April 15 Lectures

Chang

sterile below vocal chords

surfactant in alveoli is bacteriostatic (plus macs, lysozymes)
particle size  > 5 um deposit in upper airways   1-2 um can make it to alveoli (most bacteria)
virulence counts - TB less virulent than Klebsiella

colonization

direct innoculation

• aspiration
• esophageal rupture (severe vomiting - Boerhaave's syndrome)
• dental abscess; pyelonephritis (tracking fascial planes)

anaerobic pneumonia = patient with teeth

lobar pneumonia  -  spreads via pores of Kohn (openings between adjacent alveoli)

calcified lung lesions = previous TB  - tend to be in upper lobes because (she meant to say) oxygen levels are HIGHER.  Multiplication of Mycobacterium tuberculosis is favored by a high oxygen tension (high V/Q in upper lungs results in higher PO2 and lower PCO2).

chronic fungal infections:

• blasto, southeast  (duck hunters)  (includes extrapulmonary diseases)
• histo, Mississippi valley
• cocci, southwest, southern AZ, central valley of CA  ("valley fever")

pneumonias

pleural effusion

• parapneumonic effusion (no organisms)
• empyema (with organisms)
• empyema necessitans (flourishing bacteria eats way out of pleura)