Pneumonia is as an acute respiratory illness associated with recently developed radiological pulmonary shadowing, which may be segmental, lobar or multilobar.
The context in which pneumonia develops is highly indicative of the likely organism involved;
therefore, pneumonias are usually classified as community-or hospital-acquired, or as occurring in immunocompromised hosts.
‘Lobar pneumonia’ is a radiological and pathological term referring to homogeneous consolidation of one or more lung lobes. ‘Bronchopneumonia’ refers to more patchy alveolar consolidation associated with bronchial and bronchiolar inflammation, often affecting
both lower lobes.
The inflammatory response in lobar pneumonia evolves through stages of congestion, red then grey hepatisation, and finally resolution. In the first stage, the alveolar units are flooded by a proteinaceous exudate and by neutrophils and red blood cells, and numerous pneumococci may be observed. As fibrin forms on the cut surface of the affected lobe, it resembles liver and so this stage is known as ‘red hepatisation’. As congestion resolves, the lung tissue becomes grey , and ultimately, clearance.
Factors that predispose to pneumonia
- Cigarette smoking
- Upper respiratory tract infections
- Alcohol
- Old age
- Recent influenza infection
- Pre-existing lung disease
- HIV
- Indoor air pollution
Clinical features
Systemic features such as fever, rigors, shivering malaise predominate and delirium. The appetite is invariably lost and headache frequently reported.
Pulmonary symptoms include cough, which at first is characteristically short, painful and dry, expectoration of mucopurulent sputum. Rust-coloured sputum may be seen in patients
with Strep. pneumoniae, and the occasional individual may report haemoptysis. Pleuritic chest pain may be a presenting feature and, on occasion, may be referred to the shoulder or anterior abdominal wall. Abdominal tenderness is sometimes apparent in patients.
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