Inflamación y consolidación del tejido pulmonarSe aplica a inflamaciones de grandes áreas del pulmón, segmentos o lóbulos
Alveolos: neumonía alveolar (genuina)Intersticio: neumonía intersticial (neumonitis)Mixto: neumonía mixta (daño alveolar difuso)
Neumonía alveolar
Se constituye rápidamente un bloque de condensación. Desencadenada típicamente por el neumococo, menos frecuentemente por otros gérmenes (Klebsiella pneumoniae). Suele ser lobular que evoluciona con exudado fibrinoso en los alveolos (neumonía fibrinosa). El exudado se acumula en alveolos, conductos alveolares y bronquíolos respiratorios
Extrahospitalaria: adquirida en la comunidad por personas sin trastornos primarios del sistema inmunitarioHospitalaria: debida a una infección diseminada por microorganismos nosocomiales, en pacientes vulnerablesOportunistas: afecta a personas con alteración del sistema inmuntario
Patogenia:La mayoría de las bacterias productoras de neumonía residen en la orofaringe y nasofaringe aspiración de secrecionesInhalación de microorganismos del ambienteDiseminación hematógena
Neumonía neumocócica afecta típicamente a adultos jóvenes.. Corresponde a una neumonía fibrinosa que afecta grandes áreas del pulmón. Más frecuentemente lóbulos inferiores. Cursa en cuatro fases:Congestión, Hepatización roja, Hepatización gris y Resolución
Luego de la resolución ocurre regeneración del epitelio alveolar, la zona afectada vuelve a airearse en 14 días. Habitualmente existe restitución ad integrum
Complicaciones:
Empiema pleural (2-6%), cuando pasan neumococos al exudado pleural que acompaña a la neumoníaMeningitis (2%)Endocarditis úlcero-trombótica (6%)Artritis u osteomielitis (1%)Absceso pulmonar (6%)Neumonía crónica (3%, carnificación), por organización del exudadoMuerte (5% en menores de 50 años y 30% en mayores de 50 años)
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