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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/
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 - 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
TUBERCULOSISMorphological features primary infect (Ghon focus) &
primary complex caseification isolated organ metastasis tubercle, exsudate, cavity early and late generalisation
– milliary spread
TUBERCULOSISTerms –Forms– Locations:
phtisis gallopans scrofulosis meningitis basillaris lupus vulgaris mallum Potti, cold absces
SARCOIDOSIS m. Besnier–Boeck–Schaumann
morphology similar to tbc (and important dif. dg.)
forms : localised generalised
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)