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Inflammatory respiratory disorder, TB granuloma - Coggle Diagram
Inflammatory respiratory disorder
Normal defenses against pulmonary infection
Nasal clearance
gag and cough reflex
Tracheobronchial clearance (mucociliary escalator)
Alveolar clearance(alveolar macrophages)
Cellular defenses :neutrophils and lymphocyte
Extracellular soluble mediator
Defence mechanism
Mechanical
Nasal clearance by
sneezing
or blowing
Tracheobronchial clearance via
mucociliary action
,either swallowed or expectorated
Cellular
Alveolar clearance
Phagocytosed by
alveolar macrophages
digested or carry to
ciliated bronchioles
Oropharynx
Enter lymphatic
lymph nodes
Pneumonia
Infection of lung parenchyma
Occur when defense mechanism are impaired or resistance of host is lowered
Factor interfering defense mechanisms
LOSS OR SUPPRESSION OF COUGH REFLEX
咳嗽不到
exp, coma ,anaesthesia, neuromuscular disorder
INJURY TO MUCOCILIARY APPARATUS
EXP: 香烟，腐蚀性气体，viral dz，genetic defects of ciliary function
INTERFERENCE WITH PHAGOCYTIC OR BACTERICIDAL ACTION OF ALVEOLAR MACROPHAGES
alcohol, tobacco, smoke ,anoxia
PULMONARY CONGESTION / EDEMA
ACCUMULATION OF SECRETION
Cystic fibrosis
Bronchial obstruction
Pathogenesis
1.Entry
EXP:Aspiration - pneumococcus
Inhalation-TB and viruses
Inoculation -contaminated equipments
2. Replication and spread
Escaped the mucociliary defense mechanism
Virulence factor aid in local replication
Adherence factor
Cellular toxin
Decrease polymorpholeukocytes' killing ability
3. Establishing tissue damage
Direct damage
Damage induced by our own defense system
ACUTE INFLAM RESPONSE (BACT)
CELLULAR IMMUNE RESPONSE (FUNGI AND MYCOBACTERIUM)
Predisposing factor
香烟
Viral infection
酒
Bronchiectasis
Bronchial obstruction
IVDU( drug user)
Post operative
Immunosuppression
Classification
Aetiology
Bact
Viral
Fungal
Protozoa
Morphology
Lobar pneumonia
Bronchopneumonia
Granulomatous
Clinical setting
Community-acquired acute pneumonia
Community-acquired atypical pneumonia
Hospital-acquired pneumonia
Aspiration pneumonia
Chronic pneumonia
Necrotizing pneumonia and lung abscess
Pneumonia in immunocompromised host
Community-acquired (acute) pneumonia
Caused by bacterial organism
:warning:
2 forms
of acute bacterial pneumonia
Bronchopneumonia
Patchy distribution
Multiple foci of varying sizes with consolidation surrounding bronchioles
Acute inflammatory response is seen in respiratory epithelium
很多
neutrophil 在alveolar
Lobar pneumonia
Confluent lobar distribution
Fibrinosuppurative consolidation of a large portion of a lobe
4 stages of inflammatory response
:rainbow:
Congestion
Vascular engorgement （肿，filled with水）
Intra-alveolar fluid
重重的lung
Red hepatization
Massive confluent exudation with rbc, neutrophils, fibrin with alveoli spaces
像liver-like state
Solid and dull red
Due to inflammatory exudates ,red cell and fibrin filling alveoli and small bronchi
Grey hepatization
Polymorph destroy RBC
Fibrinosuppurative exudate is formed
Grayish brown dry surface
Resolution
Consolidated exudate undergo enzymatic digestion
Producing granular semifluid debris
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Restoration of pulmonary architecture
90% is Streptococcus pneumoniae
Common organisms
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus
Legionella pneumophila
Enterobacteriaceae (Klebsiella pneumoniae)
Community -acquired atypical pneumonia
Interstitial pneumonia (没有alveolar exudate)
Acute febrile respiratory dz characterised by patchy inflammatory changes in the lung ,largely confined to alveolar septa and interstitium
中等的sputum
Mycoplasma pneumoniae, influenza A &B ,RSV, adenovirus ,rhinovirus ,Chlamydia psittaci
Complication
Abscess formation
Right sided is more common
Suppurative pleuritis
Acute inflammatory condition of pleura 大多是bacteria ，strep pneumoniae
Empyema
Exudate within pleural space
Haemorrhagic pleuritis
Organization of exudate
Forming solid lung tissue
Bacteraemic dissemination
To heart valve ,pericardium, brain, kidney, spleen ,joint ,causing metastatic abscess, endocarditis ,meningitis ,suppurative arthritis
Chronic pneumonia
:check:
Localized lesion :explode:
immunocompromised person :revolving_hearts:
with or without lymph node involvement :snowman_without_snow:
Granulomatous inflammation may be due to bacteria or fungi :warning:
Tuberculosis is the most important entity
:warning:
Bact
Mycobacterium tuberculosis
Histoplasma capsulatum
Actinomyces
Aspergillosis
Nocardia
Pulmonary tuberculosis
病情更猖狂when 穷，多人和chronic illness 严重的国家
HIV 也是一个risk factor!!!
一旦有了infected，很大几率会有reactivation
Mycobacterium tuberculosis, slender rod that are acid fast
Person with active pulmonary dz 容易得到这个
Transmission：Direct(inhalation of airborne organism)
Oropharyngeal and GI TB by drinking milk contaminated by Mycobacterium bovis
Clinical feature
Low grade remitting fever
Night sweat
Mucoid sputum
Weight loss
Anorexia
Malaise
Haemoptysis :red_circle:
Pleuritic chest pain
Primary tuberculosis
Pathogenesis
First 3 weeks: In previous unexposed and immunocompetent ,develop targeted cell-mediated immunity-resistance to organism- 有tissue hypersensitivity.
3 weeks after exposure :cell mediated immunity to tubercular infection is primarily mediated by TH1 cells - stimulate macrophage to kill bact.
Comes at a cost of
hypersensitivity and accompanying tissue destruction
Reactivation of infection or reexposure in previously sensitized host
rapid defensive reaction
Individual
lacking a previous contact
with tubercle bacili :red_cross:
Asymptomatic
Often resembling acute bacterial pneumonia
Primary pulmonary focus apical/subpleural -Ghon's focus :check:
Primary focus + regional lymph node- Ghon's complex :check:
Secondary TB
:<3:
Arising from a
previously sensitized host
(
reactivation)
Involves
apex of upper lobes
of one or both lung :explode:
Initial :
small consolidation
Foci are
sharply circumscribed
, firm, gray-white to yellow areas
In immunocompetent individual ,initial parenchymal focus undergo progressive fibrous encapsulation ,leaving only fibrocalcific scars.
regional lymph nodes involve 比较少在secondary TB compare to primary
Localized secondary TB maybe asymptomatic
Cavitation occur readily
Miliary TB
Small, visible foci
of
yellow-white consolidation
scattered through lung parenchyma
Miliary lesion may
expand and coalesce
- resulting
consolidation of large regions
Lead to
serous pleural effusion
,
tuberculous empyema, obliterative fibrous pleuritis
Millet Seed
:smiley:
Gain access into
lymphatics ,blood and disseminated
:wind_blowing_face:
Disseminated
pulmonary spread
- TB gained entry into
pulmonary artery
Disseminated
systemic spread
- TB gained access into
pulmonary vein
:!?:
Can be seen in either
primary or secondary TB
Investigation of TB
Sputum
Ziehl-Neelsen stain = Acid fast bacilli
Sputum culture
Lowenstein Jensen media
Sputum TB PCR
Mantoux test
Raised ESR
Chest X-ray
Histoplasmosis, Coccidiodomycosis, blastomycosis
Caused by dimorphic fungi
Isolate
pulmonary involvement or disseminated in immunocompromised
Inhalation of dust
contaminated with bird
/bat droppings containing microconidia
Clinical presentation resemble
TB
:smiley:
Epithelioid granulomas with
coagulative necrosis
In
immunosuppressed ,granulomas are not formed
Hospital-acquired pneumonia /Nosocomial
Gram (-) rods
,enterobacteriaceae and Pseudomonas spp.
Staphy. coccus
Aspiration pneumonia
:warning:
Occur in debilitated pts or those who aspirate
gastric contents
either while unconsciousconscious (after stroke) / repeated vomiting
partly chemical due to irritating effect
of gastric acid / partly bacterial
Lung abscess is common complication
for those survive
:hand_with_index_and_middle_fingers_crossed::skin-tone-6:
Necrotizing pneumonia / Lung abscess
:check:
Anaerobic bacteria
(common)
Staphylococcus aureus ,Klebsiella pneumoniae ,Streptococcus pyogenes and type 3 pneumococcus (uncommon)
Follow
various mechanisms
Aspiration
Post-pneumonic
Septic embolism
Post-obstructive fr neoplasia
Direct trauma
Pneumonia in immunocompromised host
Cytomegalovirus
Pneumocystis jiroveci
Mycobacterium avium-intracellulare
Invasive aspergillosis
Invasive candidiasis
TB granuloma
Collection of epithelioid histocytes surrounded by a zone of fibroblast ,lymphocyte and Langhans type of multinucleated giant cell.