Lec 9 Pneumonia Pathology Flashcards Preview

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Flashcards in Lec 9 Pneumonia Pathology Deck (44):
1

Bronchopneumonia: what do you see in image

image: patchy consolidation of lung centered on bronchi

2

Lobar pneumonia: what distinguishes it?

- affects entire lung lobe
- associated with increased virulence of organism or most host vulnerability [infants, elderly]

3

What do you see on histology with bacterial pneumonia?

neutrophils in bronchi, bronchioles, and adjacent alveolar spaces

4

Can you tell which bacteria just from histology image?

Not reallly

staph aureus = really virulent so more likely to cause hemorrhage

pseudomonas = likes to hang out around RBCs + invade blood vessel wall

5

What puts you at risk for community acquired pneumonia?

usually baceteria or virus

- Extremes of age
- Chronic diseases (congestive heart failure, COPD, and diabetes)
- Congenital or acquired immune deficiencies
- Decreased or absent splenic function (sickle cell disease or post splenectomy


6

WHat is major cause of community acquired pneumonia?

strep pneumo = 80-90%

7

Who is at risk for nosocomial pneumonia?

- pt with severe underlying disease
on mechanical ventilater

8

What bugs cause nosocomial pneumonia?

staph aureus
pseudomonas
other gram neg rods [klebsiella, legionella]
EColi

9

What bugs cause community acquired pneumonia?

- stre pneumo
- H influenza
- klebsiella, legionella
- staph aureus

10

What are potential outcomes of bacterial pneumonia?

- resolution
- pleural effusion
- empyema
- fibrosis
- abcess
- bacteremia

11

What is a lung abscess? what causes it?

localized collection of pus within parenchyma

cause: 2ndary to bacterial or fungal infection; bronchila obstruction; septic emboli; aspiration

12

What are symptoms of lung abscess

cough, fever, foul-smelling sputum, fever, chest pain, weight loss

13

What is treatment of lung abscess?

need to resect

14

What is atypical pneumonia? most common causes?

pneumonia without alveolar exudate

largely confined to alveolar septa and pulmonary interstitium

lymphocytic infiltrate in interstitium rather than neutrophils in air spaces [as in typical]

see patchy inflammatory changes in lungs

most commonly due to mycoplasma, viruses

15

What is morphology of atypical pneumonia?

- predominant in interstitium
- localized within walls of alveoli
- widened septa filled with inflammatory infiltrate of lymphocytes and occassionally plasma cells

intra-alveolar neutrophils generally absent

16

What type of viral infections involve lung?

- cytomegalovirus
- herpesvirus
- adenovirus
- influenza

17

What pts generally get viral pneumonia?

pts who are immune compromised by

- AIDS
- chemo
- transplant

18

what does CMV infection look like

intranuclear and intracytoplasmic inclusions

big cell [meGALO] with huge dark nucleus from intranuclear inclusion

KNOW THIS

19

What does herpes infection look like?

ulcerative process involving airways

multi-nucleated big cells with intranuclear inclusions [not intracellular]

nuclei tend to mold together = pomegranite appearance

KNOW THIS

20

What does adenovirus infection look like?

single large intranuclear inclusion = "smudge cell"

tend not to form big pneumocytes like the others

no intracytoplasmic inclusions

21

What does primary TB infection look like?

caseating/necrotizing granuloma

22

What is ghon complex?

primary pulm granuloma [usually above or below interlobar fissure PLUS involvement of hilar lymph nodes

23

Where does secondary TB usually involve?

lung apex

24

How does miliary TB look?

multiple small granulomas in lungs

can spread to other organs due to lymphatic and hematogenous spread

25

Who gets MAI?

pts with HIV/immune compromised

pts with right/middle lobe syndrome

26

What happens in MAI with immune compromised

potential findings:
granulomas
big sheets of histiocytes
"mycobacterial pseudotumor"

27

How does right middle lobe syndrome make you at risk for MAI

happens in pts with bronchiectasis of right middle lobe; have difficulty clearing secretions

28

What are features of histoplasma capsulatum?

Small spores (2-5 mu) = same size as RBC

Unequal narrow budding = looks like bowling pins

Intra- or extracellular

Best seen by silver impregnation (GMS)

29

How does histoplasmosis present?

similar to TB

get disseminated in immune compromised

30

What location should you think for histoplasmosis?

mississipi and ohio river valleys

also caribbean, asia

31

What do histoplasmosis granulomas look like on H & E?

fibrotic rim
well circumscribed granulomas

32

What location associated with coccidioides?

arizona, san joaquin valley

33

What are features of coccidioides on stain?

- similar to histo = coin lesion [large granuloma looks like coin], large fibrotic granuloma with central necrosis

large organisms much bigger than RBC

thick walled spherules with lots of endospores

see on H&E but better with GBS or PAS stain

34

What location associated wtih blastomycosis?

deep south -- louisiana or mississipi

35

What presentation of blastomycosis?

skin/pulmonary disease

large granulomas with central necrosis containing large numbers of neutrophils in the middle of granulomas

36

What are features of blastomycosis?

- big organism
- broad base budding

- granuloma with central necrosis containing neutrophils

37

What are features of aspergillus?

- fungal hyphae, septate, narrow angle branching (40-60 degrees)

- mostly visible with H&E but best with GMS silver stains

38

What are non-invasive vs invasive aspergillosis?

non-invasive = fungal ball in body cavity

invasive = in immune compromised, goes into blood vessels get hemorrhage, infarction

39

What are two diseease presentations of cryptococcus?

meningitis
pulmonary

40

What happens in pulmonary cryptococcus?

- occurs in both immune competent and compromised

see more frequently in immune suppressed, malignancy, DM

most pts are asymptomatic

41

What are features of cryptococcus?

- big range of sizes; oval to elliptical

- may have discernible halo on H&E

- narrow based budding

capsule hilighted by muccarmine, DPAS, alcian blue

42

How can cryptococcus look?

- granulomas
- fibroinflammatory mass with histiocytes
- mucoid pneumonia

43

What do we see in pneumocystis jiroveci?

- pneumocystis filling alveolar spaces with pink foamy material

diagnose by histology slides with GMS silver stain

44

What is morphology of PCP?

- some crescent shaped, some circles
- about same size of RBC
- dark rim with central dot
- no budding