pneumonia

Definition
• Pneumonia is acute inflammation of the
lung, usually due to infection affecting
distal airways,especially alveoli,with the
formation of inflammatory exudates.
 Classification
• Etiological agent
– Bacterial
– Viral
– Fungal
– Others: mycoplasma
• Other criteria
– Clinical circumstances
– Host reaction
– Anatomical pattern
 Bacterial Pneumonias
Definition
Bacterial pneumonia is a generic term that
refers to inflammation and consolidation
(solidification) of the lung parenchyma evoked by
bacteria invasion.
•Consolidation — A process of becoming solid
and firm because air spaces are filled with
exudate.
• classification:
– Lobar pneumonia
– Lobular pneumonia (Bronchopneumonia)
 Lobar pneumonia
• Lobar pneumonia is an acute bacterial
infection of a large portion of a lobe or an
entire lobe.
• Etiology
– 90%~95% of lobar pneumonias are caused by
pneumococci (Streptococcus pneumoniae).
– Klebsiella pneumoniae, staphylococci,
streptococci, H. Influenza are occasional
cause.
• Incidence: It occurs in typically otherwise
healthy adults between 20 and 50 years of
age.
 Morphology

• Four stages:
– Congestion
– Red hepatization
– gray hepatization
– Resolution
 The stage of congestion
• Macroscopically
– the affected lobe(s) is(are) heavy, boggy, red.
Red, edematous
 The stage of congestion
• Histologically
– Alveolus walls vascular congestion and
dilation
– alveoli contain protein-rich edema fluid,
scattered neutrophils and numerous bacteria
 The stage of red hepatization
• Macroscopically
– the lung lobe is distinctly red, firm and airless
with liver-like consistency.
 consolidation of
all or the majority
of a lobe of the
lung

• Red
• Solid
• Consistency resembling fresh liver
 The stage of red hepatization
• Histologically
– Alveolar wall vascular congestion becomes
more evident
– the alveolar spaces are packed with red cells,
fibrin and neutrophils.
– the pleura usually demonstrates a fibrinous or
fibrinopurulent exudate (plueritis).
 The stage of gray hepatization
• Macroscopically
– the lung is dry 、 gray 、 firm and liver-like in
consistency.
gray hepatization in
the lower lobe of the
lung
• Dry Pale Firm
 The stage of gray hepatization
• Histologically
– Alveolus wall vascular congestion diminishes
– the fibrinous exudate, neutrophils persist and
increase within alveoli
– the number of RBC relatively reduces
(disintegration)
– The pleuritis is most intense.
　　　　　　图注：大叶性肺炎
灰色肝变期，肺泡腔完整，肺泡隔内毛细血管明显扩张充
血。腔内渗出的纤维素网络了大量的中性粒细胞。 　　
　
灰色肝样变期 ( 低倍 )
灰色肝样变期 ( 高倍 )
 The stage of resolution
• Macroscopically
– the lung is edematous (boggy and wet).
• Histologically
– Alveolus wall vascular congestion reoccurs
– Exudates within the alveoli are enzymatically digested
and either reabsorbed or expectorated, leaving the
basic architecture intact.
– The pleural reaction may similarly resolve or undergo
organization, leaving fibrous thickening or permanent
adhesions.
 Clinical Course
• The onset is abrupt, with high fever and an
episode of a severe shaking chill
• Chest pain
• A cough productive of rusty-colored purulent
sputum (when?)
• Dyspnea
 Complications
• Suppurative pleuritis
• Pulmonary carnification: organization of
the exudate
• Bacteremic dissemination: may cause
septicemia, pyemia or infective shock
• Lung abscess
Pulmonary
carnification
 Lobular pneumonia
• Lobular pneumonia has a characteristic
patchy distribution, centered on inflamed
bronchioles and bronchi with subsequent
spread to surrounding alveoli. Because
lobule is made of bronchiole and
surrounding alveoli, we also call lobular
pneumonia bronchopneumonia.
 Etiology
• The common agents are staphylococci,
streptococci, pneumococci, Haemophillus
influenza, Pseudomonas aeruginosa, etc.
 Incidence
• These people are vulnerable because of
lower defensive mechanism.
– Infants
• With whooping cough, measles.
– The old age
• With influenza, chronic bronchitis, etc.
– People suffering from chronic debilitating
illness or immunosuppression
 Morphology
• Macroscopically
– foci of inflammatory consolidation are distributed in
patches throughout one or several lobes, most frequently
bilateral and basal.
– The lesions are gray-red to yellow, varying in size up to
0.5 to 1 cm in diameter, poorly delimited in margin.
– in severe cases, they may confluent.
– The surrounding areas of consolidation is usually
hyperemia and edematous, but the large intervening
areas are generally normal.
Bronchopneumonia
 Morphology
• Histologically
– focal suppurative exudate fills the
bronchi 、 bronchioles and adjacent alveolar
spaces.
– The centers of suppurative lesions lie in
bronchi and bronchioles.
 Clinical course
• The onset is insidious, often overshadowed
by the predisposing condition.
• Low-grade fever
• Cough with purulent sputum
• Course is irregular, lying on the treatment
and patient’s condition.
• Most can be cured.
 Complications
• Respiratory failure
• Heart failure
• Pyemia
• Abscess
小叶性肺炎并发肺脓肿