Pneumonia: Encyclopedia II - Pneumonia

- Pathophysiology

Pneumonia - Pathophysiology
The symptoms of infectious pneumonia are caused by the invasion of the lungs by
microorganisms and by the immune system's response to the infection. Although over
one hundred microorganisms can cause pneumonia, only a few of them are responsible
for most cases. The most common causes of pneumonia are viruses and bacteria. Less
common causes of infectious pneumonia include fungi and parasites.

Pneumonia - Viruses

Main article: viral pneumonia

Viruses must invade cells in order to reproduce. Typically, a virus reaches the lungs when
airborne droplets are inhaled through the mouth and nose. Once in the lungs, the virus
invades the cells lining the airways and alveoli. This invasion often leads to cell death,
either when the virus directly kills the cells, or through a type of cell self-destruction
called apoptosis. When the immune system responds to the viral infection, even more
lung damage occurs. White blood cells, mainly lymphocytes, activate a variety of
chemical cytokines which allow fluid to leak into the alveoli. This combination of cell
destruction and fluid-filled alveoli interrupts the normal transportation of oxygen into the
bloodstream.

In addition to damaging the lungs, many viruses affect other organs and thus can disrupt
many different body functions. Viruses also can make the body more susceptible to
bacterial infections; for this reason, bacterial pneumonia often complicates viral
pneumonia.

Viral pneumonia is commonly caused by viruses such as influenza virus, respiratory

syncytial virus (RSV), adenovirus, and metapneumovirus. Herpes simplex virus is a rare
cause of pneumonia except in newborns. People with immune system problems are also
at risk for pneumonia caused by cytomegalovirus (CMV).

Pneumonia - Bacteria

Main article: bacterial pneumonia

Bacteria typically enter the lung when airborne droplets are inhaled, but they can also
reach the lung through the bloodstream when there is an infection in another part of the
body. Many bacteria live in parts of the upper respiratory tract, such as the nose, mouth
and sinuses, and can easily be inhaled into the alveoli. Once inside the alveoli, bacteria
may invade the spaces between cells and between alveoli through connecting pores. This
invasion triggers the immune system to send neutrophils, which are a type of defensive
white blood cell, to the lungs. The neutrophils engulf and kill the offending organisms,
and they also release cytokines, causing a general activation of the immune system. This
leads to the fever, chills, and fatigue common in bacterial and fungal pneumonia. The
neutrophils, bacteria, and fluid from surrounding blood vessels fill the alveoli and
interrupt normal oxygen transportation.

Bacteria often travel from an infected lung into the bloodstream, causing serious or even
fatal illness such as septic shock, with low blood pressure and damage to multiple parts of
the body including the brain, kidneys, and heart. Bacteria can also travel to the area
between the lungs and the chest wall (the pleural cavity) causing a complication called an
empyema.

The most common causes of bacterial pneumonia are Streptococcus pneumoniae, Gram-
negative bacteria and "atypical" bacteria. The terms "Gram-positive" and "Gram-
negative" refer to the bacteria's color (purple or red, respectively) when stained using a
process called the Gram stain. The term "atypical" is used because atypical bacteria
commonly affect healthier people, cause generally less severe pneumonia, and respond to
different antibiotics than other bacteria.

The types of Gram-positive bacteria that cause pneumonia can be found in the nose or
mouth of many healthy people. Streptococcus pneumoniae, often called "pneumococcus",
is the most common bacterial cause of pneumonia in all age groups except newborn
infants. Another important Gram-positive cause of pneumonia is Staphylococcus aureus.
Gram-negative bacteria cause pneumonia less frequently than gram-positive bacteria.
Some of the gram-negative bacteria that cause pneumonia include Haemophilus
influenzae, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and
Moraxella catarrhalis. These bacteria often live in the stomach or intestines and may
enter the lungs if vomit is inhaled. "Atypical" bacteria which cause pneumonia include
Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila.

Pneumonia - Fungi

Main article: fungal pneumonia

Fungal pneumonia is uncommon, but it may occur in individuals with immune system
problems due to AIDS, immunosuppresive drugs, or other medical problems. The
pathophysiology of pneumonia caused by fungi is similar to that of bacterial pneumonia.
Fungal pneumonia is most often caused by Histoplasma capsulatum, Cryptococcus
neoformans, Pneumocystis jiroveci, and Coccidioides immitis. Histoplasmosis is most
common in the Mississippi River basin, and coccidioidomycosis is most common in the
southwestern United States.

Pneumonia - Parasites
Main article: parasitic pneumonia

A variety of parasites can affect the lungs. These parasites typically enter the body
through the skin or by being swallowed. Once inside the body, they travel to the lungs,
usually through the blood. There, as in other types of pneumonia, a combination of
cellular destruction and immune response causes disruption of oxygen transportation.
One type of white blood cell, the eosinophil, responds vigorously to parasite infection.
Eosinophils in the lungs can lead to eosinophilic pneumonia, thus complicating the
underlying parasitic pneumonia. The most common parasites causing pneumonia are
Toxoplasma gondii, Strongyloides stercoralis, and Ascariasis.