Lung Infection Pathology

Question 1

inflammatory response to bacteria

Answer 1

typically acute inflammation w/ PMNs in alveoli, RBCs in septae

Question 2

inflammatory response to viruses

Answer 2

chronic, lymphos in septae

Question 3

inflammatory response to fungi and mycobacteria

Answer 3

granulomas- Langhans giant cells and histiocytes (connective tissue macrophage)

often have necrotic center

Question 4

differentiate broncho and lobar pneumonia

Answer 4

broncho- scatter foci in single or multiple lobes, terminally ill pts, common cause of death, any type of bacteria

lobar- complete consolidation of lobe, usually strep pneumo, red hepatization early and grey hepatization late

both are bacterial!

Question 5

describe strep pneumo

Answer 5

encapsulated G+ diplococci, normal nasopharynx resident, often preceded by viral infection and/or altered bronchial secretions

Question 6

contrast the early vs late pathology of pneumococcal pneumonia

Answer 6

early (3-4 days)- red hepatization, pulm edema, intra alveolar PMNs and RBCS

late (5-7 days)- gray hepatization, serum/ fibrinous exudates, intra alveolar organization, macrophages

Question 7

anaerobic bacteria examples

Answer 7

streptococci, fusobacteria, baccteroides

Question 8

characteristic of anaerobic aspiration pneumonia

Answer 8

necrosis w/ or w/o abscess, foul smelling sputum

Question 9

characteristics of actinomyces

Answer 9

abscesses w/ colonies (sulfur granules), not acid fast

Question 10

characteristics of nocardia

Answer 10

absecess in immunocompromised, acid fast (to distinguish from actinomyces)

Question 11

complication of bacterial pneumonia

Answer 11

abscess, pyothorax, empyema, bacteremia

Question 12

describe a pulm abscess

Answer 12

walled off infection, foul sputum, commonly predisposed by alcoholism (more oral bacteria, impaired cough)

Question 13

empyema

Answer 13

infection of pleural fluid, can become loculated

Question 14

bacteremia

Answer 14

bacteria in the blood stream- endocarditis, meningitis, pericarditis

Question 15

describe mycoplasma infection

Answer 15

acute inflammation in wall and lumen of bronchiole

milder (walking)

highly transmissible via droplets, easily treated

Question 16

culture for MTB

Answer 16

small, acid fast bacillus

slow growing, 3-6 weeks

Question 17

radiology findings for MTB

Answer 17

Gohn complex, nodules, cavities

Question 18

ghon complex

Answer 18

combo of peripheral nidus of infection (ghon focus, often caseous necrosis) and an infected lymph node (hilar or mediastinal)

Question 19

primary Tb

Answer 19

inhalation of MTB, granulomatous host response

most are asymptomatic

Question 20

secondary Tb

Answer 20

new infection in previously sensitized pt or reactivation of primary TB (w/ lower immune response)

granulomas in apical/posterior upper lobes

multi possibilities: confined in granuloma or new granulomas, cavitate, disseminate thru miliary spread

Question 21

4 complications of TB

Answer 21

miliary TB, hemoptysis (erosion into pulm artery), broncho pleural fistula (erosion into pleural space and empyema), cavity (future home for aspergilloma)

Question 22

miliary TB

Answer 22

many small granulomas in multi organs from hematogenous spread

Question 23

4 fungal pathogens and their locations

Answer 23

histo - ohio river valley, bird droppings

coccidiodies- SW US

crypto- pigeon droppings

blasto- mississippe, ohio, missouri rivers

Question 24

histo immune response

Answer 24

necrotizing granulomatous inflammation- identicle to TB w/o silver stains

Question 25

histology and gross of crypto

Answer 25

looks like a neoplasm grossly (and imaging), caseating granuloma, organisms visible w/ mucicarmine stain

Question 26

shape of aspergillus

Answer 26

septate hyphae w/ acute angle branching

Question 27

aspergillosis disease

Answer 27

invasive, aspergilloma, allergic bronchopulmonary aspergillosis (ABPA)

Question 28

invasive aspergillosis

Answer 28

immunocompromised hosts- invasion of blood vessels and causes infarction/thrombosis necrosis w/ organisms in vessel walls

Question 29

aspergilloma

Answer 29

fungus ball (mycetoma)- grows w/i preexsiting cavity usually from TB tangled mat of hyphae, visible by X ray

Question 30

ABPA

Answer 30

immune reaction to aspergillus eosinophilia of blood and sputum, increased igE

Question 31

pneumocystis patholgy

Answer 31

filling of alveolar airspace w/ organisms and proteinaceous fluid- "frothy" exudates in alveoli esp HIV pts

Question 32

staining for PJP

Answer 32

silver stain shows cup shaped bugs

Question 33

CMV histology

Answer 33

large cells w/ intranuclear inclusions

Question 34

herpes histology for pulm

Answer 34

large cells w/ nuclear inclusions 3 Ms- mult nucleation, margination, molding (fusing together)