PNEUMONIA
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Transcript of PNEUMONIA
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PNEUMONIA & SUPPURATIVE LUNG DISEASES
Dr. Thin Thin Win @ SafiyaDepartment of Pathology, PPSP
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PNEUMONIA
Definition
Infection of the lung parenchyma(consolidation or hardening of lung parenchyma)
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Etiology
Result whenever pulmonary defense mechanism are impaired or resistance of host is loweredPulmonary defense mechanism –1. cough reflex2. mucociliary apparatus3. phagocytic alveolar macrophages
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Etiology
Caused by varieties of infectious agent such as bacteria, viruses, fungi, mycoplasma etc:…Mostly bacterial pneumonia -Pneumococci, Klebsiella pneumoniae, Staphylococci, Streptococci, H.influenzae, Pseudomonas aeruginosa
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Clearing mechanism can be interfered with many factors:
1. Loss or suppression of cough reflex -aspiration of gastric contents in coma, anesthesia, neuromuscular disorders, drugs, chest pain –aspiration pneumonia
2. Injury to mucociliary apparatus –cigarette smoking, inhalation of hot or corrosive gases, viral d/s, genetic disorders
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Clearing mechanism can be interfered with many factors:
3. Interfered phagocytic/ bactericidal action of alveolar macrophages –alcohol, smoking, anoxia, O2 intoxication
4. Pulmonary congestion & edema5. Accumulation of secretions – cystic
fibrosis & bronchial obstruction
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Bacterial Pneumonia(community acquired acute pneumonia)
2 gross patterns
Lobar pneumoniaLobular bronchopneumonia
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Lobar pneumonia
Consolidation of a large portion of a lobe or an entire lobe (whereas patchy consolidation in bronchopneumonia)
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Lobar pneumonia Bronchopneumonia
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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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Uniformly consolidated lower lobe in lobar pneumonia ( gray hepatization) – lower lobebecome airless, liver like texture, gray white
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4 stages of inflammatory response
CongestionRed hepatizationGray hepatizationResolution
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Stage of congestion
Lung – heavy, boggy, redVascular engorgementIntra-alveolar fluid with few neutrophils& often numerous bacteria
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Stage of red hepatization
Massive confluent exudation with red cells, neutrophils and fibrin filling the alveolar spacesGross – lobe appear distinctly red, firm & airless with liver-like consistency
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Stage of red hepatization
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Stages of gray hepatization
Progressive disintegration of red cells Persistence of fibrinosuppurativeexudatesGross – grayish brown, dry surface
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Stages of gray hepatization
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Stage of resolution
Consolidated exudates within alveolar spaces undergoes progressive enzymatic digestion to produce a granular, semi fluid debris Resorbed & ingested by macrophages, coughed up or organized by fibroblasts growing into it
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Stage of resolution
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Bronchopneumonia
Patchy consolidation of lung May be one lobe or multilobarFrequently bilateral & basal
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Gross
3 to 4 cm in diameterSlightly elevated, dry, granular, gray-red to yellow Poorly delimited at margin
Histology Suppurative, neutrophil-rich exudates that fills bronchi, bronchioles and adjacent alveolar spaces
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At higher magnification, the pattern of patchy distribution of a bronchopneumonia is seen.
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Bronchopneumonia
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Viral and Mycoplasmal Pneumonia(Community acquired atypical pneumonia)
Morphology
Patchy or whole lobe Bilateral or unilateralRed-blue, congested & subcrepitantPleuritis or pleural effusion is infrequent
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Viral and Mycoplasmal Pneumonia(Community acquired atypical pneumonia)
HistologyInflammatory reaction in interstitial tissue, virtually within the walls of alveoliAlveolar septa – widened, edematousMononuclear infiltrates of L, H, P & N in acute casesAlveoli – free of exudatesPink hyaline membrane in alveolar walls
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Complication of pneumonia
1. Abscess formation- due to tissue destruction & necrosis
2. Empyema- spread of infection to pleura cavity causing intra-pleural fibrinosuppurativereaction
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Complication of pneumonia
3. Organization of exudates- convert portion of lung into solid tissue with fibrous scar
4. Bacterial dissemination to heart valves, pericardium, brain, kidneys, spleen, joints resulting metastatic abscesses, endocarditis, meningitis, suppurativearthritis
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Clinical features
Abrupt onset of high fever with chillsProductive coughMucopurulent sputumPleuritic pain & friction rubRadiologic appearance - well circumscribed radio-opacity in LP- focal opacities in BP
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SUPPURATIVE LUNG DISEASES
BronchiectasisLung abscessEmpyema
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BRONCHIECTASIS
Definition Disease characterized by permanent dilatation of bronchi & bronchiolescaused by destruction of the muscle & elastic tissue, resulting from or associated with chronic necrotizing infection
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Etiology
Obstruction & infection – major cause- obstruction (mucus, tumor, FB) →impaired normal clearing mechanism →pooling of secretion distal to obstruction → inflammation of airwaysSevere infection → necrotizing fibrosis and eventually dilatation of airways
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Etiology
Congenital or hereditary- cystic fibrosis- intralobular sequestration of the lung- immunodeficiency state- primary ciliary dyskinesia- Kartagener syndrome
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Morphology
Lower lobes, bilaterallyVertical air passagesMost severe in more distal bronchi & bronchioles
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Gross
Airways – dilated, up to 4 timesLong, tube-like enlargement of airways → cylindrical bronchiectasisFusiform or saccular distension →saccular bronchiectasisDilated airways can be followed directly out to pleural surfacesOn C.S → cysts filled with mucopurulentsecretions
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Bronchiectasis
Bronchial tubes are extremely dilated with thicken, fibrotic wall. Adjacent lung is almost completely destroyed
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Focal area of dilated bronchi with bronchiectasis.
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Bronchiectasis
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Histology
Full-blown, active case → intense acute & chronic inflammatory exudation within the walls of bronchi & bronchiolesDesquamation of lining epitheliumExtensive areas of necrotizing ulceration
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Clinical course
CorpulmonaleLung abscessMetastatic brain abscessesAmyloidosis
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LUNG ABSCESS
Definition
A local suppurative process within the lung, characterized by necrosis of lung tissue
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Etiology & Pathogenesis
Oropharyngeal surgical procedures, sinobronchial infection, dental sepsis, bronchitis
Aerobic & anaerobic streptococci , Staphylococcus aureus, GN organisms
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Mechanisms
Aspiration of infective material in acute alcoholism, coma, anesthesia, sinusitis, gingivodental sepsis, debilitation →cough reflexes depressedAntecedent primary bacterial infection →post-pneumonic abscess, fungal infection, bronchiectasisSeptic embolismNeoplasiaMiscellaneous
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Morphology
Size -few mm to large cavities of 5-6 cmSingle or multipleAbscess due to aspiration → more common on right ( more vertical right main bronchus ) and more singleAbscess from pneumonia or bronchiectasis → usually multiple, basal, diffusely scattered
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Morphology
Cavity filled with suppurative debrisIf communication with air passage →partially drain → air-containing cavity Continued infection → large, fetid, green-black, multilocular cavities (gangrene of the lung)Suppurative destruction of lung parenchyma within central area of cavitation
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Seen here are two lung abscesses, one in the upper lobe and one in the lower lobe of this left lung.
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abscessing bronchopneumonia in which several abscesses with irregular, rough-surfaced walls are seen within areas of tan consolidation.
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• Old pulmonary abscess cavity. • Multiloculated with delicate strands of fibrous tissue crossing the space. • No evidence of acute inflammation in the wall • Fairly normal surrounding lung.
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Course
Most resolve with antimicrobial therapyExtension of infection into pleural cavity → empyemaHemorrhage Septic emboli → brain abscess,meningitisSecondary amyloidosis
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EMPYEMA
Collection of pus in pleural cavitySuppurative pleuritisPresence of purulent pleural exudatesCharacterized by loculated, yellow-green, creamy pus composed of neutrophils admixed with other leukocytes
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Etiology
Contiguous spread of organisms from intrapulmonary infectionLymphatic disseminationHaematogenous disseminationDirect extension of infection below diaphragm (subdiaphragmatic or liver abscess) especially on right side
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Clinical course
May resolve by antibiotics
Obliterate pleural space or envelope the lungs → embarrass pulmonary expansion
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