PREPARED BY:

MOHD HAFZAN BIN SHAMSUDDIN 01200605 0599 NURLIYANA FATIN BT MOHAMAD DARIMIN 01200605 0175

BRONCHOPNEUMONIA

 Bronchopneumonia is characterized by patchy exudative consolidation of lung parenchyma due to terminal bronchiolitis with consolidation of peribronchial alveoli.

It is a common community acquired pneumonia.

Bronchopneumonia is a fairly common illness and it affects millions of people annually in the United States. The severity of the illness will depend on the type of bacteria or infection causing the illness.

Etiology:
Most bronchopneumonia cases are caused by organisms aspirated from the mouth. Causative organisms
1) Staphylococci 2) Streptococci 3) Pneumococci 4) Haemophilus influenzaea 5) Pseudomonas aeruginosa 6) Coliform bacteria

 Bronchopneumonia may occur as a complication of some disease.

Eg. In children - Diphtheria , Measles , Whooping Cough In adult - Influenza, typhoid & Paratyphoid fever etc

It is often seen in two extremes of life (in infants & old age).

Predisposing factors:
Some patients are unable to clear their lungs due to medication, old age, physical weakness and pulmonary fibrosis. Patients who are immobile develop retention of secretions; thus, most commonly involves the lower lobes. Cilia not functioning- hereditary dyskinesis, squamous metaplasia, cigarette smoking, gas exposure. Alcohol ,tobacco and oxygen therapy interfering with the ability of the alveolar macrophages to kill bacteria.

Bacteria grow within secretions collected in the chest. Eg. in chronic bronchitis, cystic fibrosis or an obstructing malignant tumour.

Clinical manifestation:
Clinical course dependent on underlying disease processes. Patients present with fever, cough and purulent sputum.

Outward clinical symptoms will be similar to those of lobar pneumonia, however, and can include chest pain, chest congestion, chills, difficulty with breathing and bloodstreaked mucus that is coughed up.
Bronchopneumonia is more common in elderly people, and in association with other viral respiratory illnesses (bronchitis), and as a complication of those who have asthma.

Pathogenesis:
There is initial terminal bronchiolitis with patchy consolidation of peribronchial lung tissue. Bronchioles are plugged by the swollen mucosa and their secretion. As a result, the air cannot enter the alveoli. The imprisoned air in the alveoli is absorbed causing collapse of the alveoli. Collapsed areas are surrounded by areas of compensatory emphysema. [Consolidated areas are surrounded, from inside outwards, by areas of congestion, collapse and emphysema ].

Resolution of the exudate usually restores normal lung structure.

Organization may occur and result in fibrous scarring in some cases. Aggressive disease may produce abscesses.

General Gross Description

1. Bilateral (less often unilateral), gray-red, patchy
consolidation with intervening normal lung tissue.
2. Nodular, elevated, edematous to hemorrhagic-purulent areas. Lesion is more extensive at the base of the lung and often fuses together resembling lobar pneumonia (confluent bronchopneumonia). Range from red to gray depending on age of the lesion.

3.

4.

Bronchopneumonia

The photo is of a slice of pulmonary parenchyma. The lung is congested. A barely visible nodularity which is easier palpated indicates bronchopneumonia. Arrows point to examples of nodules.

Microscopic feature :
1.Bronchial wall is infiltrated with polymorphs, blood
vessels are congested and bronchial lumen contains pus and desquamated epithelium. (Bronchocentric lesion)
2. Peribronchial lung alveoli are consolidated with purulent exudates (polymorphs & fibrin). 3. Escherichia coli pneumonias are mostly interstitial. 4. Parenchymal destruction depends on the organism .

Complications:
1. Pulmonary fibrosis. 2. Bronchiectasis 3. Lung abscess 4. Empyema 5. Bacteraemia with abscess in other organs

Diagnosis
Medical history and physical examination Chest X-ray may test a sample of the sputum may do a CBC to get a count of the white blood cells in the blood may take a CAT scan a pleural fluid culture of the fluid surrounding the lungs.

Treatment
Treatment depends on the severity of symptoms and the type of organism causing the infection.

Upon diagnosis, most people will be treated at home with antibiotics.

Tetracyclines Fluoroquinolones Cephalosporins Penicillins Vancomycin Macrolides

In addition to the pharmaceutical intervention, the doctor will also recommend

bedrest plenty of fluids therapeutic coughing breathing exercises proper diet cough suppressants pain relievers fever reducers, such as aspirin (not for children) or acetaminophen. In severe cases, oxygen therapy and artificial ventilation may be required.