Pathology of Pneumonia
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1 Pathology of Pneumonia Dr. Atif Ali Bashir Assistant Professor of Pathology College of Medicine Majma ah University Introduction: 5000 sq meters of area.! (olympic track) Filters >10,000 L of air / day! Normal lungs are sterile. Delicate, thin resp. mem gas exch. Filter, humidify, sterilize, highly sensitive.
2 RTI Resp. tract inf. commonest in medical practice. Enormous morbidity & mortality. Pneumonia inflammation of alveoli. Normal Lung Normal Lung Etiology: Decreased resistance - General/immune Virulent infection - Lobar pneumonia Defective Clearing mechanism Cough/gag Reflex Coma, paralysis, sick.
3 Mucosal Injury smoking, toxin aspiration Low Alveolar defense - Immunodeficiency Pulmonary edema Cardiac failure, embol. Obstructions foreign body, tumors Patterns of Lung disorders: Airway Bronchitis, Bronchiectasis, Bronchiolitis. Tumors / Cancer Parenchyma Pneumonia. Lung abscess, TB Hyaline membrane dis (HMD & ARDS)
4 Pneumoconiosis Tumors / Cancer Pleura: Pleural effusion (TB) Tumors / Cancer Pathogenesis of Pulmonary Infections Step 1: Entry Aspiration (ie Pneumococcus) Inhalation (ie Mtb and viral pathogens) Inoculation (contaminated equipment)
5 Colonization (in patients with COPD) Hematogenous spread (patients with sepsis) Direct spread (adjacent abscess) Pathogenesis: Pathogenesis: Pneumonia Types: Etiologic Types: Infective Viral Bacterial Fungal
6 Tuberculosis Non Infective Toxins chemical Aspiration Morphologic types: Lobar Broncho Interstitial Duration: Acute Chronic Clinical:
7 Primary / secondary. Typical / Atypical Community a / hospital a Lobar Pneumonia: whole lobe, exudation - consolidation 95% - Strep pneum.(klebsiella in aged, DM, alcoholics) High fever, rusty sputum, Pleuritic chest pain. Four stages: (*also in bronchopneumonia)
8 Congestion 1d vasodilatation congestion. Red Hepatization 2d Exudation+RBC Gray Hepatizaiton 4d neutro & Macrophages. Resolution 8d few macrophages, normal.
9 Pathogenesis of Pneumonia Lobar Pneumonia: Lobar Pneumonia: Lobar Pneumonia Gray hep Lobar Pneumonia: Lobar Pneumonia: Congestion
10 Lobar Pneumonia: Red hepat. Lobar Pneumonia: Grey hepat. Broncho-pneumonia Bronchopneumonia (patchy) Extremes of age. (infancy and old age) Staph, Strep, Pneumo & H. influenza
11 Patchy consolidation not limited to lobes. Suppurative inflammation Usually bilateral Lower lobes common Broncho-pneumonia Broncho-pneumonia Bronchopneumonia: Bronchopneumonia - CT Bronchopneumonia
12 Broncho Pneumonia - Lobar Extremes of age. Secondary. Both genders. Staph, Strep, H.infl. Patchy consolidation Around Small airway Not limited by anatomic boundaries. Usually bilateral. Middle age 20-50
13 Primary in a healthy males common. 95% pneumoc (Klebs.) Entire lobe consolidation Diffuse Limited by anatomic boundaries. Usually unilateral Broncho Pneumonia - Lobar
14 Interstitial / atypical Pneumonia Primary atypical pneumonia in the immunocompetant host (Mycoplasma or Chlamydia) Interstitial pneumonitis immunocompromised host : Pneumocystic carinii; CMV Immunocompetant host: Influenza A Gross features: Lungs are heavy but not firmly consolidated Microscopic features: Septal mononuclear infiltrate Alveolar air spaces either empty or filled with proteinaceous fluid with few or no inflammatory cells
15 Interstitial Pneumonia: Chronic Pneumonia Chronic, lymphoid infiltrate, No classic stages. Lung destruction cavity, abscess etc. Organisms Mycobacterium tuberculosis
16 Histoplasma capsulatum Aspergillosis Actinomyces Comm Pneumonia - Nosoc In healthy adults Gram positive. Streptococcus pneumoniae (90%) Strep. Pyogenes, Staph, H. influenzae
17 and Klebsiella in elderly or with COPD. In *sick patients. gram-negative bacilli Pseudomonas aeruginosa, Escherichia coli, Enterobacter, Proteus, and Klebsiella.
18 Pathogenesis of Clinical features: *Alveolar inflammation. Tachypnoea, Dyspnoea, Resp Acidosis Solid/airless lungs decreased oxygenation.
19 Dull percussion - Consolidation Exudation Rusty sputum - RBC & Inflammatory cells. Fever Inflammatory mediators. Complications of Pneumonia Abscesses Localized suppurative
20 necrosis, Right side often in aspiration. Staphylococcus; Klebsiella; Pneudomonas Pleuritis / Pleural effusion. Inflammation of the pleura ( Streptococcus pneumoniae)
21 Blood rich exudate (esp. rickettsial diseases) Empyema Pus in the pleural space. Septicemia Abscess formation Lung Abscess: Abscess formation Lung Abscess:
22 Lung Fungal Abscess: Candida
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