List 3 causes of injury to the mucociliary escalator.
inhaling hot or corrosive gases (firefighters)
genetic disturbances (immotile cilia syndrome)
List 3 causes of loss of cough reflex.
List 3 causes of interference with phagocytic or bacterial action of alveolar macrophages.
Review the lung defense mechanisms.
Which lymphocytes are normally found in the airspaces?
List 3 predisposing causes for secondary pneumonia.
postoperative (ventilation reduced)
smoking (mucociliary reflex)
aspiration (due to loss of cough and swallowing reflex)
preexisting lung disease (viral infection, emphysema, bronchiectasis)
bronchial obstruction (tumor, foreign bodies)
coma (cough reflex lost)
Patient presents with abrupt high fever, cough, rusty purulent sputum, chest pain, and pleural rub.
What happens to air entry into the lungs in pneumonia?
decreased air entry
Samples used to identify microbial cause of pneumonia (2)
sputum and blood
Review pneumonia syndromes.
What is the typical site of action of pneumonia? atypical site?
typical: alveolar space
atypical: alveolar wall (think Mycoplasma, but also associated with viruses)
List the 7 important causative agents of acute pneumonia.
List 4 important causative agents of atypical pneumonia.
viruses, e.g. influenza
List 3 important causative agents of nosocomial pneumonias.
gram-negative rods (Enterobacteriaceae -- Klebsiella spp., E. coli, Pseudomonas spp.)
Staph. aureus (MRSA)
Common complication of aspiration pneumonias
lung abscess formation
Describe the causative agents of aspiration pneumonias.
mixed nature of organisms --> anaerobic oral flora and aerobic organisms
List 3 anaerobic oral flora that cause aspiration pneumonia.
List 4 aerobic causes of aspiration pneumonia.
List 2 bacteria that cause chronic pneumonia.
List 2 causes of granulomatous chronic pneumonia.
List 3 fungal causes of chronic pneumonia.
Describe the metabolism of bacteria that commonly cause necrotizing pneumonia and lung abscess.
List 3 causative agents of necrotizing pneumonia and lung abscess.
List 5 causative agents of pneumonia in the immunocompromised host.
Mycobacterium avium intracellulare
Pus in the pleural cavity secondary to pneumonia
Which pathogens normally infect the alveolar spaces?
Which pathogens normally infect the alveolar walls (interstitium) of the lungs?
Pneumonia characterized by large confluent areas of consolidation of the whole lobe.
Organism associated with lobar pneumonia
How does lobar pneumonia spread?
through pores of Kohn
Pneumonia that does not involve the bronchi
Pneumonia that affects both bronchi and the surrounding alveoli
Pneumonia characterized by patchy areas of necrosis
Are more virulent organisms associated with lobar or bronchopneumonia?
Which pneumonia is rarely associated with pleuritis?
List in order the 4 stages of bronchopneumonia and lobar pneumonia.
Pneumonia stage: heavy, red, boggy lungs with bacterial multiplication in the alveoli, dilated alveolar capillaries, and early fluid exudation
List the 2 main cells involved in the acute congestion stage of pneumonia.
early red cells
What stage of pneumonia is sometimes associated with pleuritis?
List the 3 main cells involved in the red hepatization stage of pneumonia.
What happens to the lining alveolar cells in the red hepatization stage of pneumonia?
lining alveolar cells are lost
Does bronchopneumonia or lobar pneumonia leave residual damage?
Pneumonia stage: lung appears dry, gray, and firm; exudation and hyperemia have stopped and there is red cell depletion
Pneumonia stage: removal of exudate
List 3 complications of pneumonia.
List 4 organisms associated with lung abscess as a complication of pneumonia.
Patient presents with copious foul-smelling sputum, hemoptysis, fever, and malaise.
Lung abscess Rx
List 4 complications of lung abscess.