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Lecture 4
Scanning electron micrograph of Staphylococcus aureus bound to the surface of a human neutrophil. “Granulocytic Phagocytes,” by Frank R. DeLeo and William M. Nauseef.
Learning Objectives
By the end of this presentation learnings will be able to:
1. Difference between bronchopneumonia and lobar pneumonia.
2. List and discuss the defense mechanisms that protect the lung against
bacterial infection.
3. Describe the agents most commonly cause bacterial pneumonia.
4. List and describe the four classical stages of lobar pneumonia.
5. Discuss the most important complications of bacterial pneumonia.
6. Describe the clinical features of bacterial pneumonia.
7. Identify primary atypical pneumonias, and describe the most common
causes.
8. Discuss the most frequent conditions that predispose to the formation of
pulmonary abscess.
9. Read gross and microscopic pathology plates and radiographic findings of
the most common bacterial and atypical pneumonias.
Marc Imhotep Cray, M.D. 2
Pneumonia: Overview
Pneumonia is a respiratory disease characterized by inflammation of lung
parenchyma (excluding bronchi) caused by viruses, bacteria, fungi, or
irritants
General clinical signs and symptoms of pneumonia include:
Fever, chills, muscle stiffness, pleuritic chest pain, cough, blood-tinged or rusty sputum,
shortness of breath, rapid heart rate, and difficulty breathing
Diagnosis is made by several laboratory methods and (or) diagnostic
procedures, including:
Chest x-ray; Gram stain and culture (bacterial); bronchoalveolar lavage (Pneumocystis
carinii pneumonia [PCP]); serodiagnosis (Mycoplasma)
Classic laboratory findings associated with bacterial pneumonia are a
neutrophilic leukocytosis with an increase in band neutrophils (left shift)
Modified from Davis JL and King EE. Respiratory Pathology (Ch. 7) In: Deja Review Pathology , 2010 11
Four classical stages of lobar pneumonia
Congestion heavy, boggy, and red lung Histologic characteristics are vascular
engorgement, intraalveolar fluid with few neutrophils, and often presence of numerous
bacteria
Red hepatization consolidation of airspaces of lungs on cross section lungs appear
brown-red, firm, and airless, and they resemble liver
Histologically, alveolar capillaries are congested, and alveolar spaces are filled with
erythrocytes, neutrophils, and fibrin
Gray hepatization persistent consolidation exudate inside alveoli compresses
capillaries and reduces pulmonary blood flow on cross-section lung parenchyma appears
airless, consolidated and pale, and grayish-yellow
Histologically, alveoli are filled with a fibrinopurulent exudate, and capillaries in alveolar
walls appear compressed and contain less blood than in previous stage
Resolution is final stage, characterized by granular, semifluid debris that is resorbed,
ingested by macrophages, or coughed up
Abscess: It results from lytic action of neutrophils and is most often found
in pneumonia caused by Staphylococcus aureus
Chest x-ray often appears worse than patient appears (walking pneumonia)
High-Yield Note: Q-fever is most common rickettsial pneumonia,
caused by Coxiella burnetii
Who typically gets Q-fever? People working with infected cattle or
sheep, people who consume unpasteurized milk from infected animals
Marc Imhotep Cray, M.D. 22
Atypical pneumonias: interstitial pneumonitis
General features:
(a) Have a dry nonproductive cough early, often later becoming
more productive
(b) Causative agents do not show up on Gram stain of lavage
fluids or induced sputum
(c) Causative agents do not grow on blood or chocolate agar
(d) Are caused by mycoplasmas or chlamydiae
(e) Resemble viral pneumonias
http://www.intechopen.com/books/respiratory-disease-
http://www.medicalgrapevineasia.com/mg/2012/11/20/the-mycoplasma-story/ and-infection-a-new-insight/pneumonia-in-children
Marc Imhotep Cray, M.D.
Mycoplasma pneumoniae (2)
Laboratory: Diagnosis largely made by clinical recognition of
syndrome (laboratory tests of secondary value)
Cold agglutinins--Titers 1:32 or greater are considered positive
Culture (when done) is on cholesterol-containing
mycoplasma medium, taking 2 to 3 weeks and producing
tiny ‘‘fried egg’’ appearing colonies
Klatt EC. Robbins and Cotran Atlas of Pathology, 3rd Ed., 2015
Klatt EC. Robbins and Cotran Atlas of Pathology, 3rd Ed., 2015
Klatt EC. Robbins and Cotran Atlas of Pathology, 3rd Ed., 2015
Klatt EC. Robbins and Cotran Atlas of Pathology, 3rd Ed., 2015
Klatt EC. Robbins and Cotran Atlas of Pathology, 3rd Ed., 2015
Klatt EC. Robbins and Cotran Atlas of Pathology, 3rd Ed., 2015
Klatt EC. Robbins and Cotran Atlas of Pathology, 3rd Ed., 2015
Klatt EC. Robbins and Cotran Atlas of Pathology, 3rd Ed., 2015 41
Marc Imhotep Cray, M.D.
CASE
A 32-year-old man is brought into the emergency department
because of extensive bruising of the chest in a minor motor vehicle
accident. He is known to be HIV-positive. He complains of
progressive fatigue over the last 3 months and has not visited a
doctor for over a year. A complete blood count (CBC) shows
pancytopenia, and a bone marrow biopsy shows narrow-based
budding yeast.
What is the most likely diagnosis?
What are the usual mechanisms of HIV-induced disease?
49
Sources and further study:
Chen EM and Kasturi SS. Deja review, Microbiology and Immunology 2nd Ed. New York: McGraw-Hill,
2010
Kishiyama JL. Ch. 3 Disorders of the Immune System, Pgs. 31-59 and Bloch KC. Ch. 4 Infectious Diseases,
Pgs. 61-87 In: Hammer GD and McPhee Eds. JS. Pathophysiology of Disease : An Introduction to Clinical
Medicine, 7th Ed. New York: McGraw-Hill Education, 2014
Johnson AG et al. Bacterial Diseases. In: Microbiology and immunology. 4th Ed. Baltimore: Lippincott
Williams & Wilkins, 2010
Le T and Bhushan V. First Aid for the USMLE Step 1 2015, New York: McGraw-Hill, 2015
Textbooks:
Ryan KJ and Ray CG Eds. Sherris Medical Microbiology, 5th Ed. New York: McGraw-Hill, 2010
Carroll KC etal. Jawetz, Melnick, & Adelberg’s Medical Microbiology 27th Ed. New York: McGraw-Hill, 2016