Path Exam II

• —Most common Upper respiratory Infection(URI)
• —Transmission is by aerosol by droplet nuclei
• —Three types of Infection:
• —-Upper respiratory infection (rhinotracheitis)—
• -—Viral pneumonia (orthomyxoviridae family) —
• -Respiratory viral infection followed by a bacterial infection —

• —-Upper respiratory infection (rhinotracheitis)—
• -—Viral pneumonia (orthomyxoviridae family) 
• —-Respiratory viral infection followed by a bacterial infection —

1-4 days

• similar other upper resp. viruses,
• chills,
• malaise,
• fever,
• headache (HA),
• muscle aches,
• non-productive cough(NPC),
• sore throat(ST),
• profuse nasal drainage—

• Viral pneumonia,
• sinusitis,
• Otitis media,
• bronchitis,
• bacterial pneumonia—

• Usually by s/s,
• labs,
• xray for pneumonia—

• No absolute treatment- no antibiotics,
• Early Tx to manage side effects and minimize spread (keep to UR tract),
• Anti-viral drugs
• ***FLU Vaccine****— —

Acute inflammation of lung caused by microbial organism

Pneumonia

sulfa drugs and penicillin

bacteria in the alveoli

affect an entire lobe of the lung

patchy distribution over more than one lobe

Viral and mycoplasmainfections of alveolar septum or interstitium

• —Likely to result when defense mechanisms become incompetent or overwhelmed
• —↓ Cough and epiglottal reflexes may allow aspiration—
• Mucociliary mechanism impaired —
• —Alteration of leukocytes from malnutrition— Increased frequency of gram-negative bacilli from leukemia, alcoholism, and diabetes mellitus—

• —Pollution
• —Cigarette smoking
• —Upper respiratory infections—
• Tracheal intubation 
• —Aging

• Aspiration from nasopharynx or oropharynx
• Inhalation of microbes such as Mycoplasma pneumoniae —
• Hematogenous spread from primary infection elsewhere in body— —

• —Lower respiratory infection of lung 
• —Onset in community or during first 2 days of hospitalization—
• 4 million U.S. adults diagnosed yearly
• —Highest incidence in midwinter—
• Smoking important risk factor— —

• **Streptococcus pneumoniae,most common
• —Haemophilus influenzae
• Legionella—
• Mycoplasma
• —Chlamydia —
• Can be viral:

• influenza
• RSV
• adenovirus
• parainfluenza virus

• Assess ability to treat at home
• Calculate PORT (Pneumonia Patient Outcomes Research Team)
• Clinician decision for inpatient or outpatient

• Antibiotics- empiric antibiotic therapy (home)
• Hospitalization for more severe cases

—Occurring 48 hours or longer after admission and not incubating at time of hospitalization— Second most common nosocomial infection

• —Immunosuppressive therapy—
• General debility —
• Endotracheal intubation

Pneumonia

• Bacterial and viral causative agents—
• Pneumocystis jiroveci pneumonia (PCP)—
• Cytomegalovirus—
• Fungi

• Severe protein-calorie malnutrition—
• Immune deficiencies—
• Chemotherapy/radiation recipients—
• Transplant recipients

• Fever—
• Tachypnea —
• Tachycardia—
• Dyspnea—Nonproductive cough
• —Hypoxemia —

• Stage 1: Congestion from outpouring of fluid to alveoli—
• —Stage 2: Red hepatization
• Stage 3: Gray hepatization
• Resolution—

• Organisms multiply —
• Infection spreads
• —Interferes with lung function

• Massive dilation of capillaries —
• Alveoli fill with organisms, neutrophils, RBCs, and fibrin—
• - Causes lungs to appear red and granular, similar toliver

• —↓ Bloodflow 
• —Leukocyte and fibrin consolidate in affected part of lung

• —Resolution and healing if no complications
• —Exudate lysed and processed by macrophages—
• Tissue restored

• —World’s foremost cause of death from asingle infectious agent — 
• —Drug-resistant forms 
• —Mycobacterium tuberculosis hominis —Aerobic—Protective waxy capsule—Can stay alive in “suspended animation” for years—

• —Aerobic—
• Protective waxy capsule
• —Can stay alive in “suspended animation” for years—

• Spread via airborne droplets 
• Inhaled bacilli pass down bronchial system and implant themselves on bronchioles or alveoli
• Multiply with no initial resistance
• —Replicates slowly and spreads via the lymphatic system
• If cellular immune system is activated-Tissue granuloma forms

rarely

close, frequent, or prolonged

• —via airborne droplets when infected person:
• Coughs—,
• Speaks—,
• Sneezes—,
• Sings—,
• Spread

Not by hands or objects

• —Upper lobes of lungs 
• —Kidneys 
• —Epiphyses of bone
• —Cerebral cortex
• —Adrenal glands

—Immunosuppressed and diabetic

• 0 = No TB exposure—
• 1 = Exposure, noinfection—
• 2 = Latent TB, nodisease—
• 3 = TB, not clinically active
• —4 = TB suspected

usually free of symptoms

• —Fatigue—
• Malaise—
• Anorexia— —
• Weight loss—
• Low-grade fevers—
• Night sweats— —
• —Cough becomes frequent-—Produces white, frothy sputum
• Cough-—Hemoptysis is not common and is usually associated with advanced disease—

• (generalized flu symptoms)—
• High fever—
• Chills
• —Pleuritic pain—
• Productive cough—

• —Macrophages begin a cell-mediated immune response —
• Takes 3–6 weeks to develop positive TB test—
• Results in a granulomatous lesion or Ghon complex

• —Nodules in lung tissue and lymph nodes—
• Caseous necrosis inside nodules
• —Calcium may deposit in the fatty area of necrosis
• —Visible on x-rays—

• —Miliary TB lesions look like grains of millet in the tissues—
• Meat inspection was introduced to keep them out of the food supply—
• Pasteurization of milk was introduced to keep TB out of the milk supply—

• —Reinfection from inhaled droplet nuclei
• Reactivation of a previously healed primary lesion —
• Immediate cell-mediated response walls off infection inairways
• —Bacteria damage tissues in the airways, creating cavities—
• Signs of chronic pneumonia: gradual destruction of lungtissue—
• “Consumption”: eventually fatal ifuntreated—