内科学 肺炎-胡必杰.ppt

Dr.HU Bijie Respiratory Diseases Pneumonia 肺炎 What is pneumonia? To the pathologist an infection of the alveoli, distal airways, and interstitium of the lung increased weight of the lungs, consolidation alveoli filled with WBC, RBC, and fibrin To the clinician fever, chills, cough, pleuritic chest pain, sputum production, hyper- or hypothermia, increased respiratory rate, dullness to percussion, bronchial breathing, egophony, crackles, wheezes, pleural friction rub opacity on chest radiography Definition Pneumonia is the inflammation of lower respiratory tracts including alveoli, interstitial tissues, and bronchiole by the microorganisms, chemical irritations or by an immunological process Classifications? Lobar (segmental) lobular (bronchopneumonia) interstitial Classifications Terminology Acute, subacute, chronic Bacterial, viral, fungal, parasitic (tuberculosis) Typical vs. Atypical (Mycoplasma, Chlamydia, Legionella) Ventilator Associated Pneumonia (VAP) Nursing Home Acquired Pneumonia (NHAP) Health-care Associated Pneumonia (HCAP) Immune-compromised vs. immune-competent Immune-compromised Host Pneumonia (ICHP) Mild, moderate, severe Infections vs. noninfections Primary vs. Secondary CAP vs HAP community-acquired pneumonia treated in an ambulatory admission to the hospital hospital-acquired pneumonia (nosocomial) ventilator-associated non-ventilator-associated long-term-care facilities (LTCFs) PATHOGENESIS potential pathogen reach LRT in sufficient numbers or with sufficient virulence to overwhelm host defenses Possible routes gross aspiration anaerobic organisms and gram-negative bacilli microaspiration (oropharyngeal secretions colonized with pathogenic microorganisms) Streptococcus pneumoniae, Haemophilus influenzae aerosolization Mycobacterium tuberculosis, endemic fungi, Legionella spp., Coxiella burnetii, respiratory viruses (influenza viruses A, B) hematogenous spread from a distant infected site Staphylococcus aure