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Pulm > Lec 9 Pneumonia Pathology > Flashcards

Lec 9 Pneumonia Pathology Flashcards

1
Q

Bronchopneumonia: what do you see in image

A

image: patchy consolidation of lung centered on bronchi

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2
Q

Lobar pneumonia: what distinguishes it?

A
  • affects entire lung lobe

- associated with increased virulence of organism or most host vulnerability [infants, elderly]

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3
Q

What do you see on histology with bacterial pneumonia?

A

neutrophils in bronchi, bronchioles, and adjacent alveolar spaces

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4
Q

Can you tell which bacteria just from histology image?

A

Not reallly

staph aureus = really virulent so more likely to cause hemorrhage

pseudomonas = likes to hang out around RBCs + invade blood vessel wall

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5
Q

What puts you at risk for community acquired pneumonia?

A

usually baceteria or virus

  • Extremes of age
  • Chronic diseases (congestive heart failure, COPD, and diabetes)
  • Congenital or acquired immune deficiencies
  • Decreased or absent splenic function (sickle cell disease or post splenectomy
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6
Q

WHat is major cause of community acquired pneumonia?

A

strep pneumo = 80-90%

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7
Q

Who is at risk for nosocomial pneumonia?

A
  • pt with severe underlying disease

on mechanical ventilater

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8
Q

What bugs cause nosocomial pneumonia?

A

staph aureus
pseudomonas
other gram neg rods [klebsiella, legionella]
EColi

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9
Q

What bugs cause community acquired pneumonia?

A
  • stre pneumo
  • H influenza
  • klebsiella, legionella
  • staph aureus
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10
Q

What are potential outcomes of bacterial pneumonia?

A
  • resolution
  • pleural effusion
  • empyema
  • fibrosis
  • abcess
  • bacteremia
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11
Q

What is a lung abscess? what causes it?

A

localized collection of pus within parenchyma

cause: 2ndary to bacterial or fungal infection; bronchila obstruction; septic emboli; aspiration

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12
Q

What are symptoms of lung abscess

A

cough, fever, foul-smelling sputum, fever, chest pain, weight loss

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13
Q

What is treatment of lung abscess?

A

need to resect

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14
Q

What is atypical pneumonia? most common causes?

A

pneumonia without alveolar exudate

largely confined to alveolar septa and pulmonary interstitium

lymphocytic infiltrate in interstitium rather than neutrophils in air spaces [as in typical]

see patchy inflammatory changes in lungs

most commonly due to mycoplasma, viruses

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15
Q

What is morphology of atypical pneumonia?

A
  • predominant in interstitium
  • localized within walls of alveoli
  • widened septa filled with inflammatory infiltrate of lymphocytes and occassionally plasma cells

intra-alveolar neutrophils generally absent

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16
Q

What type of viral infections involve lung?

A
  • cytomegalovirus
  • herpesvirus
  • adenovirus
  • influenza
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17
Q

What pts generally get viral pneumonia?

A

pts who are immune compromised by

  • AIDS
  • chemo
  • transplant
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18
Q

what does CMV infection look like

A

intranuclear and intracytoplasmic inclusions

big cell [meGALO] with huge dark nucleus from intranuclear inclusion

KNOW THIS

19
Q

What does herpes infection look like?

A

ulcerative process involving airways

multi-nucleated big cells with intranuclear inclusions [not intracellular]

nuclei tend to mold together = pomegranite appearance

KNOW THIS

20
Q

What does adenovirus infection look like?

A

single large intranuclear inclusion = “smudge cell”

tend not to form big pneumocytes like the others

no intracytoplasmic inclusions

21
Q

What does primary TB infection look like?

A

caseating/necrotizing granuloma

22
Q

What is ghon complex?

A

primary pulm granuloma [usually above or below interlobar fissure PLUS involvement of hilar lymph nodes

23
Q

Where does secondary TB usually involve?

A

lung apex

24
Q

How does miliary TB look?

A

multiple small granulomas in lungs

can spread to other organs due to lymphatic and hematogenous spread

25
Q

Who gets MAI?

A

pts with HIV/immune compromised

pts with right/middle lobe syndrome

26
Q

What happens in MAI with immune compromised

A

potential findings:
granulomas
big sheets of histiocytes
“mycobacterial pseudotumor”

27
Q

How does right middle lobe syndrome make you at risk for MAI

A

happens in pts with bronchiectasis of right middle lobe; have difficulty clearing secretions

28
Q

What are features of histoplasma capsulatum?

A

Small spores (2-5 mu) = same size as RBC

Unequal narrow budding = looks like bowling pins

Intra- or extracellular

Best seen by silver impregnation (GMS)

29
Q

How does histoplasmosis present?

A

similar to TB

get disseminated in immune compromised

30
Q

What location should you think for histoplasmosis?

A

mississipi and ohio river valleys

also caribbean, asia

31
Q

What do histoplasmosis granulomas look like on H & E?

A

fibrotic rim

well circumscribed granulomas

32
Q

What location associated with coccidioides?

A

arizona, san joaquin valley

33
Q

What are features of coccidioides on stain?

A
  • similar to histo = coin lesion [large granuloma looks like coin], large fibrotic granuloma with central necrosis

large organisms much bigger than RBC

thick walled spherules with lots of endospores

see on H&E but better with GBS or PAS stain

34
Q

What location associated wtih blastomycosis?

A

deep south – louisiana or mississipi

35
Q

What presentation of blastomycosis?

A

skin/pulmonary disease

large granulomas with central necrosis containing large numbers of neutrophils in the middle of granulomas

36
Q

What are features of blastomycosis?

A
  • big organism
  • broad base budding
  • granuloma with central necrosis containing neutrophils
37
Q

What are features of aspergillus?

A
  • fungal hyphae, septate, narrow angle branching (40-60 degrees)
  • mostly visible with H&E but best with GMS silver stains
38
Q

What are non-invasive vs invasive aspergillosis?

A

non-invasive = fungal ball in body cavity

invasive = in immune compromised, goes into blood vessels get hemorrhage, infarction

39
Q

What are two diseease presentations of cryptococcus?

A

meningitis

pulmonary

40
Q

What happens in pulmonary cryptococcus?

A
  • occurs in both immune competent and compromised

see more frequently in immune suppressed, malignancy, DM

most pts are asymptomatic

41
Q

What are features of cryptococcus?

A
  • big range of sizes; oval to elliptical
  • may have discernible halo on H&E
  • narrow based budding

capsule hilighted by muccarmine, DPAS, alcian blue

42
Q

How can cryptococcus look?

A
  • granulomas
  • fibroinflammatory mass with histiocytes
  • mucoid pneumonia
43
Q

What do we see in pneumocystis jiroveci?

A
  • pneumocystis filling alveolar spaces with pink foamy material

diagnose by histology slides with GMS silver stain

44
Q

What is morphology of PCP?

A
  • some crescent shaped, some circles
  • about same size of RBC
  • dark rim with central dot
  • no budding

Pulm (24 decks)

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