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come true is to…...

wake up!
— Paul Valery
Pathology of
Pneumonia
Pneumonia

Introduction:
 5000 sq meters of area….! (olympic track)
 Filters >10,000 L of air / day…!
 Normal lungs are sterile.
 Delicate, thin resp. mem – gas exch.
 Filter, humidify, sterilize, highly sensitive.
 RTI – Resp. tract inf. commonest in medical
practice.
 Enormous morbidity & mortality.
 Pneumonia – inflammation of alveoli.

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Pneumonia

Normal Lung

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Pneumonia

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Normal
Lung
Pneumonia

Etiology:
 Decreased resistance - General/immune
 Virulent infection - Lobar pneumonia
 Defective Clearing mechanism
 Cough/gag Reflex – Coma, paralysis, sick.
 Mucosal Injury – smoking, toxin aspiration
 Low Alveolar defense - Immunodeficiency
 Pulmonary edema – Cardiac failure, embol.
 Obstructions – foreign body, tumors

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Pneumonia

Patterns of Lung disorders:

 Airway
 Bronchitis, Bronchiectasis, Bronchiolitis.
 Tumors / Cancer
Parenchyma
*

 Pneumonia. Infections
 Lung abscess, TB
 Hyaline membrane dis (HMD & ARDS)
 Pneumoconiosis
 Tumors / Cancer
 Pleura:
 Pleural effusion (TB)
 Tumors / Cancer
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Pneumonia

Pathogenesis of Pulmonary Infections

Step 1: Entry
 Aspiration (ie Pneumococcus)

 Inhalation (ie Mtb and viral pathogens)

 Inoculation (contaminated equipment)

 Colonization (in patients with COPD)

 Hematogenous spread (patients with

sepsis)
 Direct spread (adjacent abscess)
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Pathogenesis:
Pathogenesis:
Pneumonia

Pneumonia Types:
Etiologic Types: Morphologic types:
 Infective  Lobar

 Broncho
 Viral
 Interstitial
 Bacterial
 Fungal Duration:
 Acute
 Tuberculosis
 Chronic
 Non Infective
Clinical:
 Toxins
 Primary / secondary.
 chemical
 Typical / Atypical
 Aspiration
 Community a / hospital a
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Pneumonia

Lobar Pneumonia:
 whole lobe, exudation - consolidation
 95% - Strep pneum.(Klebsiella in aged, DM,
alcoholics)
 High fever, rusty sputum, Pleuritic chest pain.
 Four stages: (*also in bronchopneumonia)
 Congestion – 1d – vasodilatation congestion.

 Red Hepatization 2d Exudation+RBC

 Gray Hepatizaiton 4d neutrophils &

Macrophages.+ fibrin deposition

 Resolution – 8d few macrophages, normal.
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 Grey Hepatization
Resolution

Pathogenesis of Pneumonia

Congestion
Red Hepatisation
Pneumonia

Lobar
Pneumonia:

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Pneumonia

Lobar
Pneumonia:

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Pneumonia

Lobar Pneumonia – Gray hep…

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Pneumonia

Lobar Pneumonia:

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Pneumonia

Lobar Pneumonia: Congestion

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Pneumonia

Lobar Pneumonia: Red hepat.

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Pneumonia

Broncho-
pneumonia

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Pneumonia

Bronchopneumonia (patchy)
 Extremes of age. (infancy and old age)
 Staph, Strep, Pneumo & H. influenza
 Patchy consolidation – not limited to lobes.
 Suppurative inflammation
 Usually bilateral
 Lower lobes common

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Pneumonia

Broncho-
pneumonia

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Pneumonia

Broncho-
pneumonia

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Pneumonia

Broncho
Pneumonia

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Pneumonia

Bronchopneumonia:

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Pneumonia

Bronchopneumonia - CT

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Pneumonia

Bronchopneumonia

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Pneumonia

Broncho – Pneumonia - Lobar

 Extremes of age.  Middle age – 20-50
 Secondary.  Primary in a healthy
 Both genders.  males common.
 Staph, Strep, H.infl.  95% pneumoc (Klebs.)
 Patchy consolidation  Entire lobe consolidation
 Around Small airway  Diffuse
 Not limited by  Limited by anatomic
anatomic boundaries. boundaries.
 Usually bilateral.  Usually unilateral

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Broncho – Pneumonia - Lobar
Pneumonia

Interstitial / atypical Pneumonia

 Primary atypical pneumonia in the
immunocompetant host (Mycoplasma or
Chlamydia)
 Interstitial pneumonitis
 immunocompromised host : Pneumocystic carinii; CMV
 Immunocompetant host: Influenza A
 Gross features:
 Lungs are heavy but not firmly consolidated
 Microscopic features:
 Septal mononuclear infiltrate
 Alveolar air spaces either ‘empty’ or filled with
proteinaceous fluid with few or no inflammatory cells
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Interstitial
Pneumonia:
Pneumonia

Interstitial Pneumonia:

Lymphocyte
Infiltrate in
alveloar wall

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Pneumonia

Chronic Pneumonia
 Chronic, lymphoid infiltrate,
 No classic stages.
 Lung destruction – cavity, abscess etc.
 Organisms
 Mycobacterium tuberculosis
 Histoplasma capsulatum
 Aspergillosis
 Actinomyces

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Pneumonia

Comm – Pneumonia - Nosoc

 In healthy adults  In *sick patients.
 Gram positive.  gram-negative bacilli
 Streptococcus  Pseudomonas
pneumoniae (90%) aeruginosa, Escherichia
 Strep. Pyogenes, coli, Enterobacter,
Staph, H. Proteus, and Klebsiella.
influenzae and
Klebsiella in elderly
or with COPD.

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Pneumonia

Pathogenesis of Clinical features:

*Alveolar inflammation.
 Tachypnoea, Dyspnoea, Resp Acidosis 

Solid/airless lungs – decreased

oxygenation.
 Dull percussion - Consolidation –

Exudation
 Rusty sputum - RBC & Inflammatory cells.

 Fever – Inflammatory mediators.

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Pneumonia

Complications of Pneumonia
 Abscesses
 Localized suppurative necrosis, Right side
often in aspiration.
 Staphylococcus; Klebsiella; Pneudomonas
 Pleuritis / Pleural effusion.
 Inflammation of the pleura ( Streptococcus
pneumoniae)
 Blood rich exudate (esp. rickettsial diseases)
 Empyema
 Pus in the pleural space.
 Septicemia
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Pneumonia

Abscess formation

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Pneumonia

Lung Abscess:

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Pneumonia

Abscess formation

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Pneumonia

Lung Abscess:

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Pneumonia

Lung Fungal Abscess: Candida

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 Lung abscess
Pneumonia

 Local suppurative process within the lung

ch by necrosis of lung tissue
 Aerobic & anaerobic streptococci, staph
aureus, gram negative org.
 Entry-
1) Aspiration of infective material –
 Acute alcoholism, coma anesthesia
 Suppression of cough reflexes

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Pneumonia

Contd…
 2) primary bacterial infection
 Post pneumonic- staph aureus, klebseilla
 Fungal infections, bronchiectasis
 3) septic embolism- IE on RT side of heart
 4) malignancy
 5) spread from adjacent organ

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Pneumonia

Clinical features
 Cough
 Fever
 Foul smelling purulent or blood stained
excess sputum
 Chest pain
 Weight loss
 Clubbing of fingers
 Rule out carcinoma – 10 to 15 % cases

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Pneumonia

complications
 Resolution with antimicrobial therapy
 Extension of infection into pleural cavity
 Haemorrhage
 Brain abscess, meningitis
 Reactive secondary Amyloidosis - rare

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 The only place where
success comes before
work is in a dictionary…!
Vidal Sassoon