material may also
produce inflammation from chemical irritation, as
with gastric contents.
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Chronic pneumonia

• Nocardia
• Actinomyces
• Granulomatous Mycobacterium tuberculosis and
  atypical mycobacteria,
• Histoplasma capsulatum,
• Coccidioides immitis,
• Blastomyces dermatitidis

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Necrotizing Pneumonia and Lung Abscess

• Anaerobic bacteria (extremely common), with or
  without mixed aerobic infection
• Staphylococcus aureus,
• Klebsiella pneumoniae,
• Streptococcus pyogenes,
• and type 3 pneumococcus (uncommon)

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An abscess is a complication of severe pneumonia,
most typically from virulent organisms such as
Staphylococcus aureus. Abscesses are often
complications of aspiration, where they appear
more frequently in the right posterior lung.
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Web path

• 1,2,3.4 for you as a histology of lung
• ----------------------------------------------
• Chronic Obstructive lung disease (60, 61 .63,
  67 ,68, 71, 72)
• 60 bronchial asthma
• 61 high bower of bronhial asthma with
  bredominanat esophilia
• 63 chronic permenant dilataion of bronchi
  (bronchaitesis)
• 67 emphyzimaitis bullae ?????? (emphyzima)
• 68
  (emphyzima)
• 71 pan lubelar emphyzima due to defitiensi of
  alpha one
• 71 spure thin distruction of alvioli wiz spure
• dr.sohair 59

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Web path

• Restrictive lung disease (114,120,125.126,127,
  133)
• 114 ???? ????? ???????????
• 120 ansrachosis 3amla fibrosis
• 125 lung hyper sensitivity pneumonitis
• 126 high power
• 127 Example of lung fibrosisi ??? ????? ?? ?????
  
• TB(36 39 40 41 42 43 44 )

????? ?? 127 ? 133
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Web path

• TB(36 39 40 41 42 43 44 )
• 36 secondary tb chronic fibro pulmonary Tb
• 39suppelura bons focus (primary complex) wtith
  hilar lymph node
• 40 tubericlr in lung alvioli (primary without
  caziation)
• 41 graniulomtus lung show multiple tubericle
• 42 lung hanz gint cell og graneulomma of TB
• 43 zell neelssen (rood of mucrumbacterum
  sorrunded by
• 3 layer lipd protein carbohydrate)