Lecture Pathology ppt

Case Study: 13-Month-Old Girl

• Patient Profile: 13-month-old girl.

• Symptoms:

  • Altered general status.

  • Fever.

  • Headache.

  • Lethargy.

  • Diarrhea.

• Initial Diagnosis: Viral enterocolitis (COVID-19 negative).

• Progression: No significant improvement after one week of hospitalization.

• Further Investigation: Re-hospitalization for cardiac investigations due to suspicion of:

  • Congenital cardiac malformation.

  • Myocarditis.

• Outcome: Sudden death.

• Post-mortem: Autopsy required by cardiologist.

Pathology of the Respiratory System

• Scope:

  • Lesions of the upper respiratory tract (pp. 545-547).

  • Pathology of the lung.

• Disorders of Pulmonary Air Content:

  • Atelectasis.

  • Respiratory distress syndrome (adult and newborn) (pp. 495-497, 278-279).

• Obstructive Lung Diseases: (pp. 498-499, 500-506).

• Pulmonary Infections: Pneumonias (pp. 519-525).

• Injury by Non-Therapeutic Toxic Agents: Drug abuse (pp. 315-317).

• Chronic Interstitial Lung Diseases: Smoking-related interstitial diseases (pp. 506-508; 514-515).

• Lung Tumors: (pp. 537-544).

• Pleural Diseases: (pp. 544-545).

Respiratory System Anatomy (Terminology)

• General Terms:

  • Respiratory system = aparat respirator = appareil respiratoire.

• Upper Airway:

  • Epiglottis = epiglotǎ = épiglotte.

  • Nasal cavity = cavitate nazală = cavité nasale.

  • Oral cavity = cavitate bucală = cavité buccale.

  • Pharynx = faringe = pharynx.

  • Larynx = laringe = larynx.

  • Vocal cord = coardă vocală = corde vocale.

• Lower Airway:

  • Trachea = trahee = trachée.

  • Right lung = plămîn drept = poumon droit.

    • Upper lobe = lob superior = lobe supérieur.

    • Middle lobe = lob median = lobe moyen.

    • Lower lobe = lob inferior = lobe inférieur.

  • Left lung = plămîn sting = poumon gauche.

    • Upper lobe = lob superior = lobe supérieur.

    • Lower lobe = lob inferior = lobe inférieur.

• Other Structures:

  • Esophagus = esofag = desophage.

  • Heart = inimă = cœur.

  • Pericardium = pericard = péricarde.

  • Diaphragm = diafragma = diaphragme.

  • Aorta = aortă = aorte.

  • Pulmonary artery = arterǎ pulmonarǎ = artère pulmonaire.

Smoking History

• 1 pack a day for 20 years.

Pathology of the Nose, Middle Ear, and Paranasal Sinuses

• Etiology:

  • Common viruses: Rhinoviruses, Coronavirus, Respiratory Syncytial Virus, Adeno-Enteroviruses.

  • Other identified pathogens: Coxsackievirus A, EBV, Streptococcus β-hemolytic group A.

  • Unknown causes account for approximately 40% of cases.

• Rhinitis:

  • Acute catarrhal rhinitis (common cold).

  • Acute necrotizing rhinitis.

  • Allergic rhinitis: seasonal, perennial.

  • Chronic rhinitis: hyperplastic polyp, atrophic rhinitis.

• Rhinopharyngitis, Pharyngotonsillitis: Primarily in infants.

• Otitis: Acute, chronic (cholesteatoma).

• Sinusitis: Acute, chronic.

• Kartagener Syndrome:

  • Characterized by the triad of sinusitis, bronchiectasis, and situs inversus.

  • Associated with defective ciliary function.

• Specific Inflammations: Tuberculosis, syphilis, rhinoscleroma, fungal infections (rhinosporidiosis), Wegener’s granulomatosis.

Sinusitis

• Chronic sinusitis involving the ethmoid and maxillary sinuses.

Rhinoscleroma

• Caused by Klebsiella rhinoscleromatis.

• Histological features: Russell's bodies and Mikulicz cells.

Wegener's Granulomatosis

• Specific inflammatory condition affecting the respiratory tract and kidneys.

Rhinophyma

• Hyperplasia of sebaceous glands of the nose.

Tumors of the Nose and Paranasal Sinuses

• Benign:

  • Papilloma.

  • Hemangioma.

  • Angiofibroma.

  • Adenoma.

• Malignant:

  • Nasopharyngeal carcinomas.

  • Squamous cell carcinoma – HPV-related.

  • Undifferentiated (lymphoepithelial) carcinoma – EBV-related.

  • Adenocarcinoma, adenoid cystic carcinoma.

  • Malignant melanoma.

  • Lymphomas: Burkitt lymphoma (EBV-related) and other non-Hodgkin lymphomas.

Inverted Papilloma

• Characterized by inward growth pattern.

Juvenile Angiofibroma

• A benign but locally aggressive tumor, typically occurring in adolescent males.

Nasopharyngeal Carcinoma

• Tumor located in the nasopharynx region.

Larynx Anatomy

• Regions:

  • Supraglottic space.

  • Glottic space.

  • Infra-glottic space.

• Structures:

  • Epiglottis.

  • Ventriculus laryngis.

  • Vocal cord (Stimmband).

  • Schildknorpel (Thyroid cartilage).

  • Luftröhre (Trachea).

  • Taschenband (Ventricular fold).

Diseases of the Larynx

• Laryngeal Edema:

  • Causes: Allergies, inflammations, tumors.

• Laryngeal Stenosis:

  • Causes: Obstruction, compression.

• Laryngitis:

  • Acute catarrhal laryngitis: Viruses, allergies.

  • Acute epiglottitis: Haemophilus influenzae.

  • Acute pseudomembranous laryngitis (diphtheric croup): Corynebacterium diphtheriae.

  • Acute necrotizing laryngitis.

  • Chronic laryngitis with leukoplakia.

• Specific Inflammations: Tuberculosis, syphilis, Wegener’s granulomatosis.

Laryngeal Edema

• Swelling of the larynx, which can compromise the airway.

Laryngeal Obstruction

• Obstruction of the larynx, commonly caused by food or foreign objects.

Acute Laryngitis (Epiglottitis)

• Inflammation of the epiglottis, often caused by bacterial infection.

Laryngotracheitis

• Inflammation of both the larynx and trachea.

Croup and Necrotizing Tracheitis

• Croup: Viral infection causing inflammation of the larynx and trachea.

• Necrotizing tracheitis: Severe inflammation leading to necrosis of the trachea.

Trachea

• Complications:

  • Intubation-related changes: Spindle-shaped widening, mucosal necrosis.

  • Post-tracheostomy scar.

  • Hemorrhagic influenza.

  • Pseudomembranous formation.

  • Carcinoma.

Hemorrhagic-Fibrinous Laryngotracheitis

• Inflammation of the larynx and trachea characterized by hemorrhage and fibrin deposition.

Epiglottis Cyst

• Cyst formation on the epiglottis.

Tuberculous Laryngitis

• Tuberculosis infection of the larynx, presenting as:

  • Pseudopolipous tuberculosis.

  • Ulcerative tuberculosis.

Tumors of the Larynx

• Benign:

  • Papilloma.

  • Papillomatosis (HPV 6 and 11).

  • Singer’s node (laryngeal polyp).

• Malignant:

  • Squamous cell carcinoma:

    • Supraglottic: Metastasizes to cervical lymph nodes.

    • Glottic: Best prognosis.

    • Subglottic: Rare tumor.

  • Complications: Asphyxia, necrotic pneumonia, hemorrhages.

  • Sarcomas, malignant lymphomas.

Pseudotumors and Tumors of the Larynx

• Overview of various laryngeal lesions.

Papillomatosis

• Multiple papillomas in the larynx, caused by HPV infection.

Supraglottic Carcinomas

• Carcinomas located above the glottis.

Glottic Carcinomas

• Carcinomas originating in the glottis region.

• Types: Ulcerated tumors, papillomatous tumors.

Subglottic Carcinoma

• Carcinoma located below the glottis.

Laryngeal Carcinomas - Advanced Stages

• Presentation of laryngeal cancers in advanced stages.

pTNM Staging

• T1a, pT1a, T1b, pT1b, T2, pT2, T3, pT3, T4, pT4, pT1: Various pTNM staging classifications for laryngeal cancer.

Congenital Disorders of the Lung

• Lung hypoplasia.

• Polycystic lung.

• Kartagener’s Syndrome:

  • Situs inversus + bronchiectasis + chronic rhinosinusitis + lack of the frontal sinuses.

  • Defective ciliary function.

• Cystic fibrosis.

• α1-Antitrypsin deficiency.

Congenital Malformations

• Examples: Lung hypoplasia, polycystic lung (cystic dysplasia).

Cystic Fibrosis

• Genetic disorder affecting the lungs and other organs.

Disorders of Lung Circulation

• Lung hyperemia.

• Lung congestion.

• Embolism, DIC (Disseminated Intravascular Coagulation).

• Lung infarction.

• Lung hemorrhages (Goodpasture syndrome).

• Pulmonary hypertension.

Acute Pulmonary Edema

• Rapid accumulation of fluid in the lungs.

Chronic Pulmonary Congestion

• (Brown induration of the lung).

Thromboembolism and Lung Infarction

• Deep leg vein thrombosis leading to pulmonary embolism.

• Types of emboli: Massive coiled embolus, small embolus.

• Consequences: Sudden death, pulmonary infarct, pulmonary hypertension.

Embolism

• Bone marrow embolism.

• Bone marrow embolism with DIC.

DIC (Disseminated Intravascular Coagulation)

• Formation of thrombi in small blood vessels.

Goodpasture Syndrome

• Lung hemorrhages associated with autoimmune disease.

• Lungenhämosiderose (iron accumulation) in the lungs.

Bronchitis, Bronchiolitis

• Acute Bronchitis:

  • Types: Catarrhal, muco-purulent, diphtheric croup, hemorrhagic, necrotizing, ulcerative.

  • Evolution, complications: Healing, chronic bronchitis, bronchopneumonia, obstruction, lung gangrene, asphyxia.

Acute Bronchitis Types

• Comparison of catarrhal, purulent, fibrinous, and necrotizing bronchitis.

• Differentiation based on severity of inflammation and necrosis.

Mucopurulent Bronchitis

• Inflammation of the bronchi with mucus and pus production.

Acute Bronchitis and Bronchiolitis

• Inflammation of the bronchi and bronchioles.

Bronchiolitis - Children, Elderly

• Types: Purulent bronchiolitis, bronchiolitis obliterans.

• Causes of bronchiolitis obliterans: Viruses, toxins, collagen diseases, lung transplantation.

• Consequences: Bronchopneumonia, asphyxia, luminal obstruction, atelectasis, death.

Bronchiolitis Obliterans

• Obliteration of bronchioles due to inflammation and fibrosis.

Obstructive vs. Restrictive Lung Disorders

• Obstructive Lesions:

  • Lesions of the airways causing improper airflow.

  • Examples: COPD (chronic bronchitis, asthma, bronchiectasis, emphysema).

• Restrictive Lesions:

  • Decreasing of the lung parenchyma expansion, reducing total pulmonary capacity.

  • Examples: ARDS, pneumoconioses, interstitial fibrosis, smoking/drug-induced lesions, sarcoidosis, TB, thoracic wall disorders.

Chronic Obstructive Pulmonary Diseases (COPD)

• Chronic bronchitis.

• Bronchial asthma.

• Bronchiectasis.

• Chronic emphysema.

• Chronic cor pulmonale.

• Total surface area of the lung (alveolar space): 80 m^2. Daily air volume: 15,000-20,000 liters.

Chronic Cor Pulmonale

• Right ventricular enlargement and heart failure secondary to pulmonary hypertension.

Chronic Bronchitis

• Clinical Definition: Cough and sputum for 3 months in two consecutive years.

• Etiology: Smoking, air pollution.

• Classification: Simple chronic bronchitis, chronic asthmatic bronchitis (intrinsic asthma).

• Consequences: Pneumonia, lung emphysema, lung fibrosis, bronchiectasis, chronic cor pulmonale.

Chronic Bronchitis

• Inflammation of the bronchi.

Bronchial Asthma and Chronic Bronchitis

• Comparison of hypertrophic and atrophic types of chronic bronchitis with squamous metaplasia.

Bronchial Asthma

• Episodic, reversible small airways obstruction: Bronchospasm, inflammation, mucus hypersecretion, edema.

• Asthmatic attacks: Acute emphysema, status asthmaticus.

• Etiology:

  • Atopic asthma (seasonal, familial, extrinsic).

  • Non-atopic asthma (intrinsic).

  • Drug-related asthma (aspirin).

  • Occupational asthma.

  • Allergic bronchopulmonary aspergillosis (mould fungus).

• Consequences: Pneumothorax, bronchiectasis, lung emphysema, CCP, prolonged status asthmaticus, death.

Immediate Hypersensitivity (Type I) in Asthma

• Antigen binds to IgE on mast cells, leading to mediator release.

Asthma

• Acute emphysema and mucus hypersecretion in asthma.

Bronchiectasis

• Types: Cylindrical, ampullary, saccular.

Bronchiectasis

• Congenital and acquired forms.

• Causes include bronchial wall weakness, increased bronchial pressure, fibrosis.

• Morphology: Dilatation of bronchi, mucus and pus in lumen, inflammatory infiltrate, squamous metaplasia.

• Consequences: Pneumonia, lung abscesses, necrotizing bronchitis, lung fibrosis, chronic cor pulmonale, systemic metastatic abscesses, systemic amyloidosis.

Congenital Bronchiectasis

• Association with polycystic lung and mucoviscidosis.

Various Types of Bronchiectasis

• Localized and diffuse forms of bronchiectasis.

Bronchiectasis

• Advanced stage: "bronchiectasis cavernae".

Case Presentation: Chronic Lung Fibrosis and Cor Pulmonale

• 78-year-old man with chronic lung fibrosis and cor pulmonale.

• Complications: Bronchopneumonia, pleuritis, right ventricle failure, death.

Pulmonary Emphysema

• Emphysema of the air spaces: Acute, vicariant, senile, chronic obstructive.

• Interstitial emphysema.

Acute Emphysema

• Acute and reversible overdistension of the lung without tissue destruction.

• Causes: Disorders of respiration, asphyxia, bronchial asthma.

• Macroscopy: Pale and overdistended lungs.

• Microscopy: Dilated alveolar spaces.

• Evolution: Reversible process.

Vicariant (Compensatory) Emphysema

• Dilated spaces around atelectatic areas.

Senile Emphysema

• Senile lung atrophy; spongy-like small lungs, emphysematous thorax without chronic cor pulmonale.

Chronic Emphysema

• Permanent dilatation of air spaces distal to the terminal bronchiole, with alveolar wall destruction.

• Pathogenesis: Dilatation, progressive atrophy, decreased vascular network.

• Macroscopy: Overdistended lungs, spongy-like aspect, associated with chronic bronchitis.

• Microscopy: Large alveolar spaces, thin and broken alveolar septa, stretched capillaries.

Normal Lung vs. Emphysema

• Comparison of lung structure in normal and emphysematous lungs.

Diagnosis of Lung Emphysema

• Methods used for diagnosing lung emphysema.

Chronic Emphysema – Etiology and Pathogenesis

• Exogenous agents (chronic bronchitis, proteolysis) lead to difficulty in expiration, dilatation, destruction, and fusion of air spaces.

• Endogenous factors: \alpha-1 antitrypsin deficiency, lack of antiproteases, immune mechanisms.

Mechanism of Emphysema Development

• Role of tobacco, nicotine, and inflammatory mediators in causing alveolar damage.

Chronic Emphysema

• Types: Centriacinar (centrilobular) and panacinar (panlobular) emphysema.

Bullous Emphysema

• Formation of large bullae in the lungs.

Chronic Emphysema - Consequences

• Chronic hypoxia → pulmonary hypertension → chronic cor pulmonale.

• Atrophy of the lung parenchyma → respiratory failure.

• Rupture of bullae → pneumothorax.

Emphysematous Thorax

• Arteriolar sclerosis and chronic cor pulmonale.

Interstitial Emphysema

• Penetration of air into the lung interstitium.

• Causes: Cough, trauma, artificial respiration (high pressure).

• Consequences: Mediastinal emphysema, subcutaneous emphysema, pneumothorax.

Interstitial Emphysema

• Air in interstitial spaces, leading to subcutaneous emphysema, pneumothorax, mediastinal emphysema, and air embolism.

Atelectasis (Collapse)

• Neonatal atelectasis: Primary (lung anectasis) and secondary (dystelectasis).

• Causes of secondary atelectasis: Lack of surfactant, preterm babies, aspiration of amniotic fluid.

Acquired Atelectasis

• Types: Resorption, compression, scarring (contraction).

• Consequences: Reversible process, superinfection (pneumonia, purulent inflammation).

Normal Lung vs. Atelectasis

• Comparison of a normal lung and a lung with total atelectasis.

Total and Focal Atelectasis

• Total atelectasis: Collapse of the entire lung.

• Focal atelectasis: Localized areas of lung collapse.

Respiratory Distress Syndrome

• Acute restrictive lung disease associated with lung dystelectasis.

• The alveoli are lined by hyaline membranes.

• Hyaline membrane disease (Infant Respiratory Distress Syndrome):

  • Preterm babies, caesarian intervention, mother’s diabetes, lack of surfactant.

  • Dystelectasia, congestion, plasma exudation, hyaline membranes.

  • Treatment: Surfactant, oxygen therapy (may induce retrolenticular fibrodysplasia and bronchopulmonary dysplasia).

• Adult respiratory distress syndrome (ARDS), shock lung:

  • DIC, destruction of surfactant, dystelectasis, hemorrhages, hyaline membranes. Death rate: 40%.

Phases of Respiratory Distress Syndrome

• Exudative and proliferative phases with corresponding changes in lung structure.

Dystelectasis

• Dystelectasis in the context of shock.

ARDS - Hyaline Membranes

• Formation of hyaline membranes in the alveoli during ARDS.

Illicit Drug Use

• Inhaled drugs, water pipe smoking, and injected drugs.

Cocaine

• History of cocaine from its isolation to its use in medicine and recreational products.

Illicit Drug Use - Consequences

• Effects depend on individual immunity, concentrations, routes of administration, and associated substances.

• Heroin overdose: Pulmonary hemorrhagic edema.

• Cocaine: Alveolar hemorrhages, cardiac arrhythmia, infarction, seizures, respiratory arrest.

• Methylphenidate: Pulmonary emphysema.

• Inhaled drugs (marijuana – Cannabis sativa, cocaine, tobacco) → chronic bronchitis, metaplasia.

• Nasal inhalation (cocaine) → perforation of nasal septa, aspiration pneumonia, pyothorax, foreign body granulomas, pulmonary hypertension.

• Injected drugs (heroin) → foreign body granulomas → pulmonary hypertension, infective endocarditis of the right heart → septic pulmonary emboli.

• Other lung lesions: Interstitial pneumonia, lung infarction, asthma exacerbation, chronic obstructive pulmonary diseases.

Cocaine Injection

• Vasoconstriction, necrosis/perforation of the nasal septum, acute porphyria, intranasal warts, scleroderma, palpable purpura, Henoch-Schöenlein purpura, Churg-Strauss syndrome.

Crack Cocaine Abuse

• Pigment-laden macrophages and interstitial lymphocytic infiltrate. Production process: Alkalization of cocaine hydrochloride, heating, crystallization to form ‘rocks’.

Talcum-Induced Pneumoconiosis

• Caused by inhalation of adulterated marijuana.

• Restrictive lung disease due to silicium, magnesium, carbon, and calcium in aluminium-pipe.

Talc-Induced Lung Disease

• Radiographic findings of irregular nodular areas in the upper lobes with architectural distortion.

• Associated with intravenous drug abuse (methylphenidate).

Lung-Related Adverse Drug Reactions (ADR)

• Iatrogenic lung injury; over 400 medications can lead to respiratory diseases.

• Drug-induced pulmonary toxicity is about 3% of cases.

• Symptoms: Dry cough, low-grade fever, dyspnea, wheezing, hypoxemia, chest pain, fatigue, allergic reaction, rash, arthralgia.

• Serum: Increased CD8+ lymphocytes and neutrophils + eosinophils.

• Rx: Alveolar/interstitial/mixed opacities, subpleural masses, pleural thickening/effusion.

• Function: Decrease in the carbon monoxide diffusing capacity.

• Bronchoalveolar lavage fluid: Foamy macrophages ± eosinophils.

Lung-Related Adverse Drug-Reactions

• Drug-induced interstitial lung disease.

• Bronchiolitis obliterans organizing pneumonia (BOOP).

• Interstitial edema, pneumocyte necrosis → interstitial pneumonia, lipid-laden macrophages in alveolar spaces, cytoplasmic lipid inclusion in pneumocytes/interstitial cells/endothelial cells, mononuclear cell interstitial infiltrate, interstitial fibrosis, proliferation of type 2 pneumocytes (± atypia, metaplasia).

• Desquamative interstitial pneumonia.

• Diffuse alveolar damage ± hyaline membranes.

• Eosinophilic pneumonia.

• Granulomatous lung disease.

• Hypersensitivity pneumonia.

• Organizing pneumonia.

• Alveolar hemorrhage is rare.

Hypersensitivity Pneumonia

• Presence of granulomas and mononuclear cell infiltrates.

Bischloronitrosourea (BCNU)-Associated Pulmonary Fibrosis

• Marked interstitial fibrosis, most significant in the subpleural region.

Inflammations (Infections) of the Lung

• Non-Specific Inflammations:

  • Pneumonia: Bacterial (lobar, bronchopneumonia), viral (interstitial pneumonia).

  • Pulmonary fibrosis.

  • Pneumoconioses.

  • Purulent inflammations.

• Specific Inflammations:

  • Tuberculosis.

  • Sarcoidosis.

  • Mycoses, etc.

Pneumonia

*Different types of pneumonia

Lobar Pneumonia

• Bacterial infection confined to one pulmonary lobe in adults.

• Etiology: Streptococcus pneumoniae, etc.

• Evolution: Congestion (prehepatization), red hepatisation, grey hepatisation, yellow hepatisation, resolution.

Lobar Pneumonia

• Comparison of macroscopic view, microscopic type of intraalveolar exudate, and auscultation findings for each stage.

• Stages: Congestion, red hepatisation, grey hepatisation, resolution.

Lobar Pneumonia

*Stages of lobar pneumonia

Lobar Pneumonia

*Red and grey hepatization

Lobar Pneumonia

*Red hepatisation

Lobar Pneumonia

*Grey-Yellow hepatisation

Bronchopneumonia (Focal Pneumonia)

• Children, elderly people, or immunosuppressed patients.

• Localization: Paravertebral areas, bilateral, inferior lobes.

• Classification: Disseminated, confluent.

• Macroscopy: “Spotted lung”.

• Microscopy: Neutrophils and exudation.

• Evolution, complications: Similar to lobar pneumonia.

Disseminated Bronchopneumonia

• Patchy infiltrations throughout the lungs.

Lobar Pneumonia and Bronchopneumonia

• Evolution and complications include healing, death (5-8% of cases), pulmonary complications, and extra-pulmonary complications.

Purulent Inflammations

• Lung Abscess:

  • Etiology: Pneumonia, superinfection, lung infarction, lung tumors, bronchiectasis, bronchial obstruction, aspiration, septic emboli.

  • Evolution, complications: Healing with fibrosis, vascular erosions, thoracic empyema, septicopyemia, amyloidosis.

• Lung Gangrene:

  • Bronchogenic infection with anaerobes.

  • Localized cavity with gangrenous tissue within lung parenchyma.

Lung Abscesses

• Collection of pus within the lung tissue.

Classification of Pneumonia (Pneumonic Syndromes)

• Acute community-acquired pneumonia:

  • Pneumococcic bronchopneumonia: Streptococcus pneumoniae.

  • Haemophilus influenzae (+epiglottitis, meningitis).

  • Moraxella catarrhalis – elderly (in children-otitis).

  • Staphylococcus aureus (rubeola, flu, intravenous drugs – infectious endocarditis) – abscesses or hemorrhagic pneumonia.

  • Legionella pneumophila – air conditioning devices.

  • Enterobacteria: Klebsiella pneumoniae – chronic alcohol abuse, upper lobes.

  • Pseudomonas spp. – nosocomial infections, immunodepressed patients – severe evolution, associated vasculitis.

• Atypical community-acquired pneumonia = Interstitial pneumonia = interstitial inflammatory infiltrate – mononuclear cells (lympho-plasmo-histiocytes)

• A. Viral pneumonia: Flue pneumonia – para-finfluenza viruses (chidren), A and B influenza viruses (adult) H1N1, H3N2, H5N1-aviar adenovirus (military), coronavirus pneumonia – chicken pox, rubella pneumonia - CMV, respiratory sincitial virus, human metapneumovirus, etc.

• B. Pneumonia with Mycoplasma pneumoniae

• C. Pneumonia with chlamidiae: ornitosis, psitacosis

• D. Pneumonia with Ricketsii - Coxiella burnetti: Q fever

• E. Pneumonia with Pneumocystis carinii: preterm babies, AIDS

• F. Chronic interstitial pneumonia

Haemorrhagic Bronchopneumonia

• Bronchopneumonia characterized by significant hemorrhage.

Legionella-Pneumonia

• Caused by Legionella pneumophila.

Case Presentation: Lobar Pneumonia (Klebsiella)

• 52-year-old man with alcoholism and an inoperable lung tumor who developed lobar pneumonia due to Klebsiella.

Atypical Community-Acquired Pneumonia

• Interstitial pneumonia with mononuclear cell infiltrate.

• Includes viral, mycoplasma, chlamydial, rickettsial, and Pneumocystis pneumonia.

Interstitial Pneumonia

• I. Acute interstitial pneumonia = inflammatory infiltrate within alveolar septa (lymphocytes)

  • Influenza viruses (H1N1), measles, Respiratory Sincitial Virus, Mycoplasma pneumoniae

• II. Interstitial pneumonia caused by immunosupression

  • Pneumocystis carinii, CMV: preterm babies, AIDS

Viruses

*General Information about Interstitial Pneumonia

Pneumocystis Carini and Jiroveci

*Viruses in Interstitial Pneumonia

Chronic Interstitial Pneumonia

• Viruses, toxic substances, radiations, drugs, collagen diseases.

• Hypersensitivity pneumonitis (Extrinsic allergic alveolitis).

• Consequences: Respiratory failure, lung fibrosis, Chronic Cor Pulmonale.

Pulmonary Fibrosis

• Etiology: Lung inflammations or idiopathic.

Normal Lung

*Compared to Pulmonary Fibrotic Tissue

Radiation Pneumonitis

• Lung inflammation caused by radiation therapy.

Other Types of Pneumonia

• 3. Nosocomial pneumonia (in-hospital)

  • Enterobacteria (Klebsiella pneumoniae, Serratia marcescens, E. coli)

  • Pseudomonas spp.

  • Staphylococcus aureus

• 4. Aspiration pneumonia

  • Anaerobes and aerobs from oral cavity

• 5. Chronic pneumonia

  • Nocardia, Actinomyces, granulomatous pneumonia

• 6. Necrotizing pneumonia and pulmonary abscess

  • Anaerobe bacteria

  • S. Aureus, K. Pneumoniae, Streptococcus pyogenes

• 7. Pneumonia in patients with immunosupression.

  • CMV, Pneumocystis carinii/jiroveci, Mycobacterium avium complex

  • Aspergillosis, Candidoza, othere viruses, bacteria and mycoses

• 8. Other types:

  • Hypostatic pneumonia, postoperative pneumonia, lipoidic, eozinophilic pneumonia, etc.