PATHOLOGY IMP. Q. /A BY MPMEP.

Q.PNEUMONIA
Discuss the aetiology, classification, investigations,
complications, indications for hospitalisation
and treatment of pneumonia.

DEFINITION :-
•Pneumonia is defined as inflammation with exudative
solidification of the lung parenchyma, generally acute. The
term
"pneumonitis" is synonymous but is best avoided.
Classification
•Pneumonias can be classified in a number of ways. Three
classifications are given below.
A. Classification by Site
Alveolar or air space pneumonia or lobar pneumonias
•The organism causes an inflammatory exudate that
involves many contiguous alveoli. Segmental boundar-
ies are not preserved and the bronchi remain patent. This
results in a radiographic appearance of non-
segmental consolidation with air bronchograms. The
typical example is pneumococcal pneumonia
Interstitial pneumonia
•The inflammation is confined to interalveolar septa.
Radiographically, it gives a reticular pattern.
Mycoplasma pneumoniae, Pneumocystis and viruses
cause interstitial pneumonia.
Bronchopneumonia
•Inflammation is restricted to the conducting airways,
especially terminal and respiratory bronchioles, and
the surrounding alveoli. Radiographically, atelectasis may
be present and air bronchograms are
absent
•The typical example is staphylococcal pneumonia.
Classification by AETIOLOGY
•Pneumonias can also be classified into primary,
secondary and suppurative pneumonias.
Primary Pneumonia
•Primary pneumonia is caused by a specific pathogenic
organism. There is no pre-existing abnormality of the
respiratorysystem.
The organisms causing primary pneumonia are given
below.
Common
•Streptococcus pneumoniae
(most common)
•Haemophilus influenzae
•Moraxella catarrhalis
•Staphylococcus aureus
•Legionella pneumophila
•Mycoplasma pneumoniae
Less common
•Klebsiella pneumoniae
•Streptococcus pyogenes
•Pseudomonas aeruginosa
•Coxiella burnetii (Q fever)
•Chlamydophila pneumoniae or Chlamydia pneumoniae
•Chlamydophila psittaci
•Viruses: Hl Nl influenza virus, seasonal influenza
virus, corona virus producing severe acute respiratory syn-
drome (SARS)
PATHOPHYSIOLOGY :-
Pathological Stages in Development of Pneumonia
•Four stages; all stages may be seen at the same time in
different areas:
•Stage of congestion-just congestion of the•Stage of grey
hepatisation-the exudation is
vessels without alveolar exudation; fineof mainly WBCs
with minimal RBCs; tubular
crepitations may be heardbronchial breathing heard
•Stage of red hepatisation-intra-alveolar•Stage of
resolution-the exudate is absorbed
exudation especially with RBCs; tubularor removed by
macrophages & proteolytic
bronchial breathing heardenzymes; coarse crepitations
heard
CLINICAL FEATURES :-
History
•Classical features are sudden onset of rigors followed by
fever, pleuritic chest pain, cough productive of purulent
sputum and haemoptysis.
•These symptoms may be absent in elderly patients who
present with confusion.
•Patients with atypical pneumonia may have a dry cough.
These patients often have extrapulmonary features that
include myalgias, arthralgias, prominent headache, mental
confusion, abdominal pain and diarrhoea. Haemoptysis is
uncom-mon in atypical CAP.
INVESTIGATIONS :-
•Total and differential leucocyte count: Leucocytosis with a
high percentage of polymorphonuclear leucocytes suggest
bacterial pneumonia. In viral and atypical pneumonias,
total leucocyte count is often less than 5000/mm3•
• Blood culture: This may grow the causative organism,
particularly in pneumococcal pneumonia. However, blood
cultures
are recommended only in hospitalised patients.
•Respiratory secretions: Respiratory secretions should be
subjected to microscopic examinations as well as culture.
These are recommended only in hospitalised patients.
Microscopic examination should include Gram staining and
Ziehl-Neelsen staining. Culture (including anaerobic
culture when indicated) and sensitivity testing should be
done.
TREATMENT :-
General Measures :-
•Check the airway, breathing and circulation.
•Treat shock with intravenous fluids initially.
•Correct hypoxia with oxygen inhalation. If hypoxia
continues or patient develops increasing hypercapnia,
ventilate the
patient mechanically.
•Treatment of pleuritic pain with mild analgesics like
paracetamol or codeine.
Antimicrobial Therapy