General Pathology Basic Principles

of Cellular and Organ Pathology

Inflammation - III

Jaroslava Dušková

Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague

http://www1.lf1.cuni.cz/~jdusk/

InflammationDefinition:

complex reaction of organism to damage

(aim: homeostasis maintenance)

InflammationSense

defensive – agent elimination

reparative – damage reparation

Inflammation - Classification:

Time view acute subacute chronic

Inflammation - Classification:

According to the dominant phase:

alterative EXSUDATIVE proliferative

Inflammation - Classification:

According to the dominant phase:

alterative exsudative PROLIFERATIVE

Inflammation - Classification:

Type of granulation tissue:

nonspecific „specific“

GRANULOMATOUS

Granuloma

Def.:

Accumulation of macrophages transformed into epithelioid and multinucleated giant cells

infected macrophage

activated macrophage

intracellular parasites

mature Th clone creation

cytokins & bactericid subst. secretion

interferon γ

interferon receptor

interferon receptor

Macrophage activation

Granuloma - composition

MACROPHAGES lymphocytes fibrous deposits

of collagen central necrosis

Granuloma - development

fibrosis hyalinosis dystrophic

calcification

progressive necrosis

cavity formation spread with

generalisation or metastatic foci

Granulomatous Inflammatory Diseases 1. TUBERCULOSIS sarcoidosis syphilis leprosy Lyme borreliosis inf. scleroma (rhinoscleroma)

Granulomatous Inflammatory Diseases 2.

lymphogranuloma venereum (inguinale) anthropozoonoses : brucelosis, listeriosis,

tularemia,….. cat scratch disease (Afipia felis) mycoses: histoplasmosis, coccidiodomycosis… parasites: leishmaniasis, schistosomiasis,

toxoplasmosis… large antigen antibody complexes: rheumatoid

arthritis

TUBERCULOSISMycobacterium tuberculosis

(Koch 1882)

Mycobacterium bovis acidoresistance M. avium,intracellulare, Kansasii

atypical mycobacterioses

TUBERCULOSIS killing 30% patients with  AIDS killing 2–3 mill. people per year next 10 years :

90 millions infected 30 millions deaths

dev. countries - 26% preventable deaths

TUBERCULOSIS countries with combined therapy –

deaths lowered by70% death rate in  Europe lowered to 1/10

12,5 / 100 000  Asia 40x more 500 / 100 000 95% patients unable to pay for therapy

TUBERCULOSIS portae invasionis

– respiratory tract

– gastrointestinal tract

– skin types of disease (clinicoepidemiol. view)

open tbc closed

TUBERCULOSIS

Type of infection

childhood (primary, preimmune)

adult (postprimary, immune)

TUBERCULOSISMorphological features primary infect (Ghon focus) &

primary complex caseification isolated organ metastasis tubercle, exsudate, cavity early and late generalisation

– milliary spread

TUBERCULOSIS

Type of infection

childhood (primary, preimmune)

adult (postprimary, immune)

TUBERCULOSISTerms –Forms– Locations:

phtisis gallopans scrofulosis meningitis basillaris lupus vulgaris mallum Potti, cold absces

SARCOIDOSISetiology ?????

Pathogenesis: changed Th and Ts ratio

modified immune reaction

SARCOIDOSIS m. Besnier–Boeck–Schaumann

morphology similar to tbc (and important dif. dg.)

forms : localised generalised

Syphilis Treponema pallidum

(F.Schaudin 1905)

argyrophilia

Syphilis acquisita

Syphilis congenita

Syphilis acquisita Stages (1) :

I. ulcus durum + bubo indolens

II. exanthema syphiliticum, angina syphilitica, condylomata lata

Syphilis acquisita Stages (2):

III. gumma

Late syphilis (quarterly, meta–) neurosyphylis

paralysis progressivatabes dorsalis

panaortitis syphilitica

Syphilis congenita Forms:

fetus maceratus (hepatosplenomegalia) hepatitis pericellularis pericholangitis

syphilitica, pancreatitis pneumonia alba pseudogummata osteochondritis et periostitis syphilitica coryza et exanthema syphiliticum

Syphilis congenita tarda Trias Hutchinsoni:

keratitis parenchymatosa labyrinthitis Hutchinson´s teath

gummata periostitis syphilitica tibiae paralysis progressiva infantilis, iuvenilis panaortitis syphilitica

LEPROSY 700 000 new cases/year more than 10 mil. cases in the world mostly warm climates related to living conditions zoonosis - armadillo (Dasypus novemcinctus)

primates, cultivation on a nude mice

CURABLE !!!! (combination of antibiotics)

LEPROSY Mycobacterium leprae (Hanseni) 1873

Port of entry respiratory tract

Intracellular parasitism

macrophages, later Schwann cells

Reduced genom (comparing to Mycobacterium tbc)

LEPROSY Classification:

lepromatous (in nonimmune. Virchow lepra cell)

tuberculoid (granulomatous, immune patients)

indeterminate (early stage)

borderline (combined)

Rhinoscleroma –infectious scleroma

Klebsiella rhinoscleromatis

chronic granulomatose inflammation

Mikulicz cells – macrophages

scaring

curable - antibiotics