Difference between revisions of "Pneumonia"

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'''Pneumonia''' is inflammation of the lung.
[[Image:Acute pneumonia - i -- low mag.jpg|thumb|Acute pneumonia. [[H&E stain]]. (WC)]]
'''Pneumonia''' is inflammation of the lung, which includes infectious and non-infectious etiologies.


There are various types of pneumonia.
It is a subset of the [[medical lung diseases]].  This article primarily deals with the infectious pneumonias. 
 
Idiopathic interstitial pneumonias are listed at the bottom; they are dealt with in detail in the ''[[diffuse lung diseases]]'' article.


=Infectious pnemonia=
=Infectious pnemonia=
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*This is the most common form of (infectious) pneumonia.
*This is the most common form of (infectious) pneumonia.


====Lobular pneumonia====
====Lobar pneumonia====
*Pneumonia that involves a hole lobe.
*Pneumonia that involves a whole lobe.
*Rarely seen in areas where antibiotic treatments are widely available.
*Rarely seen in areas where antibiotic treatments are widely available.


==Acute infectious pneumonia==
==Acute infectious pneumonia==
===General===
{{Main|Acute infectious pneumonia}}
*This is seen by pathologists, in [[autopsy]], from time-to-time.
The most common form of pneumonia. It is usually diagnosed clinically.
 
Most common cause:
*''Streptococcus pneumoniae''.<ref name=Ref_PBoD8_711>{{Ref PBoD8|711}}</ref>
 
The top three community acquired (acute) pneumonia:<ref name=pmid12239229>{{Cite journal  | last1 = Nicolau | first1 = D. | title = Clinical and economic implications of antimicrobial resistance for the management of community-acquired respiratory tract infections. | journal = J Antimicrob Chemother | volume = 50 Suppl S1 | issue =  | pages = 61-70 | month = Sep | year = 2002 | doi =  | PMID = 12239229 }}</ref>
*''Streptococcuc pneumonia''.
*''Haemophilus influenzae''.
*''Moraxella catarrhalis''.
 
Other community acquired pneumonia:<ref name=Ref_PBoD8_711>{{Ref PBoD8|711}}</ref>
*S. aureus.
*Legionaella pneumophila.
*Klebsiella pneumoniae.
*Pseudomonas.
 
Hospital-acquired pneumonia:<ref name=Ref_PBoD8_711>{{Ref PBoD8|711}}</ref>
*Gram-negative rods.
*''Staphylococcus aureus''.
 
===Radiologic correlate===
*Air space disease.
 
===Gross pathology===
*Consolidation (the lung parenchyma is firm) - best appreciated by running a finger over the cut surface of the lung with a small-to-moderate amount of pressure.
 
===Microscopic===
Features:
*Alveoli packed with [[PMN]]s.
*+/-Clusters of bacteria - small dots or rods.
 
Image: [http://commons.wikimedia.org/wiki/File:Pneumonia_alveolus.jpg Normal alveoli & pneumonia (WC)].
 
===Stains===
*Gram stain -- to type the bacteria.


==Chronic infectious pneumonia==
==Chronic infectious pneumonia==
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Common microorganisms:<ref name=Ref_PBoD8_711>{{Ref PBoD8|711}}</ref>
Common microorganisms:<ref name=Ref_PBoD8_711>{{Ref PBoD8|711}}</ref>
*Nocardia.
*Nocardia.
*Actinomyces.
*[[Actinomyces]].
*Mycobacterium tuberculosis.
*[[Mycobacterium tuberculosis]].
*Atypical mycobacterium, e.g. Mycobacterium avium-intracellulare.
*Atypical mycobacterium, e.g. Mycobacterium avium-intracellulare.
*[[Histoplasmosis|Histoplasma capsulatum]].
*[[Histoplasmosis|Histoplasma capsulatum]].
Line 75: Line 44:
*Inflammation.
*Inflammation.
*+/-[[Granuloma]]s.
*+/-[[Granuloma]]s.
==Aspiration pneumonia==
{{Main|Aspiration pneumonia}}
==Cytomegalovirus pneumonia==
{{Main|Cytomegalovirus}}
===General===
*Immunodeficiency.
*Critical illness.<ref name=pmid20931610>{{Cite journal  | last1 = Limaye | first1 = AP. | last2 = Boeckh | first2 = M. | title = CMV in critically ill patients: pathogen or bystander? | journal = Rev Med Virol | volume = 20 | issue = 6 | pages = 372-9 | month = Nov | year = 2010 | doi = 10.1002/rmv.664 | PMID = 20931610 }}</ref>
===Microscopic===
Features:
*CMV nuclear changes:
**Large red nucleus with a pale halo.
*Eosinophilic granular cytoplasmic inclusions.
Images:
*[http://www.pathologyoutlines.com/images/lungcmv2.jpg CMV pneumonia (pathologyoutlines.com)].<ref>URL: [http://www.pathologyoutlines.com/topic/lungnontumorCMV.html http://www.pathologyoutlines.com/topic/lungnontumorCMV.html]. Accessed on: 23 January 2012.</ref>
*[http://www.pathology.washington.edu/about/education/gallery/infections/Aspergillus_d_ppt.jpg CMV pneumonia (washington.edu)].
*[http://www.art.com/products/p360692202-sa-i4008999/frederick-skvara-cytomegalovirus-cmv-pneumonitis-in-the-lung-h-e-stain.htm?sorig=cat&sorigid=177507&dimvals=177507-207238&ui=e5fd37a28e3048d8af7d3285d9b9cdfa CMV pneumonia (art.com)].
===IHC===
*CMV +ve -- cytoplasmic inclusions, large nucleus.


=Diffuse lung diseases=
=Diffuse lung diseases=
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*[[Medical lung diseases]].
*[[Medical lung diseases]].
*[[Lung]].
*[[Lung]].
=References=
{{Reflist|2}}


[[Category:Pulmonary pathology]]
[[Category:Pulmonary pathology]]

Latest revision as of 15:26, 5 March 2017

Acute pneumonia. H&E stain. (WC)

Pneumonia is inflammation of the lung, which includes infectious and non-infectious etiologies.

It is a subset of the medical lung diseases. This article primarily deals with the infectious pneumonias.

Idiopathic interstitial pneumonias are listed at the bottom; they are dealt with in detail in the diffuse lung diseases article.

Infectious pnemonia

Anatomical classification of pneumonia

  • Generally, not used by clinicians.
  • Use of the terms without qualification is discouraged... as they do not make explicit the etiology.

Bronchopneumonia

  • Multiple foci of (acute) inflammation involving the bronchi.
  • This is the most common form of (infectious) pneumonia.

Lobar pneumonia

  • Pneumonia that involves a whole lobe.
  • Rarely seen in areas where antibiotic treatments are widely available.

Acute infectious pneumonia

Main article: Acute infectious pneumonia

The most common form of pneumonia. It is usually diagnosed clinically.

Chronic infectious pneumonia

General

Common microorganisms:[1]

Note:

  • All of the later ones are granulomatous.

Microscopic

Features:

Aspiration pneumonia

Main article: Aspiration pneumonia

Cytomegalovirus pneumonia

Main article: Cytomegalovirus

General

  • Immunodeficiency.
  • Critical illness.[2]

Microscopic

Features:

  • CMV nuclear changes:
    • Large red nucleus with a pale halo.
  • Eosinophilic granular cytoplasmic inclusions.

Images:

IHC

  • CMV +ve -- cytoplasmic inclusions, large nucleus.

Diffuse lung diseases

Main article: Diffuse lung disease
  • AKA idiopathic interstitial pneumonia.

Histologic pattern:

See also

References

  1. ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 711. ISBN 978-1416031215.
  2. ↑ Limaye, AP.; Boeckh, M. (Nov 2010). "CMV in critically ill patients: pathogen or bystander?". Rev Med Virol 20 (6): 372-9. doi:10.1002/rmv.664. PMID 20931610.
  3. ↑ URL: http://www.pathologyoutlines.com/topic/lungnontumorCMV.html. Accessed on: 23 January 2012.
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