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Pneumonia
PNEUMONITIS
* Classification:
1. Bacterial pneumonia: lobar pneumonia & bronchopneumonia.
2. Viral (interstitial) pneumonia: influenza, measles, chicken pox.
3. Loeffler’s (parasitic) pneumonia: Bilharziasis, ascaris &
ankylostomiasis.
4. Granulomatous pneumonia: T.B, sarcoidosis, leprosy, syphilis,
actinomycosis .
5. Lipoid pneumonia: due to aspiration of oily nasal drops.
6. Irradiation pneumonia.
LOBAR PNEUMONIA
* Def: acute diffuse fibrinous inflammation of one or
more lung lobes.
* Etiology:
• Age: middle age.
• Predisposing factors: low resistance.
• Causative organism: pneumococci.
• Route of infection: droplet infection.
* Pathogenesis:
• Pneumococci are inhaled to reach alveoli.
They cause acute inflammation with excess
fluid exudate. This fluid exudate pass from one
alveolus to another rapidly through the interalveolar pores of Cohn to involve the whole
lung lobe. The fluid exudate expel air away
from the alveoli producing a firm airless lobe
leading to consolidation (hepatization) of the
affected lobe.
1. Stage of congestion
2. Stage of red
hepatization
3. Stage of gray
hepatization
4. Stage of
resolution
1. Duration
1st day
2nd – 4th day
5th – 8th day
9th – day 21
2. Gross Picture: the affected lobe is
- Size: Enlarged.
- Color: Red.
- Consistency: like wet
sponge.
- Cut section: exudes
frothy fluid.
- The covering pleura:
normal
- The hilar L.Ns.: normal
- Enlarged.
- Red.
- Consistency:
consolidated
(hepatized).
- Cut section: dry.
- Pleurisy.
- Enlarged hilar
LNs.
- Enlarghed.
- Gray.
- Consistency:
consolidated
(hepatized).
- Cut section:
dry.
- Pleurisy.
- Enlarged hilar
LNs.
- Since there is
no necrosis,
healing by
resolution
occurs.
Lobar pneumonia of
upper lobe
Lobar pneumonia of
the lower lobe
1. Stage of
congestion
2. Stage of red
hepatization
3. Stage of gray
hepatization
3. Microscopic Picture
a. Alveolar
capillaries:
Congested.
b. Alveolar walls:
thickened.
c. Alveolar spaces:
Show bacteria &
fluid exudate.
a. Alveolar
capillariers:
Congested.
b. Alveolar walls:
thickened.
c. Alveolar spaces:
Show bacteria,
fibrin, RBCs and
polymorphs.
a. Alveolar capillariers:
Less congested
b. Alveolar walls: thin.
c. Alveolar spaces:
Show dead bacteria,
shrinked fibrin,
hemolysed RBCs, excess
polymorphs and
macrophages.
4. Stage of
resolution
Lobar pneumonia; red hepatization
Lobar pneumonia; grey hepatization
1. Stage of
congestion
2. Stage of red
hepatization
3. Stage of gray
hepatization
4. Stage of
resolution
4. Clinical course
- Fever, cough, dyspnea and chest pain.
- At about 9th day the disease ends by crisis (sudden improvement), however
death may occur due to severe toxaemia.
1. Stage of
congestion
2. Stage of red
hepatization
3. Stage of gray
hepatization
4. Stage of
resolution
5. Complications
1.
2.
3.
Spread of infection: direct, lymphatic and blood (toxaemia,
septicaemia).
Lung fibrosis due to failure of resolution.
Post-pneumonic lung abscess.
BRONCHOPNEUMONIA
* Def: Acute suppurative inflammation of bronchioles and
adjacent alveoli characterized by patchy lung consolidation.
* Etilogy:
– Age: extremes of age (young & elderly).
– Predisposing factors: low resistance and bronchitis.
– Causative bacteria: staphylococci, streptococci & H.
influenza.
– Route of infection: endogenous invaders and exogenous
invaders (droplet infection).
* Gross picture:
 Bilateral.
 Basal.
 Multiple consolidated yellowish patches
exuding pus on pressure. Several patches may
coalesce to produce confluent
bronchopneuomonia.
 Enlarged hilar L. nodes.
Bronchopneumonia
Bronchopneumonia
* Microscopic Picture:
I. The broncioles show:
 Their lumen shows: necrotic epithelial cells,
polymorphs & pus cells.
 Their lining: ulceration.
 Their walls: congested capillaries, neutrophils and
pus cells & exudate.
II. The adjacent alveoli show: 3 successive zones: zone
of alveolitis then zone of alveolar collapse and a zone
of alveolar dilatation (compensatory emphysema).
* Complications:
1. Spread of infection: direct, lymphatic and
blood (toxaemia, septicaemia).
2. Lung fibrosis due to failure of resolution.
3. Post-pneumonic lung abscess.
4. Bronchiectasis.