Pneumonia
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ibma0007Pneumonia, Tb and
tumors of lung &
pleura
PNEUMONIA
• Pneumonia can be very broadly defined as any infection of the lung
parenchyma.
• It results whenever the local defense mechanisms are impaired or the
systemic resistance of the host is lowered.
Risk factors
• Advanced age
• History of smoking
• Upper respiratory tract infection
• Tracheal intubation
• Prolonged immobility
• Immunosuppressive therapy
• Non functional immune system
• Malnutrition and dehydration
• Chronic disease state
Pathophysiology
Offending organism/agent
Inflammatory pulmonary response
Loss of defence mechanisms of the lungs
Allow organisms to penetrate the sterile LRT
Develop inflammation
Disruption of the mechanical
defences(cough and ciliary motility)
Colonization of the lungs
Inflamed and fluid-filled alveolar sacs
Alveolar exudates tends to consolidate
Difficult to expectorate
Morphology
• Bacterial pneumonia has two
patterns of anatomic
distribution:
lobular bronchopneumonia and
lobar pneumonia.
• Patchy consolidation of the lung
is the dominant characteristic of
bronchopneumonia, while
consolidation of a large portion
of a lobe or of an entire lobe
defines lobar pneumonia.
Bronchopneumonia
• Shows consolidated areas of acute suppurative inflammation.
• May involve one lobe but more often multilobar.
• Frequently bilateral and basal because of the tendency of secretions
to gravitate to the lower lobes.
• Well-developed lesions are: slightly elevated, dry, to the pleural cavity,
causing an intrapleural fibrinosuppurative reaction known as
empyema; and bacteremic dissemination to the heart valves,
pericardium, brain, kidneys, spleen, or joints, causing abscesses,
endocarditis, meningitis, or suppurative arthritis.
Lobar pneumonia
4 stages of the inflammatory response-
I.Congestion: the lung is heavy, boggy, and red. It is
characterized by vascular engorgement, intra-
alveolar edema fluid containing a few neutrophils,
and the presence of bacteria, which may be
numerous.
II. Red hepatization: there is massive confluent
exudation, as neutrophils, red cells, and fibrin fill the
alveolar spaces. On gross examination, the lobe is
red, firm, and airless, with a liver-like consistency,
hence the name hepatization.
III. Grey hepatization: marked by progressive
disintegration of red cells and the persistence of a
fibrinosuppurative exudate resulting in a color
change to grayish-brown.
IV. Resolution: the exudate within the alveolar
spaces is broken down by enzymatic digestion to
produce granular, semifluid debris that is resorbed, Stages of bacterial pneumonia. (A) Acute pneumonia. The congested septal
ingested by macrophages, expectorated, or capillaries and numerous intra-alveolar neutrophils are characteristic of early red
hepatization. Fibrin nets have not yet formed. (B) Early organization of intra-alveolar
organized by fibroblasts growing into it. exudate, seen focally to be streaming through the pores of Kohn (arrow). (C)
Advanced organizing pneumonia. The exudates have been converted to fibromyxoid
masses rich in macrophages and fibroblasts.
Bronchopneumonia. Section of lung showing Lobar pneumonia—gray hepatization. The
patches of consolidation (arrows). lower lobe is uniformly consolidated.
Signs and symptoms
Diagnostic evaluation
• Chest auscultation- rhonchi, rales, whispering pectoriloquy
• Sputum culture analysis and sensitivity
• Fiber optic bronchoscopy/Transcutaneous needle aspiration or biopsy
• Blood and urine cultures
• ABG measurements
• Chest X-ray examination.
Treatment
