12. Chronic Inflammation II Flashcards
Cells in chronic inflam > ____ (neutrophils in acute inflam)
Macro’s need help > T cells
Macro engulfs, and will try to kill it themselves (not very good at it) > produce ____ > present on material of cell on surface > present antigens to T cells > activating ____: neutrophil recruitment and some monocyte; activate Th1: ____ > macrophages (classical); bi-directional mode of activation as long as etiology exists
macrophages
cytokines
TH17
IFNgamma
Chronic Sialadentitis
Histo of normal salivary gland in middle
Chronic: foci of ____ cells; stain with trichrome and parts would be blue > destruction, ____, and foci of inflam cells, and fibrosis all going on simultaneously
inflam
LOF
Rheumatoid Arthritis
Chronic > pannus formation (___ cells, ___ cells, ___ tissue, ___ connective tissue), and fibrous connective tissue > fibrous ankylosis (___ fused with fibrous tissue), and another example, which involves the use of bony joints
proliferating synovial lining
inflammatory
granulation
fibrous
Liver failure > most likely to be ___
transudate
Exposed to silica dust particles > lung tissue > normal lung parenchyma replaced with ___ > ___
fibrosis
LOF
Granulomatous Inflammation • Infectious: – \_\_\_ (Bacterial) – \_\_\_, Blastomycosis (Fungal) – \_\_\_ disease (Bacterial)
• Non-Infectious (foreign-body):
– ___, breast prosthesis,
– ___, food particles, ___
• Unknown:
– ___
– Orofacial granulomatosis
How is granulomatous different from non-specific chronic inflammation > in chronic: destruction taking place in a large area
Destruction here doesn’t occur uniformly, you begin to see small nodules
Where the inflam reaction is trying to contain the etiology > make sure that it doesn’t get out of hand
Most etiologic agents for GI are agents that are hard to remove, or agents that are very difficult to digest (macro’s take intracellularly, they can’t and then they induce granulomatous inflammation)
tuberculosis histoplasmosis crohn suture uric acid (gout) metals
sarcoidosis
Granulomatous Inflammation
- A distinct pattern of chronic inflammation characterized by the presence of ___
- A small nodular collection in which the predominant cell is the activated ___
• Epithelioid cells – Derived from \_\_\_ – \_\_\_ cytoplasm – Long \_\_\_ nuclei • Surrounded by a collar of \_\_\_ (and fibroblasts)
Activated macrophage > epithelioid cells > look like epithelial cells (have pink cytoplasm, but unlike epithelial, their nuclei is ___)
granulomas macrophage macrophages pink stringy "round cells"
string-like
Granulomatous Inflammation
- Giant Cells:
- “Committee of ___ cells
- > ___ um in diameter
- Abundant Cytoplasm
• Langhan’s type
– ___ or more nuclei in periphery
– “___ pattern”
• Foreign body:
– Nuclei ___
– “___ Pizza”
- ___ bodies
- ___ bodies
Giant cells are not always present > base your assessment on presence of ___
When macrophages are trying to rid of inorganic material (suture) > you also see a committee, but arranged in a pepperoni pizza (foreign body)
___ contrition > schaumann body
___ > asteroid body
epitheloid 50 20 horse shoe scattered pepperoni schaumann asteroid
granuloma
calcium
asteroid/star-shaped
You see a lot of ___ in CGD
In biospy of proud flesh > ___ tissue
PA granuloma > chronic inflam ___ tissue
These are all misnomers; when you have a granulomotous inflammation > you see the structure of a physical ___, and not examples like this
These are not examples of ___ inflammation (must have giant cells, epitheliod cells, etc.)
neutrophils/macro’s
granulation
granulomatous
granuloma
granuolomatous
Tuberculosis
Tuberculosis:
It is a disease of poverty - people of lower socioeconomic status and overcrowding
◦ Now about 1.7 billion people worldwide have been infected
‣ But infection doesn’t automatically mean ___
• Ex: Septa can be crowded and if infected person with Tuberculosis sneezes around you, you can become ___ but not ___
disease
infected
diseased
Tuberculosis
Receptors are present on ___ (not many neutrophils in alveolar space)
Takes in the microbacterium and tries to digest it > MB has something in it that prevents the macrophage from digesting it > ___ is activated, however it is ineffective and you cannot release lysosomal enzymes
The microbes multiply within the phagolysosome, and then released into the ___ > bacteremia seeding into multiple sites; this occurs 1-3 weeks after infection (may have ___ symptoms, or ___)
If ___ immune is not activated in response > trouble
Cell-mediated response tries to now contain bacterium:
___ macro’s present on MHC II > T-cells > Th1 > IFNgamma > ___ > they’re able to kill microbes by producing more chemokines/cytokines > macrophages transform into ___ cells > granuloma > can undergo ___
macrophages phagolysosome lung flu-like asymptomatic
cell-mediated
alveolar
macrophages (classical)
epitheloid
caseation
Tuberculosis
Primary infection takes place in area where microbe’s first lodged and in draining lymph node > ___ > granulomas coalesce > ___ necrosis > ___ complex:
Infected with microbacterium, organisms in lung > alveolar macro’s trying to digest, but bacteria prevent and escape > activate T-cells; granuloma occuring at site of ___ and the ___
If you have a good immune system > T/macro’s > contains the microbe > healing by ___ (this is good, no symptoms or disease, do not want to remove)
Individuals who are infected with HIV/AIDs > defective T-cell number > not able to contain microbe, and the lesion becomes ___ Tb > can occur as a result of reinfection, or reactivation > disease-state >
Can now become progressive and spread to other areas > ___ Tb
No T cells > defense mechanism compromised > cavitation > localized ___ obstructive lesions
Lung biospy > ___ staining to detect organisms > other conditions may mimic symptoms associated with Tb > histoplasmosis, coccidoiodomycosis and blastomycosis > ___ infection
caseation coag Ghon nucleation lymph node
scar
secondary
milliary
caseating
acid-fast
fungal
Histoplasmosis, Coccidiodomycosis and Blastomycosis
• Histoplasmosis:
– Most ___ systemic fungal infection in the US
– ~500,000 new cases every year:
– ___ areas with soil enriched with bird or bat ___
– Fertile river valleys; ___, ___
• Coccidiodomycosis:
– ___ part of the US
– California’s San Joaquin Valley (“___”)
• Blastomycosis:
– Overlap with ___
– Relatively ___ (1/10th of Histoplasmosis)
Top-right > CM
Bottom-left > BM; bigger cell
common humid excrement ohio mississippi
southwestern
valley fever
histoplasmosis
uncommon
Histoplasmosis
• Primary:
– ___ (fever, headache, ___ cough)
• Chronic (granulomatous):
– ___ (less common than primary)
– Similar to ___ (cough, weight loss, fever, weakness)
• Disseminated: – Spread of infection from lung – \_\_\_, AIDS – \_\_\_, GI, liver, \_\_\_ – Commonly affected: \_\_\_, \_\_\_, \_\_\_ mucosa
Ulcerated granular lesion; maxillary buccal vestibule. ___?
Ulceration: Ventral surface of the tongue. ___?
self-limited
non-productive
lung
Tb
immunosuppressed kidneys oral mucosa tongue palate buccal
cancer
cancer
Histoplasmosis
Diagnosis, Treatment and Prognosis:
• Diagnosis:
– Identification of organism in tissue section or by culture
– Serologic testing: ___
• Primary:
– self-limiting-no ___ required
• Chronic (granulomatous):
– ___/Itraconazole
• Disseminated: – Death in 80-90 % of \_\_\_ patients, if untreated – \_\_\_ then \_\_\_ (daily, 6 – 18 months) – Despite therapy, mortality rate, (7 -23%)
Medium power: ___ containing organisms (arrows)
High power: yeasts of His. cap ___ stain
antibodies
amphotericin B
immuno-suppressed
amphotericin B
itraconazole
macrophages
grocott-gomori methenamine silver
