Chronic Granulomatous Disease and Tuberculosis Overview
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Questions and Answers

What are the two possibilities that secondary tuberculosis may be due to?

  • New exogenous infection (inhalation, ingestion) and destruction of existing tubercle bacilli within a healed primary tuberculous lesion
  • New exogenous infection (inhalation, ingestion) and reactivation of dormant living tubercle bacilli within a healed primary tuberculous lesion (correct)
  • Reactivation of dormant living tubercle bacilli within a healed primary tuberculous lesion and spread to other organs
  • Reactivation of dormant living tubercle bacilli within a healed primary tuberculous lesion and production of resistant tubercle bacilli

    • What is the most common cause of secondary tuberculosis?

  • Reactivation of dormant living tubercle bacilli within a healed primary tuberculous lesion (correct)
  • New exogenous infection (inhalation, ingestion)
  • Spread of the infection from the lungs to other organs
  • Production of resistant tubercle bacilli

    • Secondary pulmonary tuberculosis can be caused by both exogenous and endogenous reinfection.

    True (A)

    What are the two forms of progressive disease in secondary tuberculosis?

    <p>Chronic fibrocaseous pulmonary tuberculosis and acute tuberculous bronchopneumonia</p> Signup and view all the answers

    Which of the following is a feature of chronic fibrocaseous pulmonary tuberculosis?

    <p>It occurs in patients with a moderate level of immunity and hypersensitivity (D)</p> Signup and view all the answers

    Acute tuberculous bronchopneumonia occurs when there is a low dose of virulent bacteria and low hypersensitivity.

    <p>False (B)</p> Signup and view all the answers

    What is the gross picture of chronic fibrocaseous pulmonary tuberculosis?

    <p>Apical lesion (Cavity formation), Basal lesions small caseous foci due to transbronchial spread, Insignificant lesions within hilar LNs</p> Signup and view all the answers

    The pulmonary focus in apical lesions is usually found at the apex of the left lung.

    <p>False (B)</p> Signup and view all the answers

    What is the process that leads to cavity formation in apical lesions?

    <p>Progressive caseation, bronchial erosion, evacuation of caseous material in the eroded bronchus forming cavities.</p> Signup and view all the answers

    What is the characteristic appearance of caseation in chronic fibrocaseous tuberculosis, lung?

    <p>Large, irregular areas of caseation appearing homogeneous pink, surrounded by tuberculous reaction and fibrous tissue (A)</p> Signup and view all the answers

    Which of the following is NOT a complication of secondary tuberculosis?

    <p>Meningitis (B)</p> Signup and view all the answers

    Which of the following is NOT a factor that can cause acute tuberculous bronchopneumonia?

    <p>Good immunity (C)</p> Signup and view all the answers

    What is the gross picture of acute tuberculous bronchopneumonia?

    <p>The affected lung shows multiple small caseous foci around the bronchioles, leading to caseous consolidation of the whole lung. Focal liquefaction and evacuation of caseous material leading to small irregular cavities. The hilar lymph nodes are enlarged and caseous.</p> Signup and view all the answers

    Acute tuberculous bronchopneumonia is characterized by a microscopic picture of massive caseation, many epithelioid cells, and many Langhan's giant cells.

    <p>False (B)</p> Signup and view all the answers

    Miliary tuberculosis is a common complication of acute tuberculous bronchopneumonia.

    <p>True (A)</p> Signup and view all the answers

    What are the clinical features of pulmonary tuberculosis?

    <p>Chronic cough, Weight loss, anemia, pallor, fever and sweating., Chest pain and dyspnea., Hemoptysis, Pleural effusion</p> Signup and view all the answers

    Which of the following is NOT a symptom of TB disease?

    <p>Swollen lymph nodes (A)</p> Signup and view all the answers

    What is the name of the bacterium that causes syphilis?

    <p>Treponema pallidum (B)</p> Signup and view all the answers

    What are the three main modes of transmission for syphilis?

    <p>Venereal type (sexual contact), Non venereal type (touching syphilitic lesions and blood transfusion), Transplacental (congenital type)</p> Signup and view all the answers

    The organisms that cause syphilis enter the body via small abrasions, mucous membranes, and hair follicles.

    <p>True (A)</p> Signup and view all the answers

    What is the primary cell involved in the syphilitic reaction?

    <p>Plasma cells (C)</p> Signup and view all the answers

    The syphilitic reaction is characterized by a microscopic picture of granulation tissue, fibrosis, endarteritis, and accumulation of chronic inflammatory cells.

    <p>True (A)</p> Signup and view all the answers

    Which stage of syphilis is considered the most infective?

    <p>Secondary syphilis (B)</p> Signup and view all the answers

    What is the typical onset of primary syphilis?

    <p>2-4 weeks after the point of contact</p> Signup and view all the answers

    Which of the following is a common site for primary syphilis in men?

    <p>Penis (C)</p> Signup and view all the answers

    The chancre of primary syphilis is typically painful, itchy, and ulcerated.

    <p>False (B)</p> Signup and view all the answers

    Antibody tests for syphilis become positive within 1-3 weeks after the chancre appears.

    <p>True (A)</p> Signup and view all the answers

    What is the typical duration of a chancre?

    <p>3-6 weeks</p> Signup and view all the answers

    Regional lymphadenitis around the chancre occurs 7-10 days after the chancre formation.

    <p>True (A)</p> Signup and view all the answers

    What is the microscopic picture of a chancre?

    <p>Dense infiltrate of mainly plasma cells, some lymphocytes, and a few macrophages (D)</p> Signup and view all the answers

    What is the typical onset of secondary syphilis?

    <p>6-8 weeks after the initial chancre</p> Signup and view all the answers

    Secondary syphilis can overlap with primary syphilis.

    <p>True (A)</p> Signup and view all the answers

    The latent phase of syphilis lasts for 2-6 weeks.

    <p>False (B)</p> Signup and view all the answers

    There is a low bacteremia during secondary syphilis.

    <p>False (B)</p> Signup and view all the answers

    Which of the following is NOT a common skin lesion in secondary syphilis?

    <p>Necrosis (D)</p> Signup and view all the answers

    What is a common manifestation of secondary syphilis in the mucous membranes?

    <p>Snail track ulcers (C)</p> Signup and view all the answers

    Generalized lymphadenopathy is common in secondary syphilis.

    <p>True (A)</p> Signup and view all the answers

    Which of the following is a systemic manifestation of secondary syphilis?

    <p>Malaise (C)</p> Signup and view all the answers

    Antibody tests are always positive during secondary syphilis.

    <p>True (A)</p> Signup and view all the answers

    Tertiary syphilis is highly infective and easily treated.

    <p>False (B)</p> Signup and view all the answers

    What are the two main manifestations of tertiary syphilis?

    <p>Gumma and diffuse syphilitic reaction</p> Signup and view all the answers

    Gummatous syphilis is the most common form of tertiary syphilis.

    <p>True (A)</p> Signup and view all the answers

    Which of the following is a common effect of gumma in solid organs?

    <p>Destructive fibrosis (A)</p> Signup and view all the answers

    Diffuse lesions in tertiary syphilis are commonly seen in the cardiovascular and nervous systems.

    <p>True (A)</p> Signup and view all the answers

    What is the basic lesion in cardiovascular syphilis?

    <p>Syphilitic aortitis mainly involving thoracic aorta</p> Signup and view all the answers

    Syphilitic aortitis can lead to aortic regurgitation, aneurysms, and obstruction of the coronary ostia.

    <p>True (A)</p> Signup and view all the answers

    What is the name of the condition characterized by the destruction of posterior columns of the spinal cord resulting in loss of sensation?

    <p>Tabes dorsalis</p> Signup and view all the answers

    Which of the following is NOT a common early manifestation of congenital syphilis?

    <p>Tuberculosis (A)</p> Signup and view all the answers

    Late congenital syphilis usually appears after 2 years of age.

    <p>True (A)</p> Signup and view all the answers

    What is the name of the painless, symmetrical hydarthrosis of the knee joint that is a late manifestation of congenital syphilis?

    <p>Clutton's joints (D)</p> Signup and view all the answers

    What is the name of the condition characterized by short, notched, and widely separated permanent central incisors?

    <p>Hutchinson's teeth (D)</p> Signup and view all the answers

    Sabre shins are caused by a weakening of the bones in the legs.

    <p>True (A)</p> Signup and view all the answers

    Flashcards

    Granuloma

    A small, localized area of inflammation in the body, often caused by a persistent infection.

    Tuberculosis

    A serious infectious disease caused by bacteria called Mycobacterium tuberculosis, mainly affecting the lungs.

    Acute Tuberculous Bronchopneumonia

    A type of tuberculosis where bacterial inflammation spreads rapidly throughout the lungs, causing pneumonia.

    Study Notes

    Chronic Granulomatous Disease

    • Chronic granulomatous disease (CGD) is a genetic disorder impacting the immune system.
    • Individuals with CGD have impaired ability to kill bacteria and fungi effectively.
    • Consequently, they experience recurring infections.

    Secondary Tuberculosis

    • Secondary tuberculosis (TB) occurs in individuals with previous primary TB exposure.
    • It involves either new exogenous infection or reactivation of dormant bacteria.
    • Most cases result from reactivation of asymptomatic primary TB, caused by reduced immunity, malnutrition, excessive alcohol consumption, or advanced age.

    Secondary Pulmonary Tuberculosis

    • Secondary pulmonary TB is categorized by exogenous reinfection (inhalation) or endogenous reactivation (reactivation of bacilli).
    • The disease progression varies, determined by bacterial virulence, the dosage of infection, and host immune response.
    • The severity of the disease varies based on factors like bacterial dose and virulence, and the patient's immune and hypersensitivity response.

    Course of Infection

    • Disease severity depends on the dose and virulence of bacteria, alongside the degree of host immunity and hypersensitivity.
    • Lesions in the disease may take different forms, either being minimal and undergoing fibrosis (regressive lesion), or progressing through two forms:
      • Chronic fibrocaseous pulmonary tuberculosis (a slow-progressing form)
      • Acute tuberculous bronchopneumonia (an acute and potentially fatal form)

    Chronic Fibrocaseous Pulmonary Tuberculosis

    • This type of TB occurs in individuals with moderate immunity and hypersensitivity.
    • It progresses slowly.
    • Grossly, it involves apical lesions (often with cavities), basal lesions showing small caseous foci, and rare significant involvement of hilar lymph nodes.

    Acute Tuberculous Bronchopneumonia

    • This form appears when one or more of several factors exist:
      • High dose of virulent bacteria
      • Low immunity
      • High hypersensitivity
    • This type rapidly progresses and is often fatal.
    • Grossly, the disease shows multiple small caseous foci around bronchioles, leading to caseous consolidation of the whole lung and potentially small irregular cavities; hilar lymph nodes are often enlarged and caseous.

    Microscopic Picture (Chronic Fibrocaseous Tuberculosis)

    • Microscopic examination typically reveals large areas of caseous necrosis surrounded by tuberculous reaction and fibrous tissue.

    Microscopic Picture (Acute Tuberculous Bronchopneumonia)

    • Characteristically shows extensive caseation, few epithelioid cells, and few Langhans giant cells; fibrosis is often absent.

    Complications

    • Complications from tuberculosis can include:
      • Haemoptysis (coughing up blood) due to erosion of blood vessels in the affected cavity
      • Pneumothorax (air in the pleural sac) from cavity rupture
      • Direct spread, including pleurisy, empyema, and pericarditis
      • Spread involving blood (miliary TB) or bronchial structures (tongue, tonsils, larynx)
      • Secondary intestinal tuberculosis (due to swallowed sputum)
      • Right-sided heart failure from lung fibrosis
      • Reactive systemic amyloidosis

    Pulmonary Tuberculosis

    • This encompasses miliary and cavitary types.
    • Tuberculosis of hilar lymph nodes is a characteristic feature.

    Clinical Features

    • Tuberculosis is often associated with chronic cough, emaciation, anaemia, pallor, fever, perspiration, and chest pain or difficulty breathing.
    • Hemoptysis (coughing up blood) and pleural effusion (fluid in the pleural space) can occur.

    Symptoms of Tuberculosis (TB)

    • Prolonged cough (>2-3 weeks)
    • Shortness of breath
    • Coughing that produces bloody sputum
    • Chest pain
    • Fever
    • Night sweats
    • Fatigue
    • Loss of appetite
    • Weight loss

    Diagnosis

    • Diagnosis of TB involves several tests:
      • Positive Mantoux skin test
      • Positive sputum for acid-fast bacilli (AFB)
      • Complete blood count (including lymphocytosis and elevated erythrocyte sedimentation rate [ESR])
      • Chest X-ray evaluation, looking for specific pattern of nodules and parenchymal changes
    • Fine-needle aspiration of peripheral lymph nodes may confirm diagnosis.

    Syphilis

    • Syphilis is a chronic sexually transmitted infection caused by the bacterium Treponema pallidum.
    • Transmission can be via
      • Sexually (most common)
      • non-venereal (touching lesions)
      • Transplacental (from mother to fetus)

    Pathogenesis of Syphilis

    • Organisms enter through minute abrasions, mucous membranes or hair follicles, and rapidly spread through blood and lymphatics.
    • The response involves chronic inflammation (granulation tissue, fibrosis, inflammatory cells including lymphocytes and histiocytes around affected blood vessels)
    • Tertiary syphilis may involve marked necrosis and tissue destruction.

    Manifestations of Acquired Syphilis

    • Syphilis progresses through distinct stages:
      • Primary syphilis
      • Secondary syphilis (highly infectious)
      • Latent syphilis (hidden stage)
      • Tertiary syphilis (late stage; usually non-infectious but highly destructive)

    Primary Syphilis (Chancre)

    • Onset: 2-4 weeks after infection
    • Sites: characteristically appears at the site of exposure (genitals, lips, tongue, nipples)
    • Appearance: chancre (lesion) is usually single, non-itchy, firm, painless, and ulcerates at the center
    • Regional lymphadenitis (enlarged and firm lymph nodes) appears 7-10 days after chancre
    • Antibody tests are positive about 1-3 weeks after the chancre develops

    Secondary Syphilis

    • Onset: 6-8 weeks after primary chancre
    • Characterized by widespread skin rash, mucous patches, loss of hair, and generalized lymphadenopathy (enlarged lymph nodes).
    • This stage is also accompanied by systemic symptoms like headache, fatigue, sore throat, and fever.
    • It is the most infectious stage.

    Latent Syphilis

    • Characterized by the absence of symptoms despite the presence of detectable serum antibodies.
    • Variability in duration, with a potential for progression to tertiary syphilis in some cases

    Tertiary Syphilis (Late Syphilis)

    • Onset can range from 3-15 years after infection
    • High destructive phase
    • Less infectious than earlier stages
    • May present as gumma (localized) or diffuse syphilitic reaction (widespread tissue damage)

    Syphilitic Gumma

    • Localized manifestation of tertiary syphilis
    • Microscopic picture : central coagulative necrosis (from endarteritis), palisaded macrophages, many plasma cells, lymphocytes, giant cells, granulation tissue, fibroblasts.
    • Appearance: single or multiple, pale yellowish-gray, rubbery lesion with central necrosis
    • Often involves many tissues (liver, testis, bone, brain) and associated with scarring in affected organs

    Disseminated Lesions of Tertiary Syphilis

    • Lesions result from widespread dissemination of spirochetes throughout the body
    • Commonly affects the cardiovascular and nervous systems

    Cardiovascular Syphilis

    • Syphilitic aortitis, resulting in weakening and dilation of the aorta,
    • Lesions involve inflammation and necrosis in the arterial wall, especially thickening of the vasa vasorum.
    • This leads to fibrosis of the elastic tissue and aortic aneurysms or aortic regurgitation.

    Neurosyphilis

    • Divided into asymptomatic and symptomatic forms
    • Asymptomatic neurosyphilis: abnormal CSF with no other signs and symptoms
    • Symptomatic neurosyphilis: -Meningovascular syphilis (affects meninges) -General paresis of insane -Tabes dorsalis

    Congenital Syphilis

    • Syphilis acquired during pregnancy/birth.
    • Two-thirds of children born with congenital syphilis are asymptomatic.
    • If the mother is highly infectious the fetus will show symptoms like stillbirth or premature delivery with skin lesions (macerated), enlarged spleen and liver, and/or syphilitic epiphysitis.
    • Early manifestations (first two years of life) might include rhinitis, skin and mucous membrane lesions similar to secondary syphilis, bony lesions (osteochondritis, periostitis), hepatosplenomegaly, lymphadenopathy and immune complex-associated glomerulonephritis.
    • Late manifestations (after age two), can manifest as Clutton's joints (painless knee joint swelling), deafness (8th cranial nerve involvement), or interstitial keratitis with corneal opacity.
    • Also can exhibit Hutchinson's teeth, saddle nose, saber shins and rhagades.

    Early Manifestation of Congenital Syphilis

    • Rhinitis, skin and mucocutaneous lesions
    • Bony lesions (osteochondritis, periostitis)
    • Hepatosplenomegaly, lymphadenopathy
    • Immune complex-induced glomerulonephritis

    Late Manifestations of Congenital Syphilis

    • Clutton's’joints
    • Deafness
    • Interstitial keratitis

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