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10-28-d: Pathogenesis
- Aerosol/droplet: virus (influenza, SARS, varicella, etc), Tb
- Microaspiration: CAP, routine bacterial/ HAP, altered flora
- Macroaspiration: lung abscess, healthcare associated pneumonia
- Reactivation: TB, fungi, granulomatous disease
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Skin failure of immunity
Staph, strep, pseudomonas
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Mucociliary clearance failure
- Pneumococcus, haemophilus, then other pathogens, more and more resistance, change in flora of inpatients
- Intubation and direct access
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Aspiration: Microaspiration
Common bacterial pneumonias, flora depends on the underlying flora of the host
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Aspiration: Larger volume aspiration
Anaerobic oral flora, lung abscess
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Neutrophils absence
- GNB including pseudomonas
- The more prolonged and under antibiotic pressure-fungi
- Can’t completely sterilize host
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Reticulo-endothelial failure
- Splenectomy, cirrhosis, failure of antibody to opsonize, multiple myeloma
- Pneumococcus, H. flu, meningococcus, other encapsulated:
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T-cell failure
- Transplant immunomodulation, HIV, Lymphoma
- PCI, TB, Fungi, Nocardia, CMV
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TNF inhibitors
- Rx for Rheumatoid arthritis, etc.
- Granulomatous diseases, especially TB, MOTB, Fungi
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T-cells
- Antigen presentation, T-cell specific response
- Tuberculosis, fungi, PCJ, Nocardia, CMV
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B-cell
- Antibody
- Opsonization
- Pneumococcus, Meningococcus, H.flu:
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Complement
- Early deficiencies: Pneumococcal
- Late deficiencies C6-C9: Meningococcus
- Antimicrobial peptides: common bacteria?
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Inrtacellular
- Virus, mycoplasma, mycobacteria, coxiella, chlamydophila, legionella, fungi
- Sometimes see a temperature-pulse deficit – pulse will not increase proportionately with temperature
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Extracellular
S. pneumoniae, H. influenzae, S. aureus, GNB
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Lobar
- Bronchopneumonia in young and old: few lobules in lung segment/a patchier lobar distribution on CXR
- Lobar Pneumonia: many lobules in lung segment/more dense consolidation on CXR
- Classic bacterial pneumonias: s. pneumoniae, H influenzae, M. catarrhalis, gram negative rods, Legionella, S. aureus
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Interstitial
- Interstitial pneumonias
- Mycoplasma, Chlamydia, viruses, Legionella, PCJ
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Symptoms
- Lobar pneumonia: cough productive of colored sputum
- Interstitial pneumonia: dry, non-productive cough
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