Pulmonary Pathology II
Terms
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- Gram - bacterial pneumonias
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Klebsiella
E. Coli
H. flu
Psedomonas - Predispositions to pneumonia
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1. Impaired Phagocytosis
2. Decreased bacterial clearing
3. Enhanced growth environment - The four phases of pneumonia infection
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1. Congestion & Dyspnea (bacterial proliferation)
2. Red Hepatization (increase PMN, RBC, fibrin, few macs)
3. Grey Hep (low PMN, high macs, fibring, RBCs breakdown)
4. Resolution (clearing) - Aspirated necrotizing substances cause?
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Lung Abscess
Unique b/c they can drain to the outside - What are the two inflamatory pathways leading to bronchiectasis
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1. Increase mucus levels creating chronic pneumonia and fibrosis
2. Bronchial wall destruction
Both lead to dialated bronchi - The primary different between viral and bacterial pneumonia
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Bacteria P. form intra-avlevolar inflitrates of PMN
Viral P form interstitial lymph inflitrate of monocytes - Make up 20% of lung infections in kids and is exclusive to the bronchioles
- Respitory Syncytial Virus
- Rare infection in children has 40% fatality
- Adenovirus
- Cause 50% of infection after bone marrow, major cause of death in organ transplants and AIDS patients
- Cytomegalovirus
- Give three examples of non-necrotizing and necrotizing granulomatous pneumonias
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N-N: sarcoidosis, dust, fungal
Nec: TB, abnormal mycobacterial, Wegener's - Primary TB infection
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1. Ghon complex
2. Caseous necrosis
3. small foci fibros, caseous calcify
4. rarely disseminates - Secondary TB infection
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1. endog reactivation or exog bacteria
2. Occurs in upper lobe b/c higher O2 - symptoms of TB
- mid-afternoon fever, night sweat, weakness, loss of appetite. blood in sputom, cough and dyspnea possible
- Atypical mycobateria affecting AIDS patients
- M. Avium-Intracellular
- Atypyical mycobateria in hairy cell leukemia
- M. kanasaii
- non-coalescing, noncaseating granulomas with lymph cuffs
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Abnormal mycobacteria
(Sarcoidosis has coalescing granulomas with out lymph cuff) -
Grow in sand of the SW
60% asymptomatic
flu-like illness
thick-wall, non ubdding spherule filled with endospores - Coccidioidomycosis
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nosocomial
dichotomous 45 degree branching hyphae
occurs in 40% of patients with leukemia - Asperillosis
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Ohio-Mississippi Valley
From nestling starling bird droppings
Similar to TB pathology
roun oval yeast with narrow base - Histoplasmosis
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From pigeon droppings
Granulomatous in regular patient
massive multiplication in alveol and consolidation
Dissemination common
round oval yeast with unqeual budding (India ink stains - Cryptococcosis
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large irregular non-parallel hyphae
angioinvasive, necrotizine, fungla balls
common in leukemia - Mucormycosis
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North America, uncertain source
Dissemination to skin common
Solitaty disseas common, progressive possible
yeast with broadpbased buds - Blastomycosis
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Mixed suppurative and mononuclean response
not granulomatous
pseudohyphae
Typical in immunocomprimised - Candidiasis
- Fungai with hyphae
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Aspergillosis
Mucormycosis
Candidiasis (pseudo) - Fungia common with leukemia
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Aspergillosis
Mucormycosis -
originally described in mallnourised children and patienst wit leukemia.
AIDS definining illness - Pneumocystis Carinii Pneumonia (PCP)