Smitha Abraham

Case 2.2-
Pathophysiology of Pneumonia
- Pneumonia is an infection of the lower respiratory tract caused by bacteria , viruses, fungi, protozoa, or parasites
- he causative microorganism influences the symptoms and signs with which the patient presents, how the
pneumonia should be treated, and the prognosis
Pathogenesis!
he lungs are constantly e"posed to particulate material and microbes that are present in the upper airways
he lower airways usually remain sterile because of the pulmonary defense mechanisms
Pathogens are usually stopped in healthy individuals by mechanisms of self defense
o Cough refle"
o #ucociliary clearance
o Alveolar macrophage
$etting past these defenses will set off defense mechanisms
o %elease of multiple inflammatory mediators
o Cellular infiltration
o &mmune activation
he development of community ac'uired pneumonia indicates
o (efect in host defenses
o )"posure to particularly virulent organism
o An overwhelming inoculums
#echanism through which pathogen reaches lung!
o Aspiration of oropharyngeal secretions *saliva+
o &nhalation of microorganisms that have been released into the air when an infected individual coughs,
sneezes, or tal,s, or from aerosolized water such as that from contaminated respiratory therapy
e'uipment
o -acteremia from infection elsewhere in the body
o &. drug abuse
&nflammatory mediators and immune comple"es can damage bronchial mucous membranes and alveolar
capillary membranes, causing acini and terminal bronchioles to fill with infectious debris and e"udates
Some microorganisms release to"ins from their cell walls that can cause further lung damage
Accumulation of e"udates in acinus leads to dyspnea and can lead to hypo"emia
.irulence factors / some microorganisms have developed specific mechanisms to overcome pulmonary host
defenses and establish infection!
o Chlamidophila *formerly Chlamydia+ pneumonia produces a ciliostatic factor
o #ycoplasma pneumonia can sheer off cilia
o &nfluenza virus mar,edly reduces tracheal mucous velocity
o Strep pneumonia and 0eisseria meningitidis produce proteases that can split host immunoglobulins
*specifically &gA+
o Pneumococcus produces!
A capsule that inhibits phagocytosis
Pneumolysin *interacts with cholesterol in host cell membrane+
1yaluronidase
o #ycobacterium species, 0ocardia species, 2egionella species are resistant to microbicidal activity of
phagocytes.
Pathophysiology of Bacterial Pneumonia
-acterial organisms initiate inflammatory and immune responses
he immune response
o Complement activation
o Production of antibodies
o &nflammatory cyto,ines and cells are released that cause alveolar edema
)dema creates a medium for the multiplication and spread of bacteria in lungs
2ungs fill with e"udates
Alveoli fill with blood, cells, fibrin, edematous fluid and organisms which gives lung tissue a red
appearance called red hepatization
Affected tissue becomes grey *grey hepatization+ because of fibrin deposition over pleural
surfaces fibrin 3 leu,ocytes are present and consolidate in the alveoli where phagocytosis ta,es
place
%apid lysis of pneumococcal bacteria *e"ample,from antibiotics+ results in release of intracellular bacterial
proteins that can be to"ic*li,e pneumolysin+ /worsening of clinical symptoms sometimes seen in individuals
immediately after they begin antibiotic treatment
Pathophysiology of Viral Pneumonia
#ost respiratory viruses multiply in the epithelium of the upper airway and secondarily infect the lung
Severe pneumonias can result in e"tensive consolidation of the lungs with barying degrees of hemorrhage
Some patients show bloody effusions and diffuse alveolar damage
#echanism of damage to tissue depend on virus involved!
o #ost viruses directly affect the pneumocytes or the bronchial cells
o 1yperactivity of inflammation from the immune response is the main pathological process
o %espiratory viruses damage the respiratory tract and stimulate the host to release multiple factors
1istamine, brady,inin, interleu,in*s+
o .iral infections also alter bacterial colonization
&ncrease bacterial adherence to respiratory epithelium
%educe mucociliary clearance
Alter bacterial phagocytosis by host cells
%)4)%)0C)S!
- #cCance , 1uether
- 5umar, Cotran, %obbins
- 6po(ate
- #edscape %eference