Pulmonary infections

Pulmonary infections

1. PULMONARY INFECTIONS (PNEUMONIAS) SUNIL KUMAR.P Haematology & Transfusion Medicine 2/19/2018 1 SUNIL KUMAR.P

2. Introduction Definition Classification Etiology ( causes ) Pathogenesis 2/19/2018 2 SUNIL KUMAR.P

3. INTRODUCTION Acute & Chronic pulmonary infections are common at all ages and are frequently cause of death. They are generally caused by a wide variety of microorganisms such as …… a. Bacteria b. Viruses C. fungi and Mycoplasma 2/19/2018 3 SUNIL KUMAR.P

4. Examples of Acute Pulmonary infections are…. 1.Pneumonias 2.Lung Abscess 3.Fungal Infections Chronic Pulmonary Infections : Pulmonary Tuberculosis 2/19/2018 4 SUNIL KUMAR.P

5. PNEUMONIA 2/19/2018 5 SUNIL KUMAR.P

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11. DEFINITION Pneumonia is defined as acute inflammation of the lung parenchyma distal to the terminal bronchioles . 2/19/2018 11 SUNIL KUMAR.P

12. The term “Pneumonia” and “ Pneumonitis” are often used synonymously for inflammation of the lungs. Consolidation : Meaning solidification is the term used for gross and radiologic appearance of the lungs in pneumonia. 2/19/2018 12 SUNIL KUMAR.P

13. CLASSIFICATION OF PNEUMONIA On the basis of the anatomic part of the lung parenchyma involved, pneumonias are traditionally classified as……….. 1. Anatomical Classification 2.Etiological Classification 2/19/2018 13 SUNIL KUMAR.P

14. 1 : Anatomical classification . A – lobar pneumonia . The consolidation involves all or part of lobe B – Bronchopneumonia the consolidation involves scattered lobules C - Interstitial pneumonia . As in viral pneumonia where inflammatory . Infiltrate involve mainly interstitial tissue between alveoli . 2/19/2018 14 SUNIL KUMAR.P

15. 2.Etiologic Classification of Pneumonias 2/19/2018 15 SUNIL KUMAR.P

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17. Causes of infectious pneumonia 2/19/2018 17 SUNIL KUMAR.P

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19. Uncommon 2/19/2018 19 SUNIL KUMAR.P

20. PATHOGENESIS 2/19/2018 SUNIL KUMAR.P 20

21. PATHOGENESIS The microorganisms gain entry into the lungs by one of the following four routes. 1.Inhalation of microbes present in the air 2. Aspiration of organisms from the nasopharynx or oropharynx. 3.Haematogenous spread from adjoining site of infection. 4. Direct spread from an adjoining site of infection. 2/19/2018 21 SUNIL KUMAR.P

22. Conti………. The lower respiratory tract is normally sterile by -Physiologic defense mechanisms including -Mucociliary clearance - Properties of normal secretion such as secretory immunoglobulin A IgA - Clearing of air way by coughing Immunologic defense mechanism of lung limit invasion by pathogenic organisms Includes macrophages are present in alveoli and bronchioles secretory IgA and others immunoglobulins 2/19/2018 22 SUNIL KUMAR.P

23. Failure of these defense mechanisms and presence of certain predisposing factors result in pneumonias. These conditions are as under. 1. Altered consciousness . Eg: CVA, Cranial Trauma. 2.Depressed cough and glottic reflexes . Eg. Old age , pain from trauma. 3.Impaired Mucociliary transport. 4.Impaired alveolar macrophage function 5.Endobronchial Obstruction. 6.Leukocyte dysfunction. 2/19/2018 23 SUNIL KUMAR.P

24. BACTERIAL PNEUMONIA Bacterial infection of the lung parenchyma is the most common cause of the pneumonia or Consolidation of one or both the lungs . 2/19/2018 SUNIL KUMAR.P 24

25. Two types of bacterial pneumonias are distinguished - Lobar pneumonia Broncho ( Lobar ) Pneumonia …… each with different etiological agent and morphological changes. 2/19/2018 SUNIL KUMAR.P 25

26. Another type distinguished by some workers separately is confluent pneumonia involves larger areas in both the lungs irregularly , while others consider this as a variant of bronchopneumonia. 2/19/2018 SUNIL KUMAR.P 26

27. Lobar pneumonia Lobar pneumonia is an acute bacterial infection of a part of a lobe or even two lobes of the lungs 2/19/2018 SUNIL KUMAR.P 27

28. ETIOLOGY Based on the etiologic microbial agent causing lobar pneumonia, following types of lobar pneumonia are described 2/19/2018 SUNIL KUMAR.P 28

29. 1.Pneumococcal pneumonia 2.staphyloccal pneumonia 3.Sreptococcal pneumonia 4.Pneumonia by gram negative aerobic bacteria. 2/19/2018 SUNIL KUMAR.P 29

30. MORPHOLOGICAL FEATURES Laennec’s original description divide lobar pneumonia into 4 sequential pathologic phases…. 2/19/2018 SUNIL KUMAR.P 30

31. 1.Stage of congestion( initial Phase ) 2. Red Hepatisation ( Early consolidation ) 3. Grey Hepatisation (Late consolidation) 4.Resolution However these classic stages seen in untreated cases are found much less often nowadays due to early institiution of antibiotic therapy. 2/19/2018 SUNIL KUMAR.P 31

32. In lobar pneumonia as the name suggest, part of a lobe , a whole lobe, or two lobes are involved, some times bilaterally. The lower lobes are affected most commonly. 2/19/2018 SUNIL KUMAR.P 32

33. 1. Stage of congestion initial phase The initial phase represents the early acute inflammatory response to bacterial infection and lasts for 1 -2 days 2/19/2018 SUNIL KUMAR.P 33

34. Gross Examination : - The affected lobe is enlarged - Heavy - Dark red - Congested . _ Cut surface exudes blood –stained frothy fluid. 2/19/2018 SUNIL KUMAR.P 34

35. Microscopic / Histological : 2/19/2018 SUNIL KUMAR.P 35