Pathogenesis of Pneumonia

  • Monroe Karetzky


Community-acquired pneumonia causes large numbers of hospital admissions each year. Although the incidence varies greatly in different geographic and socioeconomic settings, in the United States it has been found to cause 10–15 cases per 100,000 population annually, predominating in the very young and the elderly. Hospitalization may be required in as many as 25% of cases. It is this group from which all the mortality data have been recorded, in contrast to the ambulatory group with “walking pneumonia.” Thus adult community-acquired pneumonia occurs in more than 3 million persons per year in the United States; and even though most are treated as outpatients, the disease still accounts for more than 50,000 hospital admissions annually. Major determinants of hospitalization and a complicated course in patients not initially admitted to the hospital include the existence of comorbid conditions, age greater than 65 years, and high grade fever (>101°F). Social factors and patient reliability are also prominent triage considerations that classically account for the high admission rates for patients with pneumonia to municipal institutions.


Functional Residual Capacity Aspiration Pneumonia Nosocomial Pneumonia Total Lung Capacity Adult Respiratory Distress Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Fang G-D, Fine M, Orloff J, et al: New and emerging etiologies for community-acquired pneumonia with implications for therapy: a prospective multicenter study of 359 cases. Medicine (Baltimore) 1990; 69: 307–316.Google Scholar
  2. 2.
    Gwaltney JM Jr, Sande MA, Austrian R, Hendly JO: Spread of Steptococcus pneumoniae in families. II. Relation of transfer of S. pneumoniae to incidence of colds and serum antibody. J Infect Dis 1975; 132: 62–68.PubMedCrossRefGoogle Scholar
  3. 3.
    Shackelford PG, Feigin RD: Periodicity of susceptibility to pneumococcal infection: influence of light and adrenocortical secretions. Science 1973; 182: 285–287.PubMedCrossRefGoogle Scholar
  4. 4.
    Pachon J, Prados MD, Capote F, et al: Severe community-acquired pneumonia: etiology, prognosis, and treatment. Am Rev Respir Dis 1990; 142: 369–373.PubMedGoogle Scholar
  5. 5.
    Brown RB, Sands M, Ryczak M: Community-acquired pneumonia caused by mixed aerobic bacteria. Chest 1986; 90: 810–814.PubMedCrossRefGoogle Scholar
  6. 6.
    Woodhead MA, Arrowsmith J, Chamberlain-Webber R, et al: The value of routine microbial investigation in community-acquired pneumonia. Respir Med 1991; 85: 313–317.PubMedCrossRefGoogle Scholar
  7. 7.
    Dreyfuss D, Djedaini K, Weber P, et al: Prospective study of nosocomial pneumonia and of patient and circuit colonization during mechanical ventilation with circuit changes every 48 hours versus no change. Am Rev Respir Dis 1991; 143: 738–743.PubMedGoogle Scholar
  8. 8.
    Hanson LC, Weber DJ, Rutalla WA: Risk factors for nosocomial pneumonia in the elderly. Am J Med 1992; 92: 161–166.PubMedCrossRefGoogle Scholar
  9. 9.
    Atherton ST, White DJ: Stomach as source of bacteria colonizing respiratory tract during artificial ventilation. Lancet 1978; 2: 968–969.PubMedCrossRefGoogle Scholar
  10. 10.
    Driks MR, Craven DE, Celli BR, et al: Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers: the role of gastric colonization. N Engl J Med 1987; 317: 1376–1382.PubMedCrossRefGoogle Scholar
  11. 11.
    Andrews CP, Coalson JJ, Johanson WG: Diagnosis of nosocomial bacterial pneumonia in acute diffuse lung injury. Chest 1981; 80: 254–258.PubMedCrossRefGoogle Scholar
  12. 12.
    Aerdts SJA, Van Dalen R, Clasener HAL, et al: Antibiotic prophylaxis of respiratory tract infection in mechanically ventilated patients: a prospective, blinded, randomized trial of the effect of a novel regimen. Chest 1991; 100: 783–791.PubMedCrossRefGoogle Scholar
  13. 13.
    Gastinne H, Wolff M, Delatour F, et al: A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. N Engl J Med 1992; 326: 594–599.PubMedCrossRefGoogle Scholar
  14. 14.
    Garibaldi RA, Britt MR, Coleman ML, et al: Risk factors for post-operative pneumonia. Am J Med 1981; 70: 677–680.PubMedCrossRefGoogle Scholar
  15. 15.
    Tisi GM: Pre-operative evaluation of pulmonary function: validity, indications and benefits. Am Rev Respir Dis 1979; 119: 293–310.PubMedGoogle Scholar
  16. 16.
    Lawrence VA, Page CP, Harris GD: Pre-operative spirometry before abdominal operations: a critical appraisal of its predictive value. Arch Intern Med 1989; 149: 280–285.PubMedCrossRefGoogle Scholar
  17. 17.
    Ford GT, Whitelaw WA, Rosenal TW, et al: Diaphragm function after abdominal surgery in humans. Am Rev Respir Dis 1983; 127: 431–436.PubMedGoogle Scholar
  18. 18.
    Nunn JF, Coleman AJ, Sachithanandan T, et al: Hypoxaemia and atelectasis produced by forced expiration. Br J Anaesth 1965; 37: 3–12.PubMedCrossRefGoogle Scholar
  19. 19.
    Bendixen HH, Hedley-White J, Laver MB: Impaired oxygenation in surgical patients during general anesthesia with controlled ventilation: a concept of atelectasis. N Engl J Med 1963; 269: 991–996.PubMedCrossRefGoogle Scholar
  20. 20.
    Henderson Y: The physiology of atelectasis. JAMA 1929; 93: 96–98.Google Scholar
  21. 21.
    O’Donohue WJ Jr: National survey of the usage of lung expansion modalities for the prevention and treatment of post-operative atelectasis following abdominal and thoracic surgery. Chest 1985; 87: 76–80.PubMedCrossRefGoogle Scholar
  22. 22.
    Bodey GP, Powell RD Jr, Hersh EM, et al: Pulmonary complications of acute leukemia. Cancer 1966; 19: 781–793.PubMedCrossRefGoogle Scholar
  23. 23.
    Tryka AF, Godleski JJ, Fanta HH: Leukemic cell lysis pneumopathy: a complication of treated myeloblastic leukemia. Cancer 1982; 50: 2763–2770.PubMedCrossRefGoogle Scholar
  24. 24.
    Hildebrand FL Jr, Rosenow EC II, Haberman TM, Tazelaar HD: Pulmonary complications of leukemia. Chest 1990; 98: 1233–1239.PubMedCrossRefGoogle Scholar
  25. 25.
    Saito H, Anaissie EJ, Morice RC, et al: Bronchoalveolar lavage in the diagnosis of pulmonary infiltrates in patients with acute leukemia. Chest 1988; 94: 745–749.PubMedCrossRefGoogle Scholar
  26. 26.
    Witte RJ, Gurney JW, Robbins RA, et al: Diffuse pulmonary alveolar hemorrhage after bone marrow transplantation: radiographic findings in 39 patients. AJR 1991; 157: 461–464.PubMedGoogle Scholar
  27. 27.
    Ettinger NA, Trulock EP: Pulmonary considerations of organ transplantation. Part 2. Am Rev Respir Dis 1991; 144: 213–223.PubMedCrossRefGoogle Scholar
  28. 28.
    Barnes PF, Bloch AB, Davidson PT, Snider DE Jr: Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med 1991; 324: 1644–1650.PubMedCrossRefGoogle Scholar
  29. 29.
    Horsburgh CR Jr: Mycobacterium avium complex infection in the acquired immunodeficiency syndrome. N Engl J Med 1991; 324: 1332–1338.PubMedCrossRefGoogle Scholar
  30. 30.
    El-Sadr W, Simberkoff MS: Survival and prognostic factors in severe Pneumocystis carinii pneumonia requiring mechanical ventilation. Am Rev Respir Dis 1988; 137: 1264–1267.PubMedGoogle Scholar
  31. 31.
    Bennet CL, Garfinkle JB, Greenfield S, et al: The relation between hospital experience and in-hospital mortality for patients with AIDS-related PCP. JAMA 1989; 261: 2975–2979.CrossRefGoogle Scholar
  32. 32.
    Wachter RM, Russi MB, Bloch DA, et al: Pneumocystis carinii pneumonia and respiratory failure in AIDS: improved outcomes and increased use of intensive care units. Am Rev Respir Dis 1991; 143: 251–256.PubMedGoogle Scholar
  33. 33.
    Sankary RM, Turner J, Lipaysky A, et al: Alveolar-capillary block in patients with AIDS and Pneumocystis carinii pneumonia. Am Rev Respir Dis 1988; 137: 443–449.PubMedGoogle Scholar
  34. 34.
    Smith DE, Wyatt J, McLuckie A, Gazzard B: Severe exercise hypoxemia with normal or near normal x-rays: a feature of Pneumocystis carinii infection. Lancet 1988; 2: 1049–1051.PubMedCrossRefGoogle Scholar
  35. 35.
    Kagawa FT, Kirsch CM, Yenokida GG, Levine ML: Serum lactate dehydrogenase activity in patients with AIDS and Pneumocystis carinii pneumonia. Chest 1988; 94: 1031–1033.PubMedCrossRefGoogle Scholar
  36. 36.
    Kreuger JJ, Sayre VA, Karetzky M: Bronchoalveolar lavage-induced pneumothorax. Chest 1988; 94: 440–441.CrossRefGoogle Scholar
  37. 37.
    Krueger JJ, Sayre VA, Karetzky, M: Infectious interstitial emphysema in AIDS. N J Med 1987; 84: 489–491.PubMedGoogle Scholar
  38. 38.
    Aronin PA, Mahaley MS Jr, Rudnick SA, et al: Prediction of BCNU pulmonary toxicity in patients with malignant gliomas: an assessment of risk factors. N Engl J Med 1980; 303: 183–188.PubMedCrossRefGoogle Scholar
  39. 39.
    Martin WJ II, Rosenow EC III: Amiodarone pulmonary toxicity: recognition and pathogenesis. Part 2. Chest 1988; 93: 1243–1248.Google Scholar
  40. 40.
    White DA, Rankin JA, Stover DE, et al: Methotrexate pneumonitis: bronchoalveolar lavage findings suggest an immunologic disorder. Am Rev Respir Dis 1989; 139: 18–21.PubMedCrossRefGoogle Scholar
  41. 41.
    Castellino RA, Glatstein E, Turbow MM, et al: Latent radiation injury of lungs or heart activated by steroid withdrawal. Ann Intern Med 1974; 80: 593–599.PubMedGoogle Scholar
  42. 42.
    Gross NJ: Pulmonary effects of radiation therapy. Ann Intern Med 1977; 86: 8192.Google Scholar
  43. 43.
    Gibson PG, Bryant DH, Morgan GW: Radiation-induced lung injury: a hypersensitivity pneumonitis? Ann Intern Med 1988; 109: 288–291.PubMedGoogle Scholar
  44. 44.
    Keane TJ, Van Dyk J, Rider WD: Idiopathic interstitial pneumonia in bone marrow transplantation: the relationship with total body irradiation. Int J Radiat Oncol Biol Phys 1981; 7: 1365–1370.PubMedCrossRefGoogle Scholar
  45. 45.
    Clark CJ, Reid WH, Gilmour WH, Campbell D: Mortality probability in victims of fire trauma: revised equation to include inhalation injury. BMJ 1986; 292: 1303–1305.PubMedCrossRefGoogle Scholar
  46. 46.
    Clark CJ, Campbell D, Reid WH: Blood carboxyhaemoglobin and cyanide levels in fire survivors. Lancet 1981; 1: 1332–1335.PubMedCrossRefGoogle Scholar
  47. 47.
    Baud FJ, Barriot P, Toffis V, et al: Elevated blood cyanide concentrations in victims of smoke inhalation. N Engl J Med 1991; 325: 1761–1766.PubMedCrossRefGoogle Scholar
  48. 48.
    Helpern M, Rho Y-M: Deaths from narcotism in New York City: incidence, circumstances, and post morteum findings. NY State J Med 1966; 66: 2391–2408.Google Scholar
  49. 49.
    Clemmesen C, Lassen NA: Treatment of circulatory shock in narcotic poisoning. Dan Med Bull 1963; 10: 100–103.PubMedGoogle Scholar
  50. 50.
    Wendt VE, Puro HE, Shapiro J, et al: Angiothrombotic pulmonary hypertension in addicts: “blue velvet” addiction. JAMA 1964; 188: 755–757.PubMedGoogle Scholar
  51. 51.
    Ettinger NA, Albin RJ: A review of the respiratory effects of smoking cocaine. Am J Med 1989; 87: 664–668.PubMedCrossRefGoogle Scholar
  52. 52.
    Murray RJ, Albin RJ, Mergner W, Criner GJ: Diffuse alveolar hemorrhage temporarily related to cocaine smoking. Chest 1988; 93: 427–429.PubMedCrossRefGoogle Scholar
  53. 53.
    Taylor RF, Bernard GR: Airway complications from freebasing cocaine. Chest 1989; 95: 476–477.PubMedCrossRefGoogle Scholar
  54. 54.
    Mendelson CL: The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol 1946; 52: 191–204.PubMedGoogle Scholar
  55. 55.
    Amberson JB Jr: Aspiration pneumonia. Int Clin 1937; 22: 126–138.Google Scholar
  56. 56.
    Gardner AMN: Aspiration of food and vomit. Q J Med 1958; 27: 227–245.PubMedGoogle Scholar
  57. 57.
    Teabeaut JR II: Aspiration of gastric contents: an experimental study. Am J Pathol 1952; 28: 51–67.PubMedGoogle Scholar
  58. 58.
    Colebatch HJH, Halmagyi DFJ: Reflex airway reaction to fluid aspiration. J Appl Physiol 1962; 17: 787–794.Google Scholar
  59. 59.
    Berry REL, Sanslow CA: Clinical manifestations and treatment of congestive atelectasis. Arch Surg 1963; 87: 169–183.Google Scholar
  60. 60.
    Awe WC, Fletcher WS, Jacob SW: The pathophysiology of aspiration pneumonitis. Surgery 1966; 60: 232–239.Google Scholar
  61. 61.
    Cameron JL, Mitchell WH, Zuidema GD: Aspiration pneumonia: clinical outcome following documented aspiration. Arch Surg 1973; 106: 49–52.PubMedGoogle Scholar
  62. 62.
    Bartlett JG, Gorbach SL, Finegold SM: The bacteriology of aspiration pneumonia. Am J Med 1974; 56: 202–207.PubMedCrossRefGoogle Scholar
  63. 63.
    Finland M: Pneumonia and pneumococcal infections with special reference to pneumococcal pneumonia. Am Rev Respir Dis 1979; 120: 481–502.PubMedGoogle Scholar
  64. 64.
    Cugell DW, Frank NR, Gaensler EA, Badger TL: Pulmonary function in pregnancy. 1. Serial observations in normal women. Am Rev Tuberc 1953; 67: 1–30.Google Scholar
  65. 65.
    Milne JA, Howie AD, Pack AI: Dyspnea during normal pregnancy. Br J Obstet Gynaecol 1978; 85: 260–263.PubMedCrossRefGoogle Scholar
  66. 66.
    Gaensler EA, Patton WE, Verstraeten JM, Badger TL: Pulmonary function in pregnancy. III. Serial observations in patients with pulmonary insufficiency. Am Rev Tuberc 1953; 67: 55–73.Google Scholar
  67. 67.
    Taylor G, Pryse-Davies J: The prophylactic use of antacids in prevention of the acid-pulmonary-aspiration syndrome (Mendelson’s syndrome). •Lancet 1966; 1: 288–291.PubMedGoogle Scholar
  68. 68.
    Edwards G, Morton HJV, Pak EA, Wylie WD: Death associated with anaesthesia: a report on 1000 cases. Anesthesia 1956; 11: 194–220.CrossRefGoogle Scholar
  69. 69.
    Thurlbeck WM: The incidence of pulmonary emphysema: with observations on the relative incidence and spatial distribution of various types of emphysema. Am Rev Respir Dis 1963; 87: 206–215.PubMedGoogle Scholar
  70. 70.
    Norris AH, Shick NW, Landowne M, Falzone JH Jr: Pulmonary function studies: age differences in lung volumes and bellows function. J Gerontol 1956; 11: 379–387.PubMedGoogle Scholar
  71. 71.
    Tenney SM: Ventilatory control in old age. In Cander L, Moyer JH (eds): Aging of the lung. Orlauds, FL: Grune & Stratton, 1964, pp. 143–151.Google Scholar
  72. 72.
    Robinson S: Experimental studies on physical fitness in relation to age. Arbeitsphysiologie 1938; 19: 251–323.Google Scholar
  73. 73.
    Pontoppidan H, Beecher HK: Progressive loss of protective reflexes in the airway with the advance of age. JAMA 1960; 174: 2209–2213.PubMedGoogle Scholar
  74. 74.
    Simons RJ, Reynold HY: Altered immune status in the elderly. Sem Respir Infect 1990; 5: 251–259.Google Scholar
  75. 75.
    Verghese A, Berk SL: Bacterial pneumonia in the elderly. Medicine (Baltimore) 1983; 62: 271–285.Google Scholar
  76. 76.
    Arellano JLP, Sanchez RS, Encinas IP, et al: Pathogenesis of hypersensitivity pneumonitis. Allergol Immunopathol 1989; 17: 225–232.Google Scholar
  77. 77.
    Shellito JE: Hypersensitivity pneumonitis. Semin Respir Med 1991; 12: 196–203.CrossRefGoogle Scholar
  78. 78.
    Laviolette M, Cormier Y, Loiseau A, et al: Bronchoalveolar mast cells in normal farmers and subjects with farmers lung: diagnostic, prognostic and physiologic significance. Am Rev Respir Dis 1991; 144: 855–860.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 1993

Authors and Affiliations

  • Monroe Karetzky

There are no affiliations available

Personalised recommendations