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General Pathology

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Title: General Pathology


1
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
2
Inflammation
  • Definition
  • complex reaction of organism to damage
  • (aim homeostasis maintenance)

3
Inflammation
  • Sense
  • defensive agent elimination
  • reparative damage reparation

4
Inflammation - Classification
  • Time view
  • acute
  • subacute
  • chronic

5
Inflammation - Classification
  • According to the dominant phase
  • alterative
  • EXSUDATIVE
  • proliferative

6
Inflammation - Classification
  • According to the dominant phase
  • alterative
  • exsudative
  • PROLIFERATIVE

7
Inflammation - Classification
  • Type of granulation tissue
  • nonspecific
  • specific
  • GRANULOMATOUS

8
Granuloma
  • Def.
  • Accumulation of macrophages transformed into
    epithelioid and multinucleated giant cells

9
infected macrophage
intracellular parasites
Macrophage activation
mature Th clone creation
interferon receptor
interferon receptor
interferon ?
cytokins bactericid subst. secretion
activated macrophage
10
Granuloma - composition
  • MACROPHAGES
  • lymphocytes
  • fibrous deposits of collagen
  • central necrosis

11
Granuloma - development
  • fibrosis
  • hyalinosis
  • dystrophic calcification
  • progressive necrosis
  • cavity formation
  • spread with generalisation or metastatic foci

12
Granulomatous Inflammatory Diseases 1.
  • TUBERCULOSIS
  • sarcoidosis
  • syphilis
  • leprosy
  • Lyme borreliosis
  • inf. scleroma (rhinoscleroma)

13
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

14
TUBERCULOSIS
  • Mycobacterium tuberculosis
  • (Koch 1882)
  • Mycobacterium bovis
  • acidoresistance
  • M. avium,intracellulare, Kansasii
  • atypical mycobacterioses

15
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

16
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

17
TUBERCULOSIS
  • portae invasionis
  • respiratory tract
  • gastrointestinal tract
  • skin
  • types of disease (clinicoepidemiol. view)
  • open tbc
  • closed

18
TUBERCULOSIS
  • Type of infection
  • childhood (primary, preimmune)
  • adult (postprimary, immune)

19
TUBERCULOSIS
  • Morphological features
  • primary infect (Ghon focus) primary
    complex
  • caseification
  • isolated organ metastasis
  • tubercle, exsudate, cavity
  • early and late generalisation
  • milliary spread

20
TUBERCULOSIS
  • Type of infection
  • childhood (primary, preimmune)
  • adult (postprimary, immune)

21
TUBERCULOSIS
  • Terms Forms Locations
  • phtisis gallopans
  • scrofulosis
  • meningitis basillaris
  • lupus vulgaris
  • mallum Potti, cold absces

22
SARCOIDOSIS
  • etiology ?????
  • Pathogenesis
  • changed Th and Ts ratio
  • modified immune reaction

23
SARCOIDOSIS m. BesnierBoeckSchaumann
  • morphology similar to tbc
  • (and important dif. dg.)
  • forms
  • localised
  • generalised

24
Syphilis
  • Treponema pallidum
  • (F.Schaudin 1905)
  • argyrophilia
  • Syphilis acquisita
  • Syphilis congenita

25
Syphilis acquisita
  • Stages (1)
  • I. ulcus durum bubo indolens
  • II. exanthema syphiliticum, angina
    syphilitica, condylomata lata

26
Syphilis acquisita
  • Stages (2)
  • III. gumma
  • Late syphilis (quarterly, meta)
  • neurosyphylis
  • paralysis progressiva
  • tabes dorsalis
  • panaortitis syphilitica

27
Syphilis congenita
  • Forms
  • fetus maceratus (hepatosplenomegalia)
  • hepatitis pericellularis pericholangitis
    syphilitica,
  • pancreatitis
  • pneumonia alba
  • pseudogummata
  • osteochondritis et periostitis syphilitica
  • coryza et exanthema syphiliticum

28
Syphilis congenita tarda
  • Trias Hutchinsoni
  • keratitis parenchymatosa
  • labyrinthitis
  • Hutchinsons teath
  • gummata
  • periostitis syphilitica tibiae
  • paralysis progressiva infantilis, iuvenilis
  • panaortitis syphilitica

29
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)

30
LEPROSY
  • Mycobacterium leprae (Hanseni) 1873
  • Port of entry respiratory tract
  • Intracellular parasitism
  • macrophages, later Schwann cells
  • Reduced genom
  • (comparing to Mycobacterium tbc)

31
LEPROSY
  • Classification
  • lepromatous
  • (in nonimmune. Virchow lepra cell)
  • tuberculoid (granulomatous, immune
    patients)
  • indeterminate (early stage)
  • borderline (combined)

32
Rhinoscleroma infectious scleroma
  • Klebsiella rhinoscleromatis
  • chronic granulomatose inflammation
  • Mikulicz cells macrophages
  • scaring
  • curable - antibiotics
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