Pneumonia

Pneumonia

an inflammation of the lungs usually caused by infection with bacteria, viruses, fungi or other organisms. It is a serious infection or inflammation in which the air sacs fill with pus and other liquid.

Cause

Viruses, bacteria, or (in rare cases) parasites or other organisms In most cases, it is usually the bacteria Streptococcus pneumoniae. Other bacteria that may cause pneumonia include Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila, Staphylococcus aureus, Moraxella catarrhalis, Streptococcus pyogenes, Neisseria meningitidis, or Klebsiella pneumoniae. Pneumonia caused by Mycoplasma pneumoniae is sometimes mild and called walking pneumonia. Viruses, such as influenza A (the flu virus) and respiratory syncytial virus (RSV) can cause pneumonia.

Risk Factors

being in poor health age - the very young and old (over 65) are most susceptible to pneumonia smoking heart disease having a lung disease- ex. Astha, COPD a low immunity to infection ex. AIDS, or undergoing chemotherapy

Altered bacterial lung clearance ( bacterial ability of the alveolar macrophages, extreme virulence of bacteria, susceptibility of the host) Bacterial invasion (klebsiella pneumoniae)

Hyperemic Stage:
Red Hepatization Stage:

Inflammatory reaction in the alveoli Alveoli are infiltrated with RBC, fibrin & leukocytes Bacteria are contained within segments of pulmonary lobes Engorgement of the alveolar spaces with fluid & hemorrhagic exudates Exudates coagulates, resulting in red appearance of affected lung tissue

Gray Hepatization Stage:

Number of RBC in the exudates decreases & are replaced by increased numbers of Neutrophils w/c infiltrates the alveoli, causing the tissue to become solid & grayish

Alveoli are filled with exudates & becomes airless

Sustained perfusion with poor ventilation in the consolidation area

Resolution: or

Consolidation:

Exudates are converted to fibrous tissues Alveoli becomes functionless; Blood passing thru these unventilated areas are not properly oxygenated

Hypoxemia

Hypoxia

Ischemia

Acidosis

CNS Depression

RESPIRATORY FAILURE

Anaerobic metabolism

Lactic acid formation

Sustained perfusion with poor ventilation in the consolidation area

Resolution:
Exudates is lysed & reabsorde by the neutrophils & macrophages

Lymphatics carry exudates away from the site of infection

Restoration of structure & function of the lungs

Signs & Symptoms

The symptoms of pneumonia include the following: Fever Chills Sweating Rapid heart rate Rapid breathing Cough, may be dry or may produce sputum Sputum, may appear clear, greenish-yellow, or rusty Chest pain Shortness of breath Loss of energy, fatigue Weakness Headache

ARDS
Acute Respiratory Distress Syndrome

ARDS

A fulminant lung condition in which trauma to the lungs leads to inflammation of the lungs, accumulation of fluid in the alveolar air sacs, low blood oxygen, and respiratory distress. It is not a specific disease. Instead, it is a life-threatening condition that occurs when there is severe fluid buildup in both lungs.

Underlying causes that can precipitate ARDS:

Reduced perfusion - Cardiogenic shock - Trauma - Major burns - Fat embolus - Hemorrhage - Severe hypovolemia

Increased Capillary Permeability - Sepsis - Pneumonia - Noxious fume or smoke inhalation - Reactions to drugs -Venoms or toxins - Immune complex diseases - Overtransfusion of crystalloids - Uremia

Direct Tissue & Capillary Insults - Aspiration of gastrointestinal contents - Rapid decompression - Near-drowning - Oxygen toxicity - Hypoxemia - Fluid overload - Starvation

ARDS

Clinical lung Injury(decreased perfusion)

Alveolar epithelial damage

Endothelial damage Complement (C5a) activation

Platelet aggregation

Type II pneumocyte damage

Release of neutrophil Chemotactic factors Neutrophil aggregation & Release of mediators

Bacterial infection

Decreased surfactant production

Alveolocapillary membrane permeability Exudation of fluid, protein, RBCs into interstitium Pulmonary edema & hemorrhage with severe impairment of alveolar ventilation Right-to-left shunt, hyaline membrane formation & finally FIBROSIS

Vasoconstriction

Pneumonia

Atelectasis & impaired Lung compliance

Decreased flow to selected areas

V/Q mismatching

ACUTE RESPIRATORY FAILURE

Signs & Symptoms

Rapid, shallow breathing- increased RR Labored breathing retractions Respiratory alkalosis-hyperventilation Marked dyspnea Hypoxemia unresponsive to oxygen therapy (refractory hypoxemia) CXR-show progressive, patchy, bilateral infiltrates

Here is an example of diffuse alveolar damage in which the lung is diffusely firm and rubbery. Clinically, this is known as adult respiratory distress syndrome (ARDS).

References

Bullock, B. & Henze, R. (2000) Focus on Pathophysiology. Philiadelphia:Lipincott, Williams and Witkins

Mc Cance (2007) Essentials of Pathophysiology

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