复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）呼吸系统_Pneumonia

Pneumonia Yuanlin Song, M.D. Department of Pulmonary medicine, Fudan university

Yuanlin Song, M.D. Department of Pulmonary Medicine, Fudan University

Definition and classification o Pneumonia: inflammation and consolidation of lung tissue due to an intectious agent. o Category: community acquired pneumonia(Cap)and hospital-acquired pneumonia(hapy e hap divided into ventilator associated pneumonia (VAP) or Non-ventilator Associated Pneumonia

 Pneumonia: inflammation and consolidation of lung tissue due to an infectious agent.  Category: community acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP)  HAP divided into Ventilator Associated Pneumonia (VAP) or Non-ventilator Associated Pneumonia

Pathogens Bacillus Pseudomonas Clostridium Escherichia ght c 2004 Denis Kunkel M Spirulina Staphylococcus Streptococcus salmonella http://www.denniskunkel.com/

Bacillus Pseudomonas Clostridium Escherichia Spirulina Staphylococcus Streptococcus Salmonella http://www.denniskunkel.com/

Host defense mechanism ◆ Upper-airway (nasal turbinates (2)mucocillary transport system: ciliary, mucus layer, IgA, mucosal pH, colonization of non-pathogenic bacteria ◆ Lower airway (1)glottis, cough, 2)innate immunity: macrophages, lysozymes, lactoferrin IgG, defensins, complement, cathelicidins, collectins ()epithelial barrier and antimicrobial peptide (4)specific host defense: T lymphocyte

 Upper- airway: (1)nasal turbinates, (2)mucocillary transport system: ciliary, mucus layer, sIgA, mucosal pH, colonization of non-pathogenic bacteria  Lower airway: (1)glottis, cough, (2)innate immunity: macrophages, lysozymes, lactoferrin, IgG, defensins, complement, cathelicidins, collectins (3)epithelial barrier and antimicrobial peptide (4)specific host defense: T lymphocyte

Anatomical structure of airway mucus mucus layer Liquid ciliary mucosa〈Gob| et cel 19 Submucosal gla

ciliary mucus Liquid Submucosal gland Goblet cell mucus layer mucosa

Pathogenesis factors o Microbial factors: virulence factors: chlamydia mycoplasma, influenza virus, S. Pneuomiae Mycobacteria, Pneumococccal, polypeptide pneumolysin o Host factors: hypogammaglobulimia, CD4+ T cell reduction, underlying lung disease medicine o Routes of pathogenesis: gross aspiration microaspiration, aerosolization, hematogel d spread, direct spread

 Microbial factors: virulence factors: chlamydia, maycoplasma, influenza virus, S. Pneuomiae, Mycobacteria, Pneumococccal, polypeptide pneumolysin.  Host factors: hypogammaglobulimia, CD4+ T cell reduction, underlying lung disease, medicine  Routes of pathogenesis: gross aspiration, microaspiration, aerosolization, hematogenous spread, direct spread

P aeruginosa virulence factors Pili Biofilm Exos, ExoU, ExoT, ExoY FI Type III secretion agendum Quorum Sensing Type I& ll secretion Non-pilus adhesins P1 lasa elastase (type I Cell-associated factor Lasb elastase(type In) Alkaline protease(type I) Intracellular factors Hemolysins: Phospholipase C(type II) Rhamnolipid Extracellular factors E in A (Type ID) Exoenzyme s P yocyanin, Pyoverdin

Pili Flagellum Non-pilus adhesins Alginate/biofilm LPS Cell-associated factors Quorum Sensing ExoS, ExoU , ExoT, ExoY Type III secretion Intracellular factors Proteases: LasA elastase (type II) LasB elastase (type II) Alkaline protease (type I) Hemolysins: Phospholipase C (type II) Rhamnolipid Exotoxin A (Type II) Exoenzyme S Pyocyanin, Pyoverdin Type I & II secretion Extracellular factors Type III secretion Biofilm

Pathology o Lobar pneumonia: congestion-red hepatization- grey hepatization-resolution o Bronchopneumonia: patchy consolidation neutrophilic exudate centered in bronchi(ioles centrifugal spread o Miliary pneumonia: bloodstream spread or blood dissemination induced numerous discrete lesions(2-3mm in diameter) o Interstitial pneumonia: patchy or diffuse

 Lobar pneumonia: congestion-red hepatization￾grey hepatization-resolution  Bronchopneumonia: patchy consolidation, neutrophilic exudate centerted in bronchi(ioles), centrifugal spread  Miliary pneumonia: bloodstream spread or blood dissemination induced numerous discrete lesions (2-3mm in diameter)  Interstitial pneumonia: patchy or diffuse

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Pathology-microscopic