Pneumonia Tutorial

Question 1

What are different types of pneumonia?

Answer 1

community/hopsital/ventilator acquired

Question 2

What is the difference between bronchitis, bronchiolitis and pneumonia?

Answer 2

1. Bronchitis: inflammation and swelling of the bronchi
2. Bronchiolitis: Inflammation and swelling of the bronchioles
3. Pneumonia: Inflammation and swelling of alveoli

Question 3

Why, physiologically, does pneumonia present a more challenging disease than bronchitis and bronchiolitis?

Answer 3

1. Gas exchange occurs in the alveoli
2. Impairment of this process through cellular infiltration or fluid leakage into the airspace over a substantial area of the respiratory tract
3. will prevent uptake of O2 and removal of CO2.

Question 4

What is the first immune cell recruited to the site during acute bacterial pneumonia?

Answer 4

Neurophil

Question 5

Why is this the case?

Answer 5

1. Rapid release of neutrophil chemokines such as IL-8 causes rapid recruitment in all inflammation
2. However the alveoli do also have a specialised resident immune cell.
3. The alveolar macrophage.

Question 6

What type of cell accumulates during prolonged pneumonia?

Answer 6

• Prolonged inflammation will result in accumulation of
  1. lymphocytes (primarily T cells)
  2. macrophages
  3. monocytes at the site of inflammation

Question 7

Why do these cells accumulate in prolonged pneumonia?

Answer 7

If the innate immune system is not sufficient to rapidly clear an infection from the alveoli then adaptive immune responses will develop to clear the infection

Question 8

What is steptoccocus pneumoniae? How is it treated?

Answer 8

• gram-positive bacterium susceptible to beta lactams that bind proteins in the bacterial cell wall to prevent transpeptidation and bacterial replication
• admitted and given macrolife

Question 9

What is chlamydia. penuomiae? How is it treated?

Answer 9

1. gram negative and due to the difference in the bacterial cell wall is therefore penicillin resistant
2. Thus a macrolide, clarithromycin, which inhibits the 50S ribosomal subunit limiting protein synthesis was used

Question 10

How do you treat a typical bacteria like C.penuemoniae?

Answer 10

slower replication cycles thus longer treatment courses are recommended compared to typical bacteria

Question 11

What is walking pneumonia?

Answer 11

Some atypical bacteria cause milder, more prolonged symptoms due to their slower replication rate. E.g. mycoplasma pneumoniae and C. pneumoniae

Question 12

How can steroids be used to treat viral pneumonia?

Answer 12

• Steroids most likely effective by suppressing the immune inflammation and thus further lung damage
• In individuals with milder disease steroids are potentially counter productive as they may suppress the immune clearance of the virus

Question 13

Why are anti-virals only effective early?

Answer 13

Early damage is virus dependent, late damage is immune mediated