UNIVERSITY OF KHARTOUM

institute of endemic diseases

PATHOLOGY:

presentation of assignment two

prepared by:ahmed abdirahman jama

supervised by:prof. althahir Awad Gasim

(1) chronic inflammation ab initio

example:

TUBERCULLOSIS

INTRODUCTION chronic inflammation is body’s to injury

and tissue damage in prolonged duration:weeks, months etc

There are two main types of chronic inflammation :

(1) chronic supervening on acute (2) chronic ab initio : with no initial

acute phase

Traditionally, chronic inflammation ab initio is known (GRANULOMATOUS INFLAMMATION).

It is distinct type of chronic inflammation there is focal collection of activated macrophages called epithilliod cells.

It is consist of :(1) epithelliod cells(2) lymphocytes (3) plasma cells and(4) giant cells – formed by fusion of

epithelliod cells.

Granuloma

Caseous Necrosis

Epithelioid Macrophage

Langhans Giant cells Cell

Lymphocytic Rim

Types of granulomas

Based on mechanism Immune granuloma : is cell mediated

immune response a giant an insoluble particle like microbe .

eg. Tuberculosis , fungal infections

Foreign body granuloma: they result from a relatively inert substances.

.

Based on morphology:

Caseating granuloma: there are areas of caseous necrosis ( seen as cheesy white areas) in the affected tissues seen in case of tuberculosis.

Non caseating : there is no central caseation, it seen sarcoidosis and fungal infection.

Granulomatous inflammation is seen

When an organism is of low pathogenicity but excites an immune response e.g.

Mycobacterium tuberculosis Mycobacterium leprae Fungus Virus Parasite.

EXAMPLE:

TUBERCULOSIS

INTRODUCTION

Tuberculosis is a chronic infectious disease caused by mycobacterium of the “tuberculosis”. Mainly mycobacterium tuberculosis and mycobacterium bovis.

Mycobacterium tuberculosis is : Rod-shaped Slow-growing bacterium Non-spore forming Thin aerobic bacterium Neutral in Gram’s stainingbecause of it’s content in huge cell-wall lipids .

Sings and symptoms When disease is quite advanced,

sings and symptoms that arose include:

Loss of weight Loss of energy Poor appetite Fever Productive cough Night sweets.

Types of tuberculosis Pulmonary tuberculosis :

it is most initial infections either may develop of sings and symptoms discribed before or not.

That is seen to chest X-ray and 50%-60% of disease can return to it.

Pleural tuberculosis it may occur in 10% of people who have lung disease from tuberculosis. Also it occurs from rupture of diseased area into the pleural space, that is between lung and abdominal cavity. These peoples non productive cough, chest pain and fever. The disease may go away and then come back at the later date.

Miliary tuberculosis: In a minority of the people with weakened immune system. Tb bacteria may spread through their blood to various parts of the body and produces the mensioned sings and symptoms but cough and difficult breathing is less common.

About 15% of people may develop tuberculosis in an organ other than their lungs. The most common sites include the following:

Lymph nodes Genitourinary tract Bone and joint sites Meninges and Gastrointestinal tract lining.

Image credit : http://sitemaker.umich.edu/medchem13/files/tb.htm

TB Brain – Caudate n.

Prostate TB

TB Intestine

TB Peritonitis + liver Miliary TB

Testes TB Orchitis.

Adrenal TB - Addison Disease

Systemic Miliary TB

Transmission Pulmonary tuberculosis is a disease

of respiratory transmission, Patients with the active disease (bacilli) expel them into the air by: coughing, sneezing, shouting, or any other way that will expel bacilli

into the air

Who is at risk for getting Tb? Peoples that have:

HIV infections Low socio-economic diseases Alcoholism Homelessness Over crowded living condition Any disease that weakened immune system.

Migration country with high rate of infections of Tb.

Health care workers.

EPIDIMIOLOGY GLOBAL INCIDENCE AND

PREVELENCE The world health

organization(WHO) estimates that one-third of the global community is infected M.tuberculosis.

In 2000, the estimation was 8-9 millions incident cases 3 million of them was dead due to Tb occurred world-wide.

Tuberculosis: Global epidemiology

1.7 billion people

8.4 million cases, 1.9 million deaths each year

WHO TB fact sheet 2005

2 billion people ,equal to a third of world's population, are infected with TB bacilli.

2 million people die every year due to TUBERCULOSIS

TB is curable but kills 5000 people everyday.98% of TB deaths are in developing world affecting mostly young adults in their most productive years

Global TB incidence is still growing at 1% a year .TB is a worldwide pandemic; though the highest rates per capita are in Africa, half of all new cases are in 6 asian countries(Bangladesh, China, India, Indonesia, Pakistan, Philippines)

Diagnosis of TB Clinical features are not confirmatory. Zeil Nielson Stain - 1x104/ml, 60% sensitivity Release of acid-fast bacilli from cavities

intermittent. 3 negative smears to assure low infectivity* Culture most sensitive and specific test.

Conventional Lowenstein Jensen media 3-6 wks. Automated techniques within 9-16 days

PCR is available, but should only be performed by experienced laboratories

PPD for clinical activity / exposure sometime in life.

PPD Tuberculin Testing Sub cutaneous Weal formation Itching – no scratch. Read after 72 hours. Induration size. 5-10-15mm (non-

ende) < 72 hour is not

diag* +ve after 2-4 weeks. BCG gives + result.

PREVENTION By far the best way to prevent

tuberculosis is to diagnose infectious cases rapidly and administer appropriate treatment until cure. Additional strategies include BCG vaccination and treatment of persons with latent tuberculosis infection who are at high risk of developing active disease.

Prevention Maintain good personal and environmental

hygiene. Adopt a healthy lifestyle, i.e., have balanced

diet, adequate exercise and rest. Keep hands clean and wash hands properly. Wash hands when they are dirtied by

respiratory secretions e.g. after sneezing. Cover nose and mouth while sneezing or

coughing and dispose of nasal and mouth discharge properly.

Seek treatment promptly if symptoms similar to tuberculosis appear, particularly persistently cough for more than one month.

Receive BCG immunization according to immunization schedule. (Please refer to programme of immunization)

In spite of several advances Tuberculosis continues to be a difficult disease

رؤوس فوق تاج الصحةال األصحاء

المرض إال ىيراها

و “ الصحة على لله الحمد ”العافية

إستماعتكم بحسن Jشكرا .