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Respiratory III

Respiratory III. Dr Basu MD. Part I. Bacterial Pneumonia Community-Acquired Atypical Pneumonia Lung Abscess. Part II. Tuberculosis . Part I. Bacterial Pneumonia : general features. Definition of Pneumonia: Consolidation of lung Inflammation by infective agents.

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Respiratory III

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  1. Respiratory III Dr Basu MD

  2. Part I • Bacterial Pneumonia • Community-Acquired Atypical Pneumonia • Lung Abscess

  3. Part II • Tuberculosis

  4. Part I

  5. Bacterial Pneumonia : general features • Definition of Pneumonia: • Consolidation of lung • Inflammation by infective agents. • Morphological types of Bacterial pneumonia: • Lobar pneumonia • Bronchopneumonia

  6. Lobar pneumonia: acute pneumonia • Agent: Streptococcus pneumoniae, or pneumococcus ( diplococcic), kelbsiella. • Age : elderly, malnourished, debilitated person. • Features: • involve the entire lobe • Formation of intra alveolar exudates ( plenty ).

  7. Bacterial Pneumonia Streptococcus pneumoniae, or pneumococcus

  8. Lobar pneumonia • 4 morphological stages (seen if no antibiotic is used): • Congestion. • Red hepatization (consistency like liver, red due to RBC). • Gray hepatization ( consistency like liver. Gray due to exudates in alveolus). • Complete Resolution ( complete restoration of normal histology of lung).

  9. This is a : Lobar pneumonia: locate the area

  10. Streptococcus Pneumoniae Pneumonia An entire love is involved. All Neutrophils in alveolous.

  11. Broncho-pneumonia. • Patchy • Age: extreme age group ( very old and child) • Organism: Staphylococcous aureas, H. influenzae, K.Pneumoniae, streptocossous pyogens. • Infection spread from bronchi to adjacent alveoli.

  12. Broncho-pneumonia

  13. Broncho-pneumonia Patchy bronchopneumonia with areas of tan-yellow consolidation.

  14. Bronchopneumonia: Patchy area of alveoli that are filled with PMNs AND EXTEDED INTO ADJACENT BRONCHI.

  15. Complication of pneumonia • Abscess formation. • Pleural empyema • Sepsis→ ARDS • Fibrous pleural scar, Organized pneumonia. Alveolar fibrosis: Organized pneumonia ( lung become solid)

  16. Clinical course • High fever • Chest pain • Cough productive of mucopurulent sputum ( rust color ..if blood present)

  17. Community-Acquired Atypical Pneumonias • Other name:Interstitial pneumonia. • Age: children and young adult. • Clinical Presentation is different from typical bacterial pneumonia: • Cough with no or mild to moderate sputum production. • No physical finding of consolidation.

  18. Community-Acquired Atypical Pneumonias • Agents: • Chlamydia, Mycoplasma, virus • Viruses: • Respiratory syncytial virus, • parainfluenza virus (children); • influenza A and B (adults); • adenovirus (military recruits); • SARS* virus

  19. Common morphology of all Acquired Atypical Pneumonias • The interstitium in the alveolar wall is the main location of inflammation ( lymphocytes and plasma cells) with or without an intra-alveolar exudate.

  20. Mycoplasma pneumonia (most common form of ATYPICAL PNEUMONIA) • Cause: Mycoplasma infection. • Lab: Elevation of titers of cold agglutinins (IgM) in Mycoplasmal infection (in 50% of cases). • PCR for mycoplasma DNA is available.

  21. lymphocytes and plasma cells in interstitial area and no exudates in the alveolar space Mycoplasma pneumonia

  22. Any question please?

  23. Lung Abscess • Definition: localized collection of Neutrophils and necrotic lung tissue. • Cause: • Bronchiectasis • Aspiration of gastric content • Bacterial pneumonia- septic emboli. • Risk group: • Loss of consciousness ( drug, alcohol) • General anesthesia • Bad oral/dental hygiene

  24. Lung Abscess • Anaerobic / Aerobic bacteria : etiology is oral cavity disease. • Aerobic organisms frequently isolated: • Staphylococcous aureus, β hemolytic streptococci = Pneumonia. • Pseudomonas, Kelbsiella = Pneumonia.

  25. Morphology of Lung Abscess • Location: • Aspiration abscess: • Right > left lung. • Pneumonia or bronchiectasis abscesses: • Basal. • X- ray : air fluid level

  26. Lung Abscess : x ray : ‘air fluid level’ Lung abscess: liquefactive necrosis

  27. Clinical course of Lung Abscess • Cough  copious amounts of foul-smelling, purulent sputum. • Striking fever.

  28. Part II

  29. Tuberculosis

  30. Tuberculosis • Definition of tuberculosis: • Communicable Granulomatous disease caused by Mycobacterium Tuberculosis. • [M. avium-intracellulare  10-30% of patients with AIDS]

  31. TuberculosisEpidemiology • TB in the US is a disease of: • The elderly. • The urban poor. • The immuno-suppressed (AIDS).

  32. TuberculosisEpidemiology • Certain disease states increase the risk. • Diabetes mellitus, silicosis, • Malnutrition or Alcoholism. • Immunouppression (HIV).

  33. Type of tuberculosis • Primary • Lung • Lymph nodes (cervical) • GIT • Secondary

  34. Pathogenesis of granuloma formation APC activated CD4 cells through MHC II and TCR complex CD4 APC Activated CD4 cell produce INF-gamma Modify (activate) the macrophage = epitheloid cells Collection of many epitheloid cells= Granuloma Activated macrophage kill bacteria by NO Caseation necrosis

  35. Primary tuberculosis • Definition of primary tuberculosis: • The disease that develop in a previously unexposed (unsensitized) persons. • Morphology: Ghon complex • Focus of primary TB: Lung, Intestine, lympnnodes (Cervical LN).

  36. The Ghon complex: subpleural granuloma + marked hilar lymphadenopathy. Most often in children. .

  37. Primary Tuberculosis: Caseating granuloma with Langhans giant cells: this may calcify.

  38. Implications of Primary Tuberculosis • It may resolve • It may progress to progressive primary tuberculosis. • Some bacilli harbor in the apex of lung for survival (due to high Oxygen level).

  39. Secondary TB • DEF: disease that arises in a previously sensitized host . • Type: • Reactivation of dormant primary lesions. • Exogenous re-infection.

  40. Secondary Tuberculosis (location) • Location of lesions: classically localized to the apex of one or both upper lobes.

  41. Pattern of Secondary Tuberculosis Early lesion Small focus of consolidation Near the apical pleura

  42. Patterns of secondary TB: cavity formation in lung

  43. Progressive pulmonary tuberculosis • Seen in the elderly and immunosuppressed. Both lung involved with cavitary lesion. • This may progress to spread to various organs.

  44. Micro: Caseating granuloma

  45. Progression of Sec. progressive TB Erosion of Bronchus, lymphatic or blood vessels by granuloma Release of caseation in bronchus Lymphatic spread: pulmonary miliary TB Spread by Blood vessels: systemic miliary TB and hemoptysis Seeding to trachea and bronchus

  46. Miliary pulmonary tuberculosisCaseating granuloma : size of Millet seeds.

  47. Clinical Course of Tuberculosis • Low grade fever (remitting). • Night sweats. • Malaise. • Anorexia. • Weight loss.

  48. Clinical Course of Tuberculosis • Diagnosis: • Acid-fast smears and culture of the sputum. • PCR amplification of M. tuberculosis.

  49. TuberculosisMantoux skin testing • False negative (skin test anergy) maybe produced by: • Sarcoidosis. • Immunosuppression. • Overwhelming active tuberculosis. • Hodgkin disease. • False positive results  atypical mycobacterium.

  50. Nontuberculous Mycobacterial Disease • Stains implicated in the US are: • M. avium-intracellulare. • M. Kansasii. • M. abscessus. • Can mimic typical tuberculosis in presentation  upper lobe cavitary disease.

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