General Pathology

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General Pathology

• Basic Principles of Cellular and Organ Pathology
• Inflammation - III

http//www1.lf1.cuni.cz/jdusk/
Jaroslava Dušková Inst. Pathol. ,1st Med.
Faculty, Charles Univ. Prague
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Inflammation

• Definition
• complex reaction of organism to damage
• (aim homeostasis maintenance)

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Inflammation

• Sense
• defensive agent elimination
• reparative damage reparation

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Inflammation - Classification

• Time view
• acute
• subacute
• chronic

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Inflammation - Classification

• According to the dominant phase
• alterative
• EXSUDATIVE
• proliferative

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Inflammation - Classification

• According to the dominant phase
• alterative
• exsudative
• PROLIFERATIVE

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Inflammation - Classification

• Type of granulation tissue
• nonspecific
• specific
• GRANULOMATOUS

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Granuloma

• Def.
• Accumulation of macrophages transformed into
  epithelioid and multinucleated giant cells

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infected macrophage
intracellular parasites
Macrophage activation
mature Th clone creation
interferon receptor
interferon receptor
interferon ?
cytokins bactericid subst. secretion
activated macrophage
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Granuloma - composition

• MACROPHAGES
• lymphocytes
• fibrous deposits of collagen
• central necrosis

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Granuloma - development

• fibrosis
• hyalinosis
• dystrophic calcification

• progressive necrosis
• cavity formation
• spread with generalisation or metastatic foci

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Granulomatous Inflammatory Diseases 1.

• TUBERCULOSIS
• sarcoidosis
• syphilis
• leprosy
• Lyme borreliosis
• inf. scleroma (rhinoscleroma)

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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

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TUBERCULOSIS

• Mycobacterium tuberculosis
• (Koch 1882)
• Mycobacterium bovis
• acidoresistance
• M. avium,intracellulare, Kansasii
• atypical mycobacterioses

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TUBERCULOSIS

• killing 30 patients with  AIDS
• killing 23 mill. people per year
• next 10 years
• 90 millions infected
• 30 millions deaths
• dev. countries - 26 preventable
  deaths

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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

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TUBERCULOSIS

• portae invasionis
• respiratory tract
• gastrointestinal tract
• skin
• types of disease (clinicoepidemiol. view)
• open tbc
• closed

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TUBERCULOSIS

• Type of infection
• childhood (primary, preimmune)
• adult (postprimary, immune)

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TUBERCULOSIS

• Morphological features
• primary infect (Ghon focus) primary
  complex
• caseification
• isolated organ metastasis
• tubercle, exsudate, cavity
• early and late generalisation
• milliary spread

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TUBERCULOSIS

• Type of infection
• childhood (primary, preimmune)
• adult (postprimary, immune)

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TUBERCULOSIS

• Terms Forms Locations
• phtisis gallopans
• scrofulosis
• meningitis basillaris
• lupus vulgaris
• mallum Potti, cold absces

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SARCOIDOSIS

• etiology ?????
• Pathogenesis
• changed Th and Ts ratio
• modified immune reaction

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SARCOIDOSIS m. BesnierBoeckSchaumann

• morphology similar to tbc
• (and important dif. dg.)
• forms
• localised
• generalised

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Syphilis

• Treponema pallidum
• (F.Schaudin 1905)
• argyrophilia
• Syphilis acquisita
• Syphilis congenita

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Syphilis acquisita

• Stages (1)
• I. ulcus durum bubo indolens
• II. exanthema syphiliticum, angina
  syphilitica, condylomata lata

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Syphilis acquisita

• Stages (2)
• III. gumma
• Late syphilis (quarterly, meta)
• neurosyphylis
• paralysis progressiva
• tabes dorsalis
• panaortitis syphilitica

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Syphilis congenita

• Forms
• fetus maceratus (hepatosplenomegalia)
• hepatitis pericellularis pericholangitis
  syphilitica,
• pancreatitis
• pneumonia alba
• pseudogummata
• osteochondritis et periostitis syphilitica
• coryza et exanthema syphiliticum

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Syphilis congenita tarda

• Trias Hutchinsoni
• keratitis parenchymatosa
• labyrinthitis
• Hutchinsons teath
• gummata
• periostitis syphilitica tibiae
• paralysis progressiva infantilis, iuvenilis
• panaortitis syphilitica

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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)

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LEPROSY

• Mycobacterium leprae (Hanseni) 1873
• Port of entry respiratory tract
• Intracellular parasitism
• macrophages, later Schwann cells
• Reduced genom
• (comparing to Mycobacterium tbc)

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LEPROSY

• Classification
• lepromatous
• (in nonimmune. Virchow lepra cell)
• tuberculoid (granulomatous, immune
  patients)
• indeterminate (early stage)
• borderline (combined)

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Rhinoscleroma infectious scleroma

• Klebsiella rhinoscleromatis
• chronic granulomatose inflammation
• Mikulicz cells macrophages
• scaring
• curable - antibiotics