呼吸系统病理1-The Lung.ppt

1.3 Legionella pneumonia Legionella pneumophilia is the agent Organ transplant recipents are particularly susceptible 诊断 Rapid diagnosis is facilitated by demostration of Legionella antigens in the urine or sputum samples;culture remains the gold standard of diagnosis 1.4 ATYPICAL (VIRAL病毒 AND MYCOPLASMAL支原体) PNEUMONIAS The term “primary atypical pneumonia” was initially applied to an acute febrile respiratory disease characterized by patchy inflammatory changes in the lungs, largely confined to the alveolar septa and pulmonary interstitium. 肺间质 The term “atypical” denotes the moderate amount of sputum, no physical findings of consolidation, only moderate elevation of white cell count, and lack of alveolar exudate. 临床表现不典型 The pneumonitis is caused by a variety of organisms, the most common being Mycoplasma pneumoniae. Other etiologic agents are viruses, including influenza virus types A and B, the respiratory syncytial viruses, adenovirus, rhinoviruses, rubeola, and varicella viruses; Chlamydia pneumoniae; and Coxiella burnetti (Q fever). The histologic pattern depends on the severity of the disease. Predominant is the interstitial nature of the inflammatory reaction, virtually localized within the walls of the alveoli. The alveolar septa are widened and edematous and usually have a mononuclear inflammatory infiltrate of lymphocytes, histiocytes, and occasionally plasma cells. In acute cases, neutrophils may also be present. The alveoli may be free from exudate, but in many patients, there is intra-alveolar proteinaceous material, a cellular exudate, and characteristically pink hyaline membranes lining the alveolar walls. Interstitial pneumonia. The fibrosis, which varies in intensity, is more pronounced in the subpleural region. Usual interstitial pneumonia.Fibroblastic focus with fibers running parallel to surface and bluish myxoid extracellular matrix. Clinical Course Even patients with well-developed atypical pneumonia have few localizing sy