PATHOPHYSIOLOGY OF PNEUMONIA

Pneumonia is an abnormal inflammatory condition of the lung. It is often characterized as including inflammation of the parenchyma of the lung (that is, the alveoli) and abnormal alveolar filling with fluid (consolidation and exudation). The body has ways to protect the lungs from infection. In fact, each is frequently exposed to bacteria and viruses that can cause pneumonia, but the body normally uses a number of defenses, such as cough and the normal microorganisms (flora) to prevent harmful organisms from invading and overwhelming the airways. However, numerous conditions, including malnutrition and systemic illness, can lower protection and allow harmful organisms to get past body's defenses and into lungs. The invading organism causes symptoms, in part, by provoking an overly exuberant immune response in the lungs. The small blood vessels in the lungs (capillaries) become leaky, and protein-rich fluid seeps into the alveoli. This results in a less functional area for oxygen-carbon dioxide exchange. The patient becomes relatively oxygen deprived, while retaining potentially damaging carbon dioxide. The patient breathes faster and faster, in an effort to bring in more oxygen and blow off more carbon dioxide. Mucus production is increased, and the leaky capillaries may tinge the mucus with blood. Mucus plugs actually further decrease the efficiency of gas exchange in the lung. The alveoli fill further with fluid and debris from the large number of white blood cells being produced to fight the infection.

Consolidation, a feature of bacterial pneumonias, occurs when the alveoli, which are normally hollow air spaces within the lung, instead become solid, due to quantities of fluid and debris. Viral pneumonias, and mycoplasma pneumonias, do not result in consolidation. These types of pneumonia primarily infect the walls of the alveoli and the parenchyma of the lung.

SCHEMATIC DIAGRAM

Entry of microorganism through nasal passages

Invasion of the respiratory tract

Activation of immune response (Cough)

Ineffective immune response results to infection

Invading lung parenchyma

Release of endotoxins and exotoxins

Continuous mucus production

Massive Inflammation (Pneumonia)

Hazy portion of chest

Dyspnea

Altered gas exhange

Consolidation