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A 35 y.o. M presents with 2d cough,
productive of green-yellow sputum. He
complains of fever, chills, and dyspnea
PE: T 38.7℃, RR 26/min, BP 110/65 mmHg,
Examination of the lungs reveals increased
fremitus and dullness at the right
Crackles and bronchial breath sounds are
audible at the right base
Gram stain of the sputum reveals gram-
positive cocci and numerous neutrophils
• Pneumonia is the #1 killer of children under
age 5 worldwide – responsible for nearly one
in five global child deaths annually.
• Raise awareness about pneumonia, the
world’s leading killer of children under the age
• Promote interventions to protect against,
prevent and treat pneumonia; and
• Generate action to combat pneumonia.
Consolidation of the lung occurs in pneumonia
• What is consolidation?
Consolidation is exudative solidification of lung
parenchyma that occurs in bacterial invasion
of the lung.
This is known as pneumonia.
Defense mechanisms of the respiratory tree:
1. Nasal clearance: Aerosolized particles carrying
micro-organisms are normally removed by sneezing
& blowing OR by swallowing.
2. Tracheobronchial clearance: Accomplished by
mucociliary action. Partcicles are either swallowed
3. Alveolar clearance: Phagocytosis of bacteria or
solid particles by alveolar macrophages.
• Pneumonia can occur when any of these
mechanisms are damaged
When host immunity is lowered.
When the organism is highly virulent.
Factors that interfere with defense mechanisms:
1. Loss or suppression of cough reflex: Coma, general
anaesthesia, neuromuscular disorders, drugs &
2. Injury to mucociliary apparatus: Smoking,
corrosive gases, viral diseases, genetic (immotile
3. Impaired phagocytic clearance: Alcoholism,
cigarette smoke, anoxia, oxygen intoxication.
4. Pulmonary congestion & oedema.
5. Accumulation of secretions: Cystic fibrosis
• whole lobe, exudation - consolidation
• 95% - Strep pneum.(Klebsiella in aged, DM, alcoholics)
• High fever, rusty sputum, Pleuritic chest pain.
• Four stages: (*also in bronchopneumonia)
– Congestion – 1d – vasodilatation congestion.
– Red Hepatization 2d Exudation+RBC
– Gray Hepatizaiton 4d neutro & Macrophages.
– Resolution – 8d few macrophages, normal.
Stage Gross microscopy images Clinical features
red and firm
Air space: fluid,
Bacteria can be
found in sputum
Stage of red
number of RBC
Stage Gross microscopy images Clinical features
Capillary is not
Alveolar space is
7 days later
The fibrin and cell
debris are digested
The exudation is
• Extremes of age. (infancy and old age)
• Staph, Strep, Pneumo & H. influenza
• Patchy consolidation – not limited to lobes.
• Suppurative inflammation
• Usually bilateral
• Lower lobes common
• Extremes of age.
• Secondary to other
• Staph, Strep,
• Patchy consolidation
• Around Small airway
• Not limited by anatomic
• Usually bilateral.
• Middle age – 20-50
• Primary in a healthy
• males common.
• 95% pneumoc (Klebs.)
• Entire lobe consolidation
• Limited by anatomic
• Usually unilateral
Interstitial / atypical Pneumonia
• Primary atypical pneumonia in the immunocompetant
host (Mycoplasma or Chlamydia)
• Interstitial pneumonitis
• immunocompromised host : Pneumocystic carinii; CMV
• Immunocompetant host: Influenza A
• Gross features:
– Lungs are heavy but not firmly consolidated
• Microscopic features:
– Septal mononuclear infiltrate
– Alveolar air spaces either ‘empty’ or filled with
proteinaceous fluid with few or no inflammatory cells
Infiltrate in alveloar
Lobar pneumonia Broncho
Age group Any age group Infancy & old age
Any age group
Etiologic agents 90-95% of cases
Distribution Consolidation of large
areas of one lobe or
the whole lobe
of more than one
lobe of the lung
patchy or involve
Involvement of all alveoli of
one lobe by inflammatory
The 4 classical stages of
consolidation are best seen in
Patchy involvement of alveoli
around the bronchioles in
more than one lobe by
composed of lymphocytes,
virtually localized within
Community acquired – Pneumonia – Nosocomial
• In healthy adults
• Gram positive.
• Strep. Pyogenes,
Staph, H. influenzae
and Klebsiella in
elderly or with COPD.
• In *sick patients.
• gram-negative bacilli
• Pseudomonas aeruginosa,
Enterobacter, Proteus, and
Complications of Pneumonia
– Localized suppurative necrosis, Right side often involved in aspiration.
– Common etiologic agents are Staphylococcus, Klebsiella,
• Pleuritis / Pleural effusion.
– Inflammation of the pleura ( Streptococcus pneumoniae)
– Blood rich exudate (esp. rickettsial diseases)
– Pus in the pleural space.
• Septicemia: with bacteremic dissemination to heart valves, pericardium,
brain, spleen, kidneys or joints causing metastatic abscesses, endocarditis,
meningitis or suppurative arthritis.
• Organization of the exudate resulting in fibrosis.