Bronchopneumonia
| Bronchopneumonia | |
| ICD-10 | J18.0 |
|---|---|
| ICD-9 | 485 |
| MeSH | D001996 |
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Overview[edit | edit source]
- Bronchopneumonia (Lobular pneumonia) - is one of two types of bacterial pneumonia as classified by gross anatomic distribution of consolidation (solidification). In bacterial pneumonia, invasion of the lung parenchyma by bacteria produces an inflammatory immune response. This response leads to a filling of the alveolar sacs with exudate. The loss of air space and its replacement with fluid is called consolidation. In bronchopneumonia, or lobular pneumonia, there are multiple foci of isolated, acute consolidation, affecting one or more pulmonary lobes.
It should be noted that although these two patterns of pneumonia, lobar and lobular, are the classic anatomic categories of bacterial pneumonia, in clinical practice the types are difficult to apply, as the patterns usually overlap. Bronchopneumonia (lobular) often leads to lobar pneumonia as the infection progresses. The same organism may cause one type of pneumonia in one patient, and another in a different patient. From the clinical standpoint, far more important than distinguishing the anatomical subtype of pneumonia, is identifying its causative agent and accurately assessing the extent of the disease.
Historical Perspective[edit | edit source]
- Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
- In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.
Classification[edit | edit source]
- Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
- Lobar
- Lobular (Bronchopneumonia)
Pathophysiology[edit | edit source]
- The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
- On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a bronchia, are poorly delimited and have the tendency to confluence, especially in children.
- On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with acute bronchiolitis is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with neutrophils and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma..
- Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.
Clinical Features[edit | edit source]
- Common clinical findings in Bronchopneumonia include cough, fever, chills, dyspnea, pleuritic chest pain and sputum production. However, many of these features may be absent in older patients.
- Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
- Older patients may also present with altered mental status.
Differentiating [disease name] from other Diseases[edit | edit source]
- [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
- [Differential dx1]
- [Differential dx2]
- [Differential dx3]
Epidemiology and Demographics[edit | edit source]
- The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
- In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
Age[edit | edit source]
- Patients of all age groups may develop Bronchopneumonia.
- Bronchopneumonia is more commonly observed among elderly patients.
Gender[edit | edit source]
- Bronchopneumonia affects men and women equally.
Race[edit | edit source]
- There is no racial predilection for Bronchopneumonia.
Risk Factors[edit | edit source]
- Common risk factors in the development of Bronchopneumonia are Influenza infection, Alcohol abuse, Hyposplenism/splenectomy, smoking, COPD/Asthma and Immunocompromise. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
- Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a nosocomial infection.
Natural History, Complications and Prognosis[edit | edit source]
- Early clinical features include sudden fever, chills, cough and chest pain.
- If left untreated, patients with Bronchopneumonia may progress to develop tachypnea and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
- Common complications of Bronchopneumonia include parapneumonic effusion, empyema, necrotizing pneumonia, lung abscess and metastatic infections such as endocarditis, septic arthritis, peritonitis, pericarditis and meningitis.
Diagnosis[edit | edit source]
Diagnostic Criteria[edit | edit source]
- The diagnosis is made when clinical and radiological evidence suggests the presence of Bronchopneumonia.
Symptoms[edit | edit source]
- Symptoms of Bronchopneumonia may include the following:
- Fever
- Chills
- Cough
- Chest Pain
- Shortness of breath
Physical Examination[edit | edit source]
- Physical examination may be remarkable for:
- Fever
- Respiratory rate >24 breaths/min (Tachypnea)
- Tachycardia
- Chest Examination:
- Audible crackles
- Decreased or bronchial breath sounds
- Dullness to percussion in areas of consolidation
- Tactile fremitus
- Egophony
Laboratory Findings[edit | edit source]
- There are no specific laboratory findings associated with Bronchopneumonia.
- A Leukocytosis (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
- An elevated concentration of ESR or CRP is a non-specific indication of inflammation in the body.
Imaging Findings[edit | edit source]
- Chest x-ray is the imaging modality of choice for Bronchopneumonia.
- On chest x-ray, Bronchopneumonia is characterized by multiple foci of isolated, acute consolidation, affecting one or more pulmonary lobes.
- In the case of a negative chest x-ray and a high clinical suspicion, HRCT scan may be used to confirm the diagnosis as it has a higher sensitivity and accuracy in detecting lesions and anatomical changes.
- In case of emergency where chest x-ray and HRCT cannot be performed, lung ultrasound performed by an experienced physician can yield findings.
Other Diagnostic Studies[edit | edit source]
- Microbial analysis in Bronchopneumonia can be performed using techniques such as Blood culture, Sputum analysis, PCR and Urine antigen detection, however, pathogens are not commonly identified and empiric treatment should be started once the diagnosis is made.
Treatment[edit | edit source]
Medical Therapy[edit | edit source]
- The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
- Choice of antibiotics is dependent on epidemiology of microbes, resistance and patients' co-morbidities and severity of illness.
- In patients without co-morbidities Macrolides such as Azithromycin and Clarithromycin can be used. In the case of Macrolide resistant pneumonias and patients with multiple co-morbidities, Doxycycline, Amoxicillin-Clavulanate, and Cephalosporins such as Cefpodoxime and Cefuroxime may be used.
- Response to antibiotics can be monitored with clinical improvement, serum inflammatory markers and chest x-ray findings. However, most non-complicated pneumonias are treated out-patient and only require two follow up treatments to clinically determine improvement and resolution of the pneumonia, respectively. Follow-up chest x-rays are only required in male patients over the age of 50 years and smokers.
Prevention[edit | edit source]
- Effective measures for the primary prevention of Bronchopneumonia include vaccination against influenza and pneumococcal antigens, and smoking cessation .
References[edit | edit source]
- Abbas, Abul K, Kumar, Vinay and Fausto, Nelson. Robbins and Coltran Pathologic Basis of Disease, 7th ed. Philadelphia: Elsevier Saunders, 2005.