Granulomatous Inflammation (2)

7/25/2019 Granulomatous Inflammation (2)

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GRANULOMATOUS INFLAMMATION

BY:

DR. RITU MATHUR

(POST GRADUATE STUDENT)

(DEPTT. OF PERIODONTICS)


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CONTENTS

Definition

Pathogenesis

Causes

Mechanism of granuloma formation

Types of granuloma

Tuberculosis

Leprosy Sarcoidosis

Conclusion


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DEFINITION:

Granulomatous inflammation is a distinctive pattern of

chronic inflammatory reaction.

What is a granuloma

! granuloma is a microscopic aggregation of

macrophages that are transformed into epithelium"li#e

cells surrounded by a collar of mononuclear

leu#ocytes$ principally lymphocytes and occasionally

plasma cells.

.


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%pithelioid cells fuse to form giant

cells containing &' or more nuclei.

The nuclei arranged either

peripherally (Langhans-type giant

cell) or hapha*ardly (foreign body-type

giant cell).

These giant cells can be found either

at the periphery or the center of the

granuloma


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CAUSES

Bacterial

Tuberculo! (M"cob#c$er!u% $uberculo!)

Le&ro" (M"cob#c$er!u% le&r#e)

S"&'!l!$!c u%%# (Tre&oe%# ll!*u%)

C#$+cr#$c' *!e#e

Ber"ll!o!

Parasitic

Sc'!$oo%!#! (Sc'!$oo%# %#o!, S. '#e%#$ob!u%,

S. -#&o!cu%)

Fungal

H!$o&l#%# c#&ul#$u%

Bl#$o%"co!

Cr"&$ococcu eoor%#

Cocc!*!o*e !%%!$!


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Inorganic Metals or Dusts

S!l!co!

Ber"ll!o!

Foreign Body

Su$ure, bre#$ &ro$'e!, /#cul#r r#$

Unknown

S#rco!*o!


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MECHANISM OF

GRANULOMA FORMATION


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Granuloma:

bacilli are inhaled by drolets

Bacteria are hagocytosed by!acrohages

"#ter a!assing substances that they

cannot digest$ !acrohages lose

their !otility$ accu!ulate at the site

o# in%ury and trans#or! the!sel&es

into nodular collections' the

(ranulo!a


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" locali)ed in*a!!atory

resonse recruits !ore

!ononuclear cells

The granulo!a consists o# a

kernel o# in#ected

!acrohages surrounded by

#oa!y !acrohages and a ring

o# ly!hocytes and a +brous

cu, -contain!ent hase.

/ontain!ent usually

#ails when the

i!!une status o# the

atient changes' the

granulo!a caseates$

rutures and sills

into the airway


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T0PE1 OF (2"NU3OM"1:

Foreign bodygranulo!as0 or%1'e %#$er!#l uc' #$#lc, u$ure, or o$'er

2ber #re l#re eou' $o&reclu*e &'#oc"$o! b"# !le %#cro&'#e.

I!!une granulo!as0c#ue* b" !oluble r$!cle

$'#$ #re c#ble o !*uc!# cell+%e*!#$e* re&oe

E: $uberculo!


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ORAL CA3ITY


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S4IN


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LUNGS


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TUBERCULOSIS

Mycobacterium

5+67%!cro%e$er ! le$'.

S$ruc$ru#ll" r#% &o!$!/e bu$ #lo co$#! l#re #%ou$ o l!&!* !

$'e cell 1#ll:%#8! $'e% #c!* #$.

No $o9!

No &ore

Obl!#$e Aerob!c

El!c!$ r#ulo%#$ou !#%%#$!o


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M+C,-!CT%/0M T0-%C0L,S/S

Tuberculo! ! # c'ro!c co%%u!c#ble *!e#e !

1'!c' $'e lu #re $'e &r!%e $#re$ , #l$'ou' #"

or# %#" be Iec$e*

TYPES

Pr!%#r" TB

Seco*#r"TB

Prore!/e &ul%o#r" TB

M!l!#r" TB


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P"T4O(ENE1I1

The course of tuberculosis depends on age and immune

competence !1D total burden of the organisms

Tuberculous Infection2 refers to gro3th of the organism in aperson$3hether there is symptomatic disease or not.

Active Tuberculosis4 refers to infection manifested by tissue

destruction"""""symptomatic disease.


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PRIMARY TUBERCULOSIS

Pr!%#r" $uberculo! ! $'e or% o *!e#e $'#$ *e/elo&! # &re/!oul" ue9&oe* #* ue!$!;e* &ero.

Tuberculo! ! # $"&e o *el#"e* $!ue '"&ere!$!/!$"

$o $'e $uberculou b#c!llu 1'!c' el!c!$ # cell+%e*!#$e*!%%ue re&oe 1'!c' 1!ll re!$ $'e ro1$' #*&re#* o $'e %"cob#c$er!u%.

T'! '"&ere!$!/!$" re#c$!o &ro*uce $'e $'olo!c

e#$ure o $uberculo! ! !%%uoco%&e$e$!*!/!*u#l, !.e. r#ulo%#, c#e#$!o, c#/!$"or%#$!o.


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I c'#r#c$er!;e* b":

(hon Focus 55555 lu le!o o

&r!%#r" TB,!/ol/e u&&er

e%e$ o $'e lo1er lobe or

lo1er e%e$ o $'e u&&er lobe.

(hon co!le65++++ co%b!#$!o o

# &er!&'er#l 'o ocu #*

!/ol/e* %e*!#$!#l or '!l#r

l"%&'o*e.

M!croco&!c#ll" $'e cl#!c le!o o

TB ! # c#eou r#ulo%#


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SECONDARY TUBERCULOSIS

I $'e $$er o *!e#e $'#$ #r!e ! # &re/!oul"e!$!;e* 'o$.

I uu#ll" # re#c$!/#$!o o *or%#$ &r!%#r" le!o

1'e $'e 'o$ re!$#ce ! lo1ere*.

Or e9oeou re!ec$!o b" # '!' *oe o /!rule$b#c!ll! 1'!c' occur %ore co%%ol" ! e*e%!c #re#.

Ol"


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COMPLICATIONS OF SECONDARY TB

Sc#rr! >c#lc!2c#$!o

S&re#* $o o$'er #re#

Pleur#l 2bro!>#*'e!o

Ru&$ure o c#eou le!o

I%&l#$#$!o o b#c$er!#! $'e l#r"9 +++'o#ree


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MILIARY TUBERCULOSIS

Occur 1'e or#!% *r#! $'rou' l"%&'#$!c !$o $'el"%&'#$!c *uc$, 1'!c' e%&$" !$o $'e /eou re$ur $o$'e r!'$ !*e o $'e 'e#r$ #* 'ece !$o $'e&ul%o#r" #r$er!e.

I*!/!*u#l le!o #re e!$'er %!croco&!c or %#ll, /!!ble(5+%%) oc! o "ello1+1'!$e cool!*#$!o c#$$ere*$'rou' $'e lu rec'"%#.

M!l!#r" le!o %#" e9* #* co#lece $o "!el* #l%o$$o$#l cool!*#$!o o l#re re!o or e/e 1'ole lobeo $'e lu.


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?!$' &rore!/e &ul%o#r" $uberculo!, $'e &leur#lc#/!$" ! !/#r!#bl" !/ol/e*, #* erou leurale,usions$tuberculous e!ye!a, or obliterati&e+brous leuritis%#" *e/elo&.

M!l!#r" $uberculo! ! %o$ &ro%!e$ ! : $'e l!/er, boe %#rro1, &lee, #*re#l, %e!e, 8!*e", #llo&!# $ube, #* e&!*!*"%!.


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TUBERCULIN TEST

I$ ! # cl#!c e9#%&le o *el#"e* '"&ere!$!/!$".

T'e tuberculin reaction, ! &ro*uce* b" $'e !$r#cu$#eou!-ec$!o o $ubercul!, # &ro$e!+l!&o&ol"#cc'#r!*e co%&oe$o $'e $ubercle b#c!llu.

I # &re/!oul" e!$!;e* !*!/!*u#l, re**e! #* !*ur#$!o o$'e !$e #&&e#r ! @ $o 65 'our, re#c' # &e#8 ! 5 $o 5'our, #* $'ere#$er lo1l" ub!*e.

Mor&'olo!c#ll", *el#"e* $"&e '"&ere!$!/!$" ! c'#r#c$er!;e* b"$'e #ccu%ul#$!o o %ooucle#r cell #rou* %#ll /e! #*/eule, &ro*uc! # &er!/#cul#r cu .


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LEPROSY

M. lepraeis an acid"fast obligate

intracellular organism that gro3s

very poorly in culture

/nhaledM. leprae$ li#eM.tuberculosis$ is ta#en up by alveolar

macrophages and disseminates

through the blood$ but gro3s only in

tissues of the s#in and e5tremities.

Cell"mediated immunity is reflected

by delayed type hypersensitivity

reactions to dermal in6ections of a

bacterial e5tract called lepromin


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Leprosy is primarily a granulomatousdisease of theperipheral nervesand

mucosaof the upper respiratory tract4 s#in lesions are the primary

e5ternal sign

Leprosy may also be divided into the follo3ing types

arly and indeterminate leprosy Tuberculoid leprosy

!orderline tuberculoid leprosy

!orderline leprosy

!orderline lepromatous leprosy Lepromatous leprosy

"istoid leprosy
http://en.wikipedia.org/wiki/Granulomahttp://en.wikipedia.org/wiki/Peripheral_nervous_systemhttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Upper_respiratory_tracthttp://en.wikipedia.org/wiki/Tuberculoid_leprosyhttp://en.wikipedia.org/wiki/Borderline_tuberculoid_leprosyhttp://en.wikipedia.org/wiki/Borderline_leprosyhttp://en.wikipedia.org/wiki/Borderline_lepromatous_leprosyhttp://en.wikipedia.org/wiki/Lepromatous_leprosyhttp://en.wikipedia.org/wiki/Histoid_leprosyhttp://en.wikipedia.org/wiki/Histoid_leprosyhttp://en.wikipedia.org/wiki/Histoid_leprosyhttp://en.wikipedia.org/wiki/Lepromatous_leprosyhttp://en.wikipedia.org/wiki/Lepromatous_leprosyhttp://en.wikipedia.org/wiki/Borderline_lepromatous_leprosyhttp://en.wikipedia.org/wiki/Borderline_lepromatous_leprosyhttp://en.wikipedia.org/wiki/Borderline_lepromatous_leprosyhttp://en.wikipedia.org/wiki/Borderline_leprosyhttp://en.wikipedia.org/wiki/Borderline_tuberculoid_leprosyhttp://en.wikipedia.org/wiki/Borderline_tuberculoid_leprosyhttp://en.wikipedia.org/wiki/Borderline_tuberculoid_leprosyhttp://en.wikipedia.org/wiki/Tuberculoid_leprosyhttp://en.wikipedia.org/wiki/Tuberculoid_leprosyhttp://en.wikipedia.org/wiki/Upper_respiratory_tracthttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Peripheral_nervous_systemhttp://en.wikipedia.org/wiki/Granuloma


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SARCOIDOSIS

#arcoidosis(fromsarcmeaning 7flesh7$ -oid$ 7li#e7$ and -osis$

7diseased or abnormal condition7)$ also called sarcoid$ !esnier-

!oec$ diseaseor!esnier-!oec$-#chaumanndisease $

/t is a syndrome involving abnormal collections of chronic

inflammatory cells (granulomas) that can form as nodules in

multiple organs.The granulomas that appear are usually not of

the caseating variety and are most often located in the lungs or

thelymph nodes$ but virtually any organ can be affected.


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CONCLUSION

Chronic inflammation is inflammation of prolonged duration

(weeks to years) in which continuing inflammation, tissue injury,

and healing, often by fibrosis occurs and involves comple5

interactions bet3een several cell populations and their secreted

mediators. 0nderstanding the pathogenesis of chronic inflammatory

reactions re8uires an appreciation of these cells and their biologic

responses and functions and also treatment modalities 3hich 3ill

differ according to the underlying or systemic cause of thegranulomatosis.


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REFERENCES

Te5tboo# of pathology 9 :arshmohan ( ;thedi)

obbins and cotran pathologic basis of disease

(


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Granulomatous Inflammation (2)

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