Flashcards in Pathology of inflammatory disease Deck (27)
usually pyogenic bacteria with neutrophils in alveoli
usually not pyogenic - atypical (viral or mycoplasmic)
chronic pneumonias - causes
often TB, fungi, parasites, odd bacteria
what are factors predisposing to pneumonia?
1. loss of cough reflex
2. injury to mucociliary apparatus
3. interference with phagocytic or bactericidal action of alveolar macrophages
4. pulmonary edema, congestion
5. accumulated secretions
what are the two overlapping patterns of bacterial pneumonia? what does the pattern depend upon?
bacterial virulence and host resistance
90-95% of lobar pneumonia cases are due to what organism?
what are the classic morphologies of lobar pneumonia?
what are the presenting features of primary atypical pneumonia?
lack of alveolar exudate
very little sputum
confined to alveolar septa and interstitium
"walking pneumonia" is typically due to what organism? what are the most serious symptoms?
bad persistent cough
what is the common pathogenic mechanism of atypical pneumonia?
attachment of organisms to respiratory epithelium - necrosis of cells and inflammatory response
if it extends to alveoli - interstitial inflammation
what is possible if sputum changes from green to yellow?
superimposed bacterial infection
what is the typical histopathology in atypical pneumonia?
interstitial pneumonia with mononuclear infiltrate, diffuse alveolar damage
systemic disease of unknown cause, noncaseating granulomas in many tissues and organs
diagnosis of exclusion
how is the diagnosis of sarcoidosis made?
what are the immunologic factors involved in sarcoidosis?
cell mediated immunity type IV hypersensitivity
1. interstitial and intra-alveolar accumulation of CD4 Th1 cells
2. elevated levels of T cell derived Th1 cytokines - IL-2 and INFy
3. elevated IL-8, TNF
what are the genetic factors associated with sarcoidosis?
what are the "oddities" found inside sarcoid granulomas?
schaumann bodies - lamellated calcified structures usually in giant cells (aka berylliosis)
asteroid bodies - star shaped eosinophilic bodies made of compressed intermediate filaments; common in foreign body giant cells
what is seen on CXR in sarcoidosis?
bilateral interstitial infiltrates and hilar lymphadenopathy
hypersensitivity pneumonitis typically involves what lung structure?
alveoli (allergic alveolitis)
what type of hypersensitivity is associated with hypersensitivity pneumonitis?
type III early (abs in serum)
type IV later (poorly formed granulomas)
what cells are seen in acute hypersensitivity pneumonitis?
what cells are seen in chronic hypersensitivity pneumonitis?
mononuclear interstitial infiltrate (lymphs, plasma cells, macrophages)
what is silo fillers disease?
pulmonary edema due to widespread bronchiolotis obliterans with scar tissue forming in burned small airways
what is the smoker related interstitial disease?
what are the features of pulmonary alveolar proteinosis?
accumulation of acellular surfactant in intra-alveolar and bronchiolar spaces, PAS positive
minimal inflammatory response, normal alveolar walls
what are the clinical features of pulmonary alveolar proteinosis?
insidious onset of cough
chunks of white gelatinous appearing sputum (jello)
progressive dyspnea, cyanosis