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2. HDS Pulmonary > Pulmonary Infection Pathology > Flashcards

Pulmonary Infection Pathology Flashcards

1
Q

Pulmonary

Host Defenses

A
  • Physical barriers
    • Nasal turbinates, epiglottis, larynx
  • Dichotomously branching conducting airways
    • Anatomic barrier
    • Mucociliary clearance
    • Coughing
    • Antibaterial activity of bronchial secretions
      • Lysozyme, lactoferrin, sIgA
  • Defenses in alveolar spaces
    • Surfactant ⇒ antibacterial activity
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2
Q

Pulmonary Infection

Risk factors

A
  • Intubation
  • Malnutrition
  • Cigarette smoke & other noxious fumes
  • Congenital structual defects of cilia
  • LOC or anesthesia
  • Pulmonary congestion, edema, emphysema
  • Immunosuppression
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3
Q

Routes of Infection

A
  • Inhalation of infectious droplets
  • Aspiration of oral/gastric contents
  • Hematogenous
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4
Q

Pulmonary Consolidation

A

When alveoli filled with supprative exudates

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5
Q

PNA

Patterns

A
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6
Q

Lobar PNA

A

Involves one or more lobes uniformly

Strep. pneumoniae most common cause

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7
Q

Bacterial PNA

Inflammatory Stages

A
  1. Congestion
  2. Red hepatization
  3. Gray hepatization
  4. Resolution vs organization
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8
Q

Congestion

A

Stage 1:

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9
Q

Red Hepatization

A

Stage 2:

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10
Q

Grey Hepatization

A

Stage 3:

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11
Q

Resolution

A

Stage 4:

Exudates resolves or undergoes organization.

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12
Q

Organizing PNA

A
  • Virulent organisms damaged basement membrane
  • Activates repair reaction
  • Influx of fibroblasts ⇒ collagen secretion
  • Exudates become organized
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13
Q

Bronchopneumonia

A

Lobular, patchy, non-uniform distribution of consolidation

Caused by many pathogens:

  • Gram ⊕
    • S. aureus, S. pneumoniae, S. pyogenes, H. inluenzae
  • Gram ⊖
    • P. aeruginosa, Enterobacteriaceae, L. pneumophila
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14
Q

Bronchopneumonia

Gross Appearance

A

Granular consolidation, often adjacent to major airways.

Seen as pale-colored, firm nodules.

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15
Q

Bronchopneumonia

Microscopic Appearance

A

Alveoli filled with edema, extravasated RBCs, bacteria, PMN, and alveolar Mφ.

Can see virulent organisms, likely to organize:

S. aureus ⇒ microabscesses, results in permanent lung damage

P. aeruginosa ⇒ vasculitis, necrosis

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16
Q

Aspiration Pneumonia

A
  • Material enters LRT
    • Respiratory secretions
    • Food or gastric contents from OP
  • Acute event associated with sudden death vs a chronic recurrent problem
  • Etiology ⇒ mixed enteric and anaerobic organisms
  • Gross ⇒ necrosis of RML & RLL
  • Micro:
    • Foreign material inside of FB giant cells
    • Surrounding inflammatory cells
    • Tissue may be disgested by process
17
Q

Bacterial

Interstitial PNA

A

Few bacteria cause interstitial PNA that looks similar to viral infections:

  • Mycoplasma pneumoniae
  • Chlamydia trachomatis (in infants)
  • Chlamydia pneumoniae
18
Q

Viral PNA

A

Three major morphologic manifestations:

  1. Bronchiolitis
  2. Interstitial PNA
  3. PNA associated w/ viral inclusions
19
Q

Bronchiolitis

A

Morphological manifestation of viral PNA.

  • Peribronchiolar collections
    • Lymphocytes
    • Epithelial damage and sloughing
    • Squamous metaplasia
    • Mucus plugging of bronchioles
  • Local hyperinflation and subsequent atelectasis
  • Pathogens:
    • RSV, parainfluenza, influenza A & B, adenovirus
  • Bronchiolitis obliterans ⇒ uncommon complication
20
Q

Interstitial PNA

A

Morphologic manifestation of viral PNA.

  • Lymphocytes and plasma cells within alveolar walls and around small airways
  • ± Hyaline membranes
  • Pathogens:
    • RSV, influenza
21
Q

PNA w/ Viral Inclusions

A

Morphologic manifestation of viral PNA.

Viral infection includes morphological changes within the host cell.

22
Q

CMV

Pneumonia

A
23
Q

Adenovirus

PNA

A
24
Q

Measles Virus

PNA

A

Warthin-Finkeldy Gaint Cells

25
Q

Herpes

PNA

A

Ground-glass appearance and nuclear molding.

26
Q

Fungal PNA

A

Pneumocystis jirivecii

  • Epidemiology
    • Colonizes immunocompetent persons
    • Causes disease in immunocompromised hosts
      • Esp. AIDS pts
  • Pathology:
    • Mononuclear cell interstitial infiltrate ⇒ interstitial PNA
    • Alveoli filled with foamy eosinophilic material ⇒ pathogens
  • Trophozoites (replicating form) ⇒ stain w/ Giemsa stain
  • Cysts ⇒ stain w/ silver stain

2. HDS Pulmonary (28 decks)

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