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Tuberculosis
Tuberculosis is a chronic
communicable disease with
specific
granulomatous
inflammation caused by a
variety of tubercle bacilli,
especially
Micobacterium
tuberculosis hominis and M.
t. bovis.
Mode of transmission
By inhalation into the respiratory tract.
Ingestion. Through ingestion into GI
tract leads to development to tonsillar
or intestinal tuberculosis.
Inoculation.
Through
mucous
membranes of mouth and throat, skin.
Transplacental
route
results
in
development of congenital tuberculosis
in fetus from infected mother.
3
Classification of
tuberculosis
1. Primary tuberculosis
2. Post primary tuberculosis:
a) Hematogenous tuberculosis
b) Secondary tuberculosis
Postprimary
Pathogenesis of
Tuberculosis
Hypersensitivity and
immunity in
tuberculosis
Features of Primary
Tuberculosis
III
II
I
There is small
tan-yellow
subpleural
granuloma
in
the
mid-lung
field on the right
(1). In the hilum
is a small yellow
tan granuloma
in a hilar lymph
node next to a
bronchus (2).
12
Microscopical picture of
Primary affect
It is 1-2 cm
solitary area of
caseous
pneumonia
surrounding by
perifocal serous
inflammation. A
central area of
necrosis appears
irregular,
amorphous, and
pink. Grossly,
areas of
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Tuberculous
lymphadenitis
Seen here in a
hilar lymph
node is a
"caseating"
granuloma.
Granulomas have
prominent
caseous necrosis.
Grossly, areas of
caseation appear
cheese-like.
14
CASEATING LYMPH
NODE TUBERCULOSIS
PRODUCTIVE
TUBERCULOSIS
OF THE LYMPH NODES
15
In the case of
primary
tuberculosis
of
alimentary tract
due to ingestion
of
tubercle
bacilli, a small
primary focus is
seen
in
the
intestine. It is
tuberculous
16
17
Duration of Primary
tuberculosis
In course of time, the primary lesion can
heal, expand locally or lead to disseminated
disease.
This can occur at both the
sites: the lung and the lymph nodes.
3 variants of the duration of Primary
tuberculosis are probable:
healing of primary complex;
generalization of process (lymphogenous
and hematogenous);
chronic duration.
18
Healing of primary
complex begins at
initial affect:
1.
Perifocal
inflammation resolute
and
exudative
inflammation
replaces by fibrous
capsule (1);
2. Caseous masses
are being dehydrated
and petrificated, and
then ossificated (2).
Such healed initial
focus
is
called 19
20
Hematogenous generalization
of primary tuberculosis
Hematogenous generalization of
Primary Tuberculosis
The
lesions
are
classically 0.5 mm
to
2
mm
in
diameter, firm and
tan,
and
evenly
distributed through
the affected organ.
The name "miliary"
derives from their
supposed
resemblance
to
millet
seeds.
A
punctate area of
necrosis may be 22
seen in the center.
Microscopical features
of Miliary Tuberculosis
Here
are
two
pulmonary
granulomas.
Granulomatous
inflammation
typically consists
of
epithelioid
cells,macrophage
s,
giant
cells,
lymphocytes,
plasma cells, and
fibroblasts. There
may
be
some
neutrophils.
23
Lymphogenous
generalization
26
in
When there is
extensive
caseation and the
granulomas
involve a larger
bronchus, it is
possible for much
of the soft,
necrotic center to
drain out and
leave behind a
cavity. Cavitation
is typical for large
tuberculous
granulomas.
Cavitation is more
common in the
28
Hematogenous
Tuberculosis
29
31
Classifications
of hematogenous tuberculosis
Hematogenous
unpulmonary
tuberculosis:
tuberculosis
lesions
or
with
organic
Features
of hematogenousdisseminative tuberculosis:
On closer inspection,
the granulomas have
areas of caseous
necrosis with
formation of the
small cavernes. This
is very extensive
granulomatous
disease. This pattern
of multiple caseating
granulomas primarily
in the upper lobes is
most characteristic of
postprimary
hematogenous
(reactivation)
34
tuberculosis.
TUBERCULOUS OSTEOARTHRITIS
35
Tuberculous endometritis
Epithelioid cells
Langhans cell
36
Tuberculosis
of the testis (1)
and
epididymus (2)
37
Tuberculous meningitis
38
RENAL TUBERCULOSIS
Large foci of
caseous necrosis
39
40
41
Characteristics
of the Secondary
Tuberculosis
May
be
in
adults
only
with
postprimary disease (or reinfection);
Only Pulmonary localization (often 1st and 2-nd segments so called
Simons foci);
Contact and intracanalicular
spreading;
Shifts of the clinical-morphological
forms.
42
Forms or stages
of the secondary
tuberculosis:
44
44a
45
Greyish-white
wall of the
cavity 2 to 3
mm thick
46
47