General Pathology Basic Principles of Cellular and Organ Pathology Inflammation - III 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 v acute v subacute v chronic

Inflammation - Classification: According to the dominant phase: v alterative v EXSUDATIVE v proliferative

Inflammation - Classification: According to the dominant phase: v alterative v exsudative v PROLIFERATIVE

Inflammation - Classification: Type of granulation tissue: v nonspecific v „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 Macrophage activation

Granuloma - composition u MACROPHAGES u lymphocytes u fibrous deposits of collagen u central necrosis

Granuloma - development u fibrosis u hyalinosis u dystrophic calcification u progressive necrosis u cavity formation u spread with generalisation or metastatic foci

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

Granulomatous Inflammatory Diseases 2. v lymphogranuloma venereum (inguinale) v anthropozoonoses : brucelosis, listeriosis, tularemia,….. v cat scratch disease (Afipia felis) v mycoses: histoplasmosis, coccidiodomycosis… v parasites: leishmaniasis, schistosomiasis, toxoplasmosis… v large antigen antibody complexes: rheumatoid arthritis

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

TUBERCULOSIS u killing 30% patients with AIDS u killing 2–3 mill. people per year u next 10 years : v 90 millions infected v 30 millions deaths u dev. countries - 26% preventable deaths

TUBERCULOSIS u countries with combined therapy – deaths lowered by70% u death rate in Europe lowered to 1/10 12,5 / u Asia 40x more 500 / u 95% patients unable to pay for therapy

TUBERCULOSIS u portae invasionis – respiratory tract – gastrointestinal tract – skin u types of disease (clinicoepidemiol. view) v open tbc v closed

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

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

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

TUBERCULOSIS Terms –Forms– Locations : u phtisis gallopans u scrofulosis u meningitis basillaris u lupus vulgaris u mallum Potti, cold absces

SARCOIDOSIS etiology ????? Pathogenesis: v changed T h and T s ratio v modified immune reaction

SARCOIDOSIS m. Besnier–Boeck–Schaumann u morphology similar to tbc (and important dif. dg.) u forms : v localised v 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: v fetus maceratus (hepatosplenomegalia) v hepatitis pericellularis pericholangitis syphilitica, v pancreatitis v pneumonia alba v pseudogummata v osteochondritis et periostitis syphilitica v coryza et exanthema syphiliticum

Syphilis congenita tarda Trias Hutchinsoni: v keratitis parenchymatosa v labyrinthitis v Hutchinson´s teath v gummata v periostitis syphilitica tibiae v paralysis progressiva infantilis, iuvenilis v panaortitis syphilitica

LEPROSY u new cases/year u more than 10 mil. cases in the world u mostly warm climates u related to living conditions u 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: v lepromatous (in nonimmune. Virchow lepra cell) v tuberculoid (granulomatous, immune patients) v indeterminate (early stage) v borderline (combined)

Rhinoscleroma –infectious scleroma u Klebsiella rhinoscleromatis u chronic granulomatose inflammation u Mikulicz cells – macrophages u scaring u curable - antibiotics