Systemic Disease Flashcards
Opportunistic infections in HIV
o Pneumocystis jiroveci PCP pneumonia
o CMV especially retina and GIT
I.E. CMV oesophagitis
o Candida
o Tuberculosis and atypical mycobacteria
o Cryptococcus meningitis
o Toxoplasma gondii encephalitis and mass lesions
Tumours in HIV
o Kaposi’s sarcoma (HHV-8) (A) Dermis expanded by a solid tumour
(B) Made of spindle-shaped cells – infiltrated by HHV-8
(C) HHV-8 identified in nuclei of tumour cells
o Lymphoma
CNS diseases in HIV
o Progressive encephalopathy = AIDS dementia complex
o Plus, opportunistic infections and tumours
o CNS lymphoma
Characteristics of TB
o Caseating granulomas – in immunocompetent people
• Mycobacterial infections can affect:
Lung, Lymph nodes, Bone,Heart GIT, CNS
Characteristics of sarcoid
o NON-caseating granulomas – collection of macrophages with a cuff of lymphocytes around
o Diagnosed as a diagnosis of exclusion
Affects many organs including, lung, liver, heart, skin, spleen etc
IgG4 related disease characteristics
o Inflammation dominated by IgG4-AB producing plasma cells
o Fibrosis and obliteration of veins
Plasma cell rich inflammatory infiltrate
Immunohistochemistry for IgG4
IgG4 related diseases
o Salivary and lacrimal glands: Mikulicz syndrome
o Thyroid: Riedel thyroiditis
o Peritoneum: Retroperitoneal fibrosis
o Liver: Biliary obstruction
Conditions caused by alcohol
o Liver: fatty change (steatosis), steatohepatitis, cirrhosis
o GI Tract: acute gastritis, oesophageal varices
o Nervous system: peripheral neuropathy, Wernicke-Korsakoff syndrome etc
o Cardiovascular system: dilated cardiomyopathy, hypertension
o Pancreas: acute pancreatitis, chronic pancreatitis
o Cancer: oral cavity, pharynx. oesophagus, liver and breast
Areas affected in cystic fibrosis
o Pancreas: duct obstruction, exocrine atrophy
o Salivary glands: duct obstruction, atrophy
o Intestine: meconium ileus
o Liver: biliary obstruction, cirrhosis
o Lung: bronchial obstruction, superimposed infection with abscess formation (Staphylococcus aureus, Haemophilus influenzae and Pseudomonas aeruginosa)
o Male genital tract: infertility, absence of the vas
Amyloid pathophysiology
- Deposition of an abnormal proteinaceous substance in non-branching fibrils, 7.5-10nm diameter
- Always contains P-component
- Beta-pleated sheet structure
- A variety of proteins can take on this conformation
- Resistant to enzymic degradation
Staining of amyloid
o Stains with Congo Red Dye
o Shows apple-green birefringence under polarised light
Classification of amyloid
AA – derived from serum amyloid A (e.g. RhA, Crohn’s Disease / chronic inflammatory diseases)
AL – derived from light chains (e.g. multiple myeloma, B cell lymphoma)
Clinical effects of amyloid
o Proteinuria, renal failure Restrictive cardiomyopathy, arrhythmias
o Autonomic neuropathy Carpal tunnel syndrome
o Macroglossia Bleeding on injury
o Also deposited in blood vessels, endocrine organs, liver, spleen
