Pathology

of
Pulmonary infection
Pneumonia
 Pneumonia
Infection and inflammation of lung parenchyma

• AETIOLOGY
– Infectious pneumonia
• Bacteria, viruses, fungi, mycoplasma, chlamydia.
– It is usually caused by bacteria.
– Microbiological identification of organism often not possible.

– Non infectious pneumonia

 Pneumonia
• Mechanism of development:

– Inhalation of droplets of infected saliva that are small

enough to reach the alveoli.

– Hematogenous
– lymphatic spread
– Direct extension
 Precipitating factors

• Viral infection with influenza or parainfluenza.

• Hospitalized 'ill' patients
• Cigarette smoking
• Alcohol excess.
• Bronchiectasis (e.g. in cystic fibrosis).
 Precipitating factors

• Bronchial obstruction.
• Immunosuppression
• Intravenous drug abuse - frequently associated with
Staph. aureus infection.
• Inhalation from oesophageal obstruction.
 The Pneumonia: Types
Aetiologic types:

• Infective • Non infective

– Bacterial – Toxines
– Viral – Chemicals
– Fungal – Aspiration
– Tubercolosis
 The Pneumonia: Types
Morphological types:
• lobar pneumonia
– An entire lobe is Consolidated

• bronchopneumonia
– Scattered solid foci (patchy distribution of inflammation) in
the same or several lobes.
– Results from initial infection of bronchi and bronchioles
with extension into alveoli
Pneumonia
 The Pneumonia
bronchopneumonia lobar pneumonia
• Extremes of age • Middle age
• Secondary • Primary
• Both gender • Male common
• Staph, strep, H infl • 95% pneumococcus
• Patchy consolidation • Entire lobe consolidation
• Around small bronchi • Diffuse
• Not limited to anatomic • Limited to anatomic
boundaries boundaries
• Usually bilateral • Usually unilateral
 The Pneumonia Syndromes
• Community-acquired acute pneumonia
– Pneumococcus, H infl, moraxella catarrhalis, staph, legionella

• Community-acquired atypical pneumonia

– Mycoplasma, chlamydia, coxiella burnetti, viral

• Hospital-acquired pneumonia
– Gram –ve, pseudomonas, staph

• Aspiration pneumonia
– Anarobic oral flora (bacteroids), mixed bacteria
 The Pneumonia Syndromes
• Chronic pneumonia
– Nocardia, actinomyces, granulomatous

• Necrotizing pneumonia and lung abscess

– Anarobic bacteria

• Pneumonia in the immunocompromised host

– CMV, Pneumocytes carinii, candida
 Pathology of lobar pneumonia:
• Four classic phases:

• Congestion
• Red hepatization
• Grey hepatization
• Resolution: healing
Pathology of lobar pneumonia:

Congestion:

– Vascular congestion and engorgement

– Early acute inflammatory response to infection

– Lasts 1-2 days
– Affected lobe(s) is (are) enlarged, heavy, dark red
– Alveoli filled with edema fluid
– Few neutrophils and numerous bacteria.
Pathology of lobar pneumonia:
Red hepatization:

– Liver-like consistency
– Red, firm, 'meaty' and airless appearance of lung.

– Exudation of alveolar space with neutrophils , RBCs and

fibrin.
– Pleura: Fibrinous exudate
Red hepatization:
 Pathology of lobar
pneumonia:

• Gray hepatization:

– Less hyperaemia.
– Lung is dry, gray and firm
– Macrophages, neutrophils +
fibrin
 Pathology of lobar pneumonia:
• Resolution:

– Lysis and removal of fibrin via sputum + lymphatics.

– - Begins after 8-9 days (without antibiotics).
– - Sudden improvement of patient's condition.
 Microscopic apperance
• The alveoli are packed with an
exudate composed of
polymorphonuclear leukocytes
and occasional macrophages.
Pathology of lobar pneumonia:
Pathology of lobar pneumonia:
Normal lung histology
 Bronchpneumonia
• Foci of inflammatory consolidation are distributed in
patches throughout one or several lobes
• Bilateral and basal
• Lesion are 3-4 cm, elevated and gray-red to yellow
• Lung tissue surrounding foci are hyperemic and
edomatous
• plural involvement are less common than lobar
pneumonia
Bronchopneumonia:

• Patchy distribution of consolidation

 CLINICAL FEATURES
• Onset – abrupt

• fever and chills.

• cough
• Purulent sputum
• Chest pain secondary to pleural involvement is
common.
• Hemoptysis is frequent
 Investigations :
• Chest radiography : X-ray
– Confirms the area of consolidation
– Usually return to normal by 6 weeks
X-ray: pneumonia
X-ray
 Investigations :
• Gram's Stain and Culture of Sputum :
– help to identify certain pathogens (e.g., S. pneumoniae, S.
aureus, and gram-negative bacteria) by their characteristic
appearance.

• Blood Culture in the presence of bacteramia .

• Serology
 Complications of pneumonia
• Pleuritis
• Plural effusion
• abscess formation
• Empyema
• bacteremic dissemination
– metastatic abscesses, endocarditis, meningitis, or
suppurative arthritis
• Pulmonary fibrosis
Thank you