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52 Cards in this Set
- Front
- Back
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Suppurative (purulent) inflammation |
-Predominantly neutrophils -Pyogenic (pus forming) bacteria |
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Mononuclear or granulomatous |
-Macrophages, lymphocytes, and/or plasma cells -Granulomas evoked by organisms that resist eradication and stimulate T cell mediated immunity -Granulomas comprised of activated epithelioid macrophages which fuse to form giant cells combined with lymphocytes +/- necrosis |
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Cytopathic cytoproliferative reaciton |
Usually produced by viruses - intracellular, use host machinery + damage host cells |
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Tissue necrosis |
-Gangrenous necrosis due to powerful toxins -Ex: C. perfringens |
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Chronic inflammation and scarring |
caused by many infections |
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Potential anatomic distributions of pulmonary infections |
Lobar vs lobular/bronchopneumonia |
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Types of CAP |
Bacterial Atypical Viral |
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Causes of healthcare associated pneumonia |
-S. aureus (methicillin resistant) -Pseudomonas aeruginosa |
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Causes of aspiration pneumonia |
Anaerobic oral flora admixed with aerobic bacteria |
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Characteristic of chronic pneumonia? |
Granulomatous |
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Necrotizing pneumonia + lung abscess - causes |
-Anaerobic bacteria +/- aerobic infection -S. aureus, Klebsiella pneumoniae |
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Causes of pneumonia in immunocompromised hosts |
-CMV -Invasive aspergillosis |
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Anatomic distribution of pneumonia? |
Lobar |
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With aspiration pneumonia, where do you find problems if pt is upright vs supine? |
Upright = R middle/lower lobe Supine = R upper lobe, posterior segment |
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Anatomic distribution of pneumonia? |
L lower lobe pneumonia |
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Anatomic distribution of pnuemonia? |
Bronchopneumonia (aka Lobular) |
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Pulmonary defense mechanisms against bacteria |
Cough reflex Mucociliary escalator Secretions Macrophage function Immune system |
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When is the cough reflex impaired? |
Coma, alcohol, NM disorders, drugs, pain |
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What is the mucociliary escalator impaired? |
-Primary ciliary dyskinesia -Cigarette smoke -Gases -Viral infections |
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When are secretions impaired? |
CF Obstruction (COPD) |
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When is macrophage function impaired? |
Alcohol Tobacco smoke |
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Features of an acute bacterial infection |
-Intra-alveolar -Acute inflammation -Fibrinopurulent debris (neutrophils) |
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Features of subacute bacterial infection |
-Macrophage infiltrate (mononuclear) -Fibroblast proliferation -Advanced organizing pneumonia |
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Abscess formation from bacterial infection - define + causes |
-Local suppurative process that produces necrosis of lung tissues -Mechanisms: aspiration of infective material, antecedent lung infection, septic embolism, neoplasm - post-obstructive pneumonia -Others: trauma, spread from neighboring organs, hematogenous seeding |
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Complications from bacterial pulmonary infections |
-Abscess -Spread beyond lungs -Bronchopleural fistula -Empyema -Fibrosis -Bronchiectasis |
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Non-viral cause of viral-like pneumonia |
-Mycoplasma pneumoniae -Chlamydia pneumoniae and C. psittaci (ornithosis) -Coxiella burnetti (Q fever) |
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Opportunistic viral pathogens |
Varicella Herpes CMV |
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Viral infections - upper respiratory tract findings |
-Mucosal hyperemia and swelling -Lymphocplasmacytic infiltrate (not neutrophils) -Overproduction of mucus secretions (due to damaged cells) -Predisposes to secondary bacterial infections |
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Histology findings associated with viral pulmonary infections |
-Interstitial process -Chronic inflammation -Necrotizing bronchiolitis |
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Viral or bacterial process? |
Viral - intersitial |
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viral or bacterial process |
Viral - necrotizing bronchiolitis |
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Cytopathic effects seen with viral infections? |
Multinucleated giant cells (formation of syncytium) |
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Classic CMV cell findings? |
-Characteristic Cowdry Type A intranuclear inclusions (Herpesvirus) -"Owl eye" appearance of cells |
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Viruses that cause multinucleated syncytia? |
RSV + HSV |
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Morphology of bacterial vs viral infections (histo findings) |
-Bacterial: intra-alveolar, acute inflammation, +/- necrosis -Viral: chronic inflammation, necrotizing bronchiolitis, cytopathic effect |
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Fungal infections - possibilities in healthy vs immunocompromised ppl |
Healthy: histoplasma, blastomyces, coccidioides, cryptococcus Immunocompromised: aspergillus, zygomycetes (mucormycosis), candida, pneumocystitis |
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Common histo finding seen with fungal infections? |
Granulomas |
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ID features of a granuloma |
Don't confuse multinucleated cells here with those from cytopathic effect (virus) -- would NOT see granulomas with a virus |
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Morphologic features of histoplasmosis |
-3-5 um thin wall yeast forms -Narrow based budding yeast |
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Distribution/acquisition of histoplasmosis |
Inhalation from soil contaminated with bird or bat droppings Ohio-Mississippi River Valleys |
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Organism? |
Histoplasmosis - fungus |
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Morphology of coccidioidomycosis? Clinical presentation? Distribution? |
-Thick walled non-budding 20-60 um spherules with endospores (big) -Granulomas +/- pyogenic reaction (neutrophils) -Develop delayed type hypersensitivity reaction -SW and W US |
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Organism? |
Coccidioidomycosis (see endospores + thick wall) |
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Organism? What is being stained? Symptoms you would see in infected patient? |
Cryptococcus - stain highlights mucin in the capsule; pt would have pneumonia + neuro symptoms and immunocompromised |
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Morphology of blastomycosis |
-5-15 um thick wall yeast forms -Broad based budding (Bs) -Suppurative granulomas |
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Reservoir + distribution of Blastomycosis |
-Soil inhabiting fungus -Central and SE US |
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For a necrotizing, caseating granuloma, would not NOT be on the differential diagnosis? |
Mycoplasma pneumoniae - would resemble viral infection which does not have granulomas |
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TB pathogenesis - before initiation of cell mediated immunity |
Mycobacterium is taken into phagosomes - see maturation arrest, lack of acid pH, ineffective phagolysosome formation Unchecked bacillary proliferation in the phagolysosome --> bacteremia with seeding of multiple sites |
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Initiation and consequence of cell-mediated immunity - TB pathogenesis |
Alveolar macrophages send IL-12 to recuirt T cells T-cells release IFN-gamma to activate macrophages --> leads to phagolysosome maturation and activation, production of NO, production of reactive oxygen species, autophagy --> leads to monocyte recruitment and granuloma formation |
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Primary tuberculosis |
-Inhalation -Formation of a Ghon complex: Ghon nodule/lesion in the periphery seeds the lymphatics, when lymph node is also involved called a complex -Minority progress (most are healed, scar) |
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Primary or secondary TB? |
Primary TB - see Ghon lesion in the periphery (subpleural) |
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Secondary tuberculosis |
-Reactivation (or huge second inoculum) -Lung apex involved (high O2 content) (different from primary) -Manifestations: fibrocalcific scar, cavitary TB (if you can't make a scar, for ex immunocompromised), fibrocaseous TB, miliary TB (small reaction around the blood vessels), TB pneumonia, pleural involvement, spead beyond the lungs |
