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BRS: Pulm Infections


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- infectious inflammatory process of pulmonary parenchyma
- chills, fever, rusty sputum, SOB, cyanosis
- bacterial: neutrophilic leukocytosis (left shift)
lobar, broncho-, interstitial pneumonia
3 morphological types of pneumonia
lobar pneumonia
- streptococcus pneumoniae
- intra-alveolar exudate, consolidation
- involves an entire lung lobe
- caused by several bugs: staph aureus, H. flu, Klebsiella pneumoniae, Strep pyogenes
- acute inflam. infiltrate from bronchioles to alveoli
- patchy infiltrates
interstitial pneumonia (primary atypical)
- viruses or mycoplasma pneumonia
- diffuse, patchy inflammation localized to interstitial areas of alveolar walls
- one or more lobes
Streptococcus pneumoniae
- elderly, debilitated pts with cardiopulmonary diseased, malnourished
- possible empyema (pus in pleural cavity)
Staph aureus
- complication of influenza or viral pneumonia; result of blood-borne infections from IV drug use
- seen in debilitated hospitalized pts., elderly with chronic lung disease
- focal inflamm. exudates or abscess; can lead to bacterial endocarditis, brain and kidney abscess
Streptococcus pyogenes
- complication of influenza or measles
- lung abscess
Klebsiella pneumoniae
- debilitated, hosp, diabetic, alcoholic pts; high mortality rate in elderly
- lots of alveolar wall damage, necrosis, occasional abscess
H. influenza
- seen in infants and children, debilitated adults, most often in those with COPD
- meningitis and epiglottitis in babies and kids
Legionella pneumophila
- inhalation of aerosol from contaminated water
top 3 causes of nosocomial pneumonia
Klebsiella, Pseudomonas aeruginosa, Escherichia coli
ornithosis (psittacosis)
transmitted by inhalation of bird crap
Q fever, the most common rickettsial pneumonia, caused by Coxiella burnetii
infects persons working with infected cattle or sheep; people who drink unpasteurized milk from infected animals
giant cell pneumonia
what type of pneumonia is caused by the measles virus?
Ghon complex
- due to initial TB lesion; a tubercle characterized by central caseous necrosis and by Langhans giant cells; calcified lesions seen by x-ray
milliary TB
- after lymphatic and hematogenous spread; seeding of distal organs with innumerable small millet seed-like lesions
various areas affected by spread of TB to other body parts
TB meningitis, Pott disease of the spine, paravertebral abscess, psoas abscess
Langhans multinucleated giant cells and epithelioid cells
what is created after macrophages are morphologically altered in TB
- abscess, sinus tract formation
- exudate with sulfur granules, yellow clumps of organism
- gram + anaerobic filamentous bacteria
- gram + aerobic, filamentous, weakly acid-fast
- opportunistic infection
- can disseminate to brain and meninges
- immunocomprimised pts., can produce bloodborne dissemination
- pulm, renal, hepatic absceses and vegetative endocarditis
- infection starts in lungs, but can produce meningitis
- encapsulated appearance seen in India ink prep
- invasive form has predilection for growth into vessels and later spread by blood
- pulm. manifestation similar to TB; pulm lesions with late calcification
- disseminated form marked by multisystem involvement with macrophages filled with fungal yeast forms
- fungal spherules containing endospores in granulomas
- occurs only in dry and dusty setting
squamous cell carcinoma
- central, hilar mass, cavitation, link to smoking
- can involve inappropriate PTH-like activity with hypercalcemia
bronchial-derived adenocarcinoma
- peripheral, develops on prior scar from injury or inflammation
bronchioalveolar adenocarcinoma
- peripheral, columnar to cuboidal tumor cells line alveolar walls, mimicks pneumonia on x-ray
small cell (oat cell) carcinoma
- most aggressive bronchogenic carcinoma, usually already metastatic at diagnosis
- often assoc. with ectopic production of ACTH or ADH
- greatly increased in smokers
large cell carcinoma
- peripheral, may show features of squamous cell or adenocarcinoma on electron microscopy
- major bronchi
- low malignancy, spread to adjacent tissues, can result in carcinoid syndrome

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