Fig. 31.—Unresolved bronchopneumonia with measles showing a nodule of chronic fibrous pneumonia surrounding a respiratory bronchiole. Autopsy 481.
The incidence of unresolved bronchopneumonia among instances of bronchopneumonia following measles is higher than that among bronchopneumonias following influenza. There have been 6 instances of chronic or unresolved bronchopneumonia among 18 pneumonias following measles, namely 33.3 per cent. The incidence of unresolved bronchopneumonia among 241 autopsies on pneumonia following influenza has been 21, namely 8.7 per cent. The essential features of this chronic lesion have been as follows: (a) chronic peribronchiolar pneumonia indicated by the presence of firm nodules of peribronchiolar consolidation which have considerable resemblance to miliary tubercles. Induration of the nodule occurs because the walls of alveoli surrounding and adjacent to a respiratory bronchiole (Fig. 31) become thickened and infiltrated with cells and there is organization of exudate within the alveoli. New formation of fibrous tissue (Fig. 32) occurs where the acute inflammatory reaction of peribronchiolar consolidation is most advanced (p. [169] and compare with Figs. 3 and 4), namely, about the respiratory bronchiole, alveolar duct and the proximal parts of the infundibula, disappearing as the distal half of the infundibulum is approached. Distention of the alveoli explaining the distention of the lung and its failure to collapse on section is a noteworthy feature of the lesion. (b) Chronic peribronchial inflammation (Fig. 30) with new formation of fibrous tissue about the smaller and medium-sized bronchi extending into immediately adjacent alveolar walls and often associated with organization of peribronchial fibrinous pneumonia. (c) Chronic lobular inflammation with changes similar to those just cited, distributed throughout entire lobules. (d) Moderate thickening of interlobular septa. Bronchiectasis may be associated with the chronic lesion (Autopsies 443, 481, 484, 492 and 496) but with one exception (Autopsy 443) has been only moderately advanced. Suppurative pneumonia with abscess formation has occurred twice (Autopsies 438 and 492).
Fig. 32.—Unresolved bronchopneumonia with measles showing chronic pneumonia about a respiratory bronchiole and alveolar duct; alveoli about the proximal parts of three distended infundibula are filled with polynuclear leucocytes, whereas inflammatory changes disappear as the distal parts of the infundibula are approached. Autopsy 481.
With acute bronchopneumonia following measles the average duration of pneumonia, determined by the date upon which physical signs of pneumonia were first recognized and in consequence subject to some error, was seven days; in instances of chronic bronchopneumonia the average duration of pneumonia has been fifteen days.
The bacteriology of acute bronchopneumonia following measles is shown in Table LXXII.
| Table LXXII | ||||
|---|---|---|---|---|
| WITH NO SUPPURATION | SPUTUM IN LIFE | BACTERIA IN BLOOD OF HEART | BACTERIA IN LUNGS | BACTERIA IN BRONCHI |
| Autopsy 390 | Pneum. II atyp. | |||
| 439 | 0 | Pneum. II atyp. S. aur. | B. coli | |
| 441 | 0 | B. inf., S. aur. | B. inf., S. aur. | |
| 444 | B. inf. | Pneum. II atyp. | Pneum. II atyp. B. inf. | Pneum. II atyp. B. inf. |
| 453 | Pneum. I | Pneum. I | Pneum. I, B. inf. | |
| With suppuration: | ||||
| 442 | S. hem. | S. hem. | B. inf., S. hem. | |
| 491 | S. hem. | S. hem. | S. hem., B. coli | B. inf., B. coli |
| 507 | S. hem. | S. hem. | S. hem., S. aur. | S. hem., B. inf., S. aur. |
It is noteworthy that pneumococci have been recovered from the heart’s blood or lung in all but 1 (Autopsy 441) of 5 instances of acute bronchopneumonia with no suppuration and is doubtless the cause of this pneumonia. Pneumococcus II atypical has been found in 3 of 4 instances of lobar pneumonia following measles and is present in 3 of these 5 instances of bronchopneumonia.
Where suppuration has been found, hemolytic streptococci have been present in the sputum, in the heart’s blood and either in the lungs (Autopsy 491) or in the bronchi (Autopsy 442) or in both (Autopsy 507). In these instances pneumococci have not been found, though in view of the readiness with which pneumococci disappear from the lungs it is possible that they have been the primary cause of bronchopneumonia.
The bacteriology of 6 instances of unresolved bronchopneumonia following measles is given in Table LXXIII.