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2010-10-28 19:36:53

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  1. 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
  2. Skin failure of immunity
    Staph, strep, pseudomonas
  3. Mucociliary clearance failure
    • Pneumococcus, haemophilus, then other pathogens, more and more resistance, change in flora of inpatients
    • Intubation and direct access
  4. Aspiration: Microaspiration
    Common bacterial pneumonias, flora depends on the underlying flora of the host
  5. Aspiration: Larger volume aspiration
    Anaerobic oral flora, lung abscess
  6. Neutrophils absence
    • GNB including pseudomonas
    • The more prolonged and under antibiotic pressure-fungi
    • Can’t completely sterilize host
  7. Reticulo-endothelial failure
    • Splenectomy, cirrhosis, failure of antibody to opsonize, multiple myeloma
    • Pneumococcus, H. flu, meningococcus, other encapsulated:
  8. T-cell failure
    • Transplant immunomodulation, HIV, Lymphoma
    • PCI, TB, Fungi, Nocardia, CMV
  9. TNF inhibitors
    • Rx for Rheumatoid arthritis, etc.
    • Granulomatous diseases, especially TB, MOTB, Fungi
  10. T-cells
    • Antigen presentation, T-cell specific response
    • Tuberculosis, fungi, PCJ, Nocardia, CMV
  11. B-cell
    • Antibody
    • Opsonization
    • Pneumococcus, Meningococcus, H.flu:
  12. Complement
    • Early deficiencies: Pneumococcal
    • Late deficiencies C6-C9: Meningococcus
    • Antimicrobial peptides: common bacteria?
  13. Inrtacellular
    • Virus, mycoplasma, mycobacteria, coxiella, chlamydophila, legionella, fungi
    • Sometimes see a temperature-pulse deficit – pulse will not increase proportionately with temperature
  14. Extracellular
    S. pneumoniae, H. influenzae, S. aureus, GNB
  15. 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
  16. Interstitial
    • Interstitial pneumonias
    • Mycoplasma, Chlamydia, viruses, Legionella, PCJ
  17. Symptoms
    • Lobar pneumonia: cough productive of colored sputum
    • Interstitial pneumonia: dry, non-productive cough