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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
Inflammation
Definition:
complex reaction of
organism to damage
(aim: homeostasis maintenance)
Inflammation
Sense
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
intracellular
parasites
Macrophage
activation
mature Th clone
creation
interferon
interferon
receptor
receptor
interferon γ
cytokins & bactericid subst.
secretion
activated
macrophage
Granuloma - composition
MACROPHAGES
 lymphocytes

 fibrous deposits

of collagen
central necrosis
Granuloma - development
progressive
necrosis
cavity formation
spread with
generalisation
or metastatic
foci
fibrosis
 hyalinosis
 dystrophic
calcification

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

TUBERCULOSIS
Mycobacterium 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)
TUBERCULOSIS
Morphological 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)
TUBERCULOSIS
Terms –Forms– Locations:
 phtisis gallopans
 scrofulosis
 meningitis basillaris
 lupus vulgaris
 mallum Potti, cold absces
SARCOIDOSIS
etiology ?????
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 progressiva
tabes 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

indeterminate
borderline

(granulomatous, immune
patients)
(early stage)
(combined)
Rhinoscleroma –infectious scleroma

Klebsiella rhinoscleromatis

chronic granulomatose inflammation

Mikulicz cells – macrophages

scaring

curable - antibiotics