S. pneumoniae generally resides harmlessly in the nasopharynx but can cause pneumonia when it spreads to the lungs. Viral infections increase the ability of S. pneumoniae to attach to lung cells. Once in the alveoli, S. pneumoniae infects and spreads between lung cells, causing inflammation. Atypical organisms like Legionella attach to lung cells through pili or other mechanisms, then injure the cells and spread beyond a single lung lobe. Hospitalized patients are prone to nosocomial pneumonia through aspiration, as their oropharynx often becomes colonized with bacteria within days and aspiration plays a central role in pneumonia development.
S. pneumoniae generally resides harmlessly in the nasopharynx but can cause pneumonia when it spreads to the lungs. Viral infections increase the ability of S. pneumoniae to attach to lung cells. Once in the alveoli, S. pneumoniae infects and spreads between lung cells, causing inflammation. Atypical organisms like Legionella attach to lung cells through pili or other mechanisms, then injure the cells and spread beyond a single lung lobe. Hospitalized patients are prone to nosocomial pneumonia through aspiration, as their oropharynx often becomes colonized with bacteria within days and aspiration plays a central role in pneumonia development.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOCX, PDF, TXT or read online from Scribd
S. pneumoniae generally resides harmlessly in the nasopharynx but can cause pneumonia when it spreads to the lungs. Viral infections increase the ability of S. pneumoniae to attach to lung cells. Once in the alveoli, S. pneumoniae infects and spreads between lung cells, causing inflammation. Atypical organisms like Legionella attach to lung cells through pili or other mechanisms, then injure the cells and spread beyond a single lung lobe. Hospitalized patients are prone to nosocomial pneumonia through aspiration, as their oropharynx often becomes colonized with bacteria within days and aspiration plays a central role in pneumonia development.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOCX, PDF, TXT or read online from Scribd
S pneumoniae generally resides in the nasopharynx and is carried asymptomatically in approximately 50% of healthy individuals. Invasive disease may occur upon acquisition of a new epithelium serotype. A strong association exists with viral illnesses, such as influenza. Viral infections increase pneumococcal attachment to the receptors on activated respiratory epithelium. Once aerosolized from the nasopharynx to the alveolus, pneumococci infect type II alveolar cells. The pneumonic lesion progresses as pneumococci multiply in the alveolus and invade alveolar epithelium. Pneumococci spread from alveolus to alveolus through the pores of Kohn, thereby producing inflammation and consolidation along lobar compartments. A recent multivariate analysis showed an independent association between pneumococcal CAP and alcoholism. Current alcohol abuse was associated with severe CAP. No significant differences were found in mortality, antibiotic resistance of S pneumoniae, and other etiologies. Pathogenesis of atypical infection After aspiration or inhalation, the atypical organisms attach to the respiratory epithelial cells by a variety of mechanisms. The presence of pili on the surface of Legionella species facilitates attachment. Once adhered, the organisms cause injury to the epithelial cells and their associated cilia. Many of the pathogenetic mechanisms may be immune-mediated rather than due to direct injury by the bacteria. A host defense is mounted via cell-mediated and humoral immunity. Infection caused by atypical organisms often spreads beyond the lobar boundaries and frequently is bilateral. Pathogenesis of nosocomial pneumonia Aspiration plays a central role in the pathogenesis of nosocomial pneumonia. Approximately 45% of healthy subjects aspirate during sleep, and an even higher proportion of severely ill patients aspirate routinely. Depending on the number and virulence of the pathogenic organisms reaching the lower respiratory tract and on the host defense factors, pneumonia may develop. The oropharynx of hospitalized patients may become colonized with aerobic gram-negative bacteria within a few days of admission. Therefore, nosocomial pneumonia is caused predominantly by the gram-negative bacilli. However, the incidence of Staphylococcus aureus lower respiratory tract infection is increasingly common in the hospitalized and institutionalized patient and must now be considered a possible pathogen for nosocomial pneumonia.