Infections MIU-2024 PDF

‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Faculty of Oral and Dental Medicine...

‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Faculty of Oral and Dental Medicine ‫رؤية ورسالة الكلية‬ ‫الرؤية‬ ‫تتطلع الكلية أن تكون في مصاف المؤسسات التعليمية المعترف بها إقليميًا وعالميًا‬.‫من خالل برامج تعليمية متطورة وأبحاث تطبيقية مبتكرة وتنمية مجتمعية مستدامة‬ Vision The Faculty of Oral and Dental Medicine aspires to be a recognized educational institution, regionally and internationally, by providing advanced educational.programs, innovative applied research, and sustainable community development ‫الرسالة‬ ‫ ذو كفاءة معرفية‬،‫إعداد طبيب أسنان ملتزم بالقيم االنسانية واألخالق المهنية‬ ‫وتطبيقية من خالل برامج تعليمية متطورة تتوافق مع االحتياجات الفعلية لسوق‬ ‫ كما تلتزم الكلية بإعداد بحوث تطبيقية متوافقة مع‬.‫العمل المحلي والعالمي‬ ‫االستراتيجيات القومية وكذلك تقديم خدمة مجتمعية مستدامة وفقًا لمعايير الجودة‬.‫العالمية‬ Mission The mission of the Faculty of Oral and Dental Medicine is to prepare knowledgeable and well- trained dentists committed to human values and professional ethics, by developing advanced educational programs that correspond to the actual needs of the local and global labor market. The Faculty is also committed to preparing applied research in line with national strategies, as  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology ‫كلية طب الفم‬ GDN202 ‫واألسنان‬ Infections By Dr. Hany Khattab Professor of Pathology Faculty of Medicine, Cairo University Dr. Nelly M.Said Assistant Professor of Pathology Faculty of Medicine, Zagazig University  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Student learning outcomes of course (SLOs) 1.Define and describe etiology, pathogenesis, pathologic features and effects of toxemia, bacteremia, septicemia and pyemia. 2.Discuss the pathology of tuberculosis (mode of transmission, tissue reaction, types, spread) Tuberculosis of lung Tuberculosis of tonsils Tuberculosis of lymph nodes Tuberculosis of bones Tuberculosis of intestine Tuberculosis of peritoneum Tuberculosis of joints Tuberculosis of kidney Tuberculosis of nervous system Tuberculosis of skin 3.Discuss the pathology of leprosy, 4.Discuss the pathology of sarcoidosis, 5.Discuss the pathology of syphilis 6.Discuss the pathology of actinomycosis.  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Toxaemia Definition  Bacterial toxins circulating in the blood Toxins may be:  Endotoxins: produced mainly by gram negative bacteria.  Exotoxins: produced mainly by gram positive bacteria, such as:  Cholera enterotoxin: severe diarrhea and dehydration.  Diphtheria toxins: nerve paralysis and toxic myocarditis.  Clostridium tetani toxins: muscle spasm and risus sardonicus.  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Toxaemia Manifestations  Constitutional signs and symptoms: fever, rigors, headache, weakness and loss of appetite.  Degenerations: cloudy swelling and fatty degeneration of some organs.  Acute heart failure in acute toxaemia & amyloidosis in chronic toxaemia.  Necrosis and haemorrhage of suprarenal gland.  Anaemia: due to bone depression.  Acute respiratory distress syndrome may occur.  Septic shock and disseminated intravascular coagulation (DIC).  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Bacteraemia Definition  Transient presence of some bacteria in blood without toxic manifestations. Pathogenesis  Bacteria enter the blood from a septic focus e.g. tonsillitis, sinusitis, or may follow tooth extraction or during the incubation periods of some infections. Fate  Usually bacteria are engulfed by phagocytic cells.  Sometimes it may localize and produce acute osteomyelitis, renal abscess or subacute bacterial endocarditis.  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Septicaemia Definition  Circulation and multiplication of large numbers of virulent bacteria and their toxins in the blood.  It is a highly fatal condition.  It is caused by highly virulent bacteria in the course of infected operations, septic wounds, puerperal sepsis, large abscess and cellulitis.  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Septicaemia Pathological features Severe toxaemia with severe constitutional signs. Petechial Hemorrhages in skin, mucous membranes and serous membr. Degeneration and focal necrosis in some organs. Acute adrenal insufficiency may occur. Serofibrinous inflammation of serous sacs. Acute bacterial endocarditis (vegetations), toxic myocarditis, acute HF. Acute splenic swelling (congested pulp with lymphoid hyperplasia)  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Pyaemia  Circulation of septic emboli in the blood with their arrest in different organs resulting in multiple small abscesses.  It is a highly fatal condition, usually seen with septicaemia. Types 1-Systemic pyaemia  Septic emboli originate from cases of pulmonary infections, lung abscess, infective bacterial endocarditis.  They are arrested in the kidneys, spleen, brain,… 2-Pulmonary pyaemia  Septic emboli originate from cases of puerperal sepsis, otseomyelitis, cellulitis,….  They are arrested in the lung. 3-Portal pyaemia  Septic emboli originate from cases of acute suppurative appendicitis, acute cholecystitis, infected piles,…  They are arrested in the liver.  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Examples of Chronic Bacterial Infections Tuberculosis Definition  Chronic infective granuloma caused by Mycobacterium tuberculosis (Tubercle bacillus). Methods of infection: 1-Inhalation 2-Ingestion 3-Inoculation  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Tuberculosis Methods of infection: 1-Inhalation :The commonest method, human bacilli are inhaled and usually affect lungs and tonsils. 2-Ingestion:The next common method, ingestion of infected milk containing bovine bacilli usually affects intestine and tonsils. 3-Inoculation:The rarest, handling of infected materials may affect the skin.  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Tissue reaction in Tuberculosis A- Proliferative tissue reaction:  Occurs usually with the first contact between the tubercle bacilli and the human tissues and is characterized by tubercle formation. Gross:  Multiple small tubercles fuse together and appear as small (1- 2mm) greyish yellow foci with yellowish caseous center. Micro  The tubercles appear as rounded or oval collections of 1. Epithelioid cells 2. Langhan’s gaint cells 3. T-lymphocytes: With the release of lymphokines, the centre undergoes caseation and appears as pale pink homogenous structureless material.  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 The tubercle  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Tubercle  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 TB bacilli inside epithelioid cells  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 B- Exudative tissue reaction:  Occurs usually with the second contact between the tubercle bacilli and sensitized human tissues containing sensitized T- lymphocytes and is characterized by : 1. Rapid formation of tubercles 2. Rapid caseation of tubercles 3. Rapid liquefaction of caseous material.  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology Types of Tuberculosis GDN202 Primary Tuberculosis Secondary Tuberculosis infection for the first -infection of previously time with formation of infected sensitized primary complex individuals. Age - Usually in children - Usually in adults. Sites - Usually affects lungs, -May affect any organ. tonsils, intestine and rarely skin Spread of infection more common less common Tissue reaction slow and rapid and proliferative exudative Tissue destruction less marked marked  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Spread of tuberculosis 1. Direct spread to the surroundings. 2. Lymphatic spread to draining lymph nodes. 3. Blood spread: a- Isolated organ tuberculosis. b- Miliary tuberculosis 4. Intracanalicular spread  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Pulmonary Tuberculosis Primary pulmonary tuberculosis:  Usually in children (childhood type).  Usually results from inhalation of human type of bacilli.  Represents the first contact between the tubercle bacilli and lung tissue.  Characterized by the formation of primary tuberculous pulmonary complex: 1. Ghon’s focus 2. Tuberculous lymphangitis 3. Tuberculous lymphadenitis  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Fate of primary pulmonary complex A. Healing: B. Spread: a) Direct : to surrounding lung or pleura. b) Blood : Isolated organ tuberculosis or miliary tuberculosis. c) Bronchial : tuberculous bronchopneumonia or affection of tonsils and larynx. d) Lymphatic spread: to the hilar or tracheobronchial lymph nodes  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Primary pulmonary complex  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 II-Secondary Pulmonary Tuberculosis  Usually in adults (adulthood type).  It usually results from new exogenous infection or reactivation of previous endogenous infection. Types: A. Chronic fiberocaseous pulmonary tuberculosis 1. Apical lesion (Apical cavity) 2. Acinar (Basal) lesions 3. Insignificant nodal lesions B. Tuberculosis bronchopneumonia.  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 TB cavity with caseation  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Chronic firocaseous TB  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Chronic firocaseous TB with acinar lesions  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 TB cavities with caseation  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Chronic fibrocaseous tuberculosi caseation Tuberculous cavities caseation Fibrosis  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Fibrocaseous TB lung  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Miliary tuberculosis  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Miliary tuberculosis  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Miliary Tuberculosis, lung Lung tissue Granuloma Many yellowish tubercles all over the lung  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Sarcoidosis  Granuloma characterized by tubercle like lesions without caseation, of unknown etiology. Pathology  Sites: Lesions may affect skin, lymph nodes, lung, liver, …..  Micro: small rounded non caseating tubercles each is formed of epithelioid cells, lymphocytes and Langhan’s like giant cells which may contain inclusion bodies, such as Schawmann & Asteroid bodies.  Lesions heal by fibrosis.  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology Leprosy GDN202 Definition : chronic infective granuloma caused by lepra bacilli.  Gross: nodular masses usually less than 1 cm called lepromas.  Micro: granulomas formed of macrophages, lymphocytes, plasma cells and few giant cells. The macrophages engulf the lepra bacilli which multiple inside them and become vacuolated cells called lepra cells. Types: A-Nodular leprosy (Lepromatous leprosy): showing skin, nasal, nerve, trophic, visceral lesions.  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Definition: Actinomycosis  Chronic infective suppurative granuloma caused by anaerobic gram positive bacteria called Actinomyces isrealii. Gross:  Multiple intercommunicating abscesses opening to the surface by multiple sinuses discharging pus with yellowish colonies of the organism. Micro:  In the center, bacterial colony is surrounded by many acute and chronic inflammatory cells.  Granulation tissue is formed at periphery, followed by fibrosis. Types:  Cervico-facial actinomycosis (60%).  Pulmonary actinomycosis (15%).  Intestinal actinomycosis (20%).  Skin actinomycosis (5%).  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 26- Actinomycosis (Mycetoma): 1) Section in suppurative granuloma. 2) There are multiple abscesses showing central bluish colonies, surrounded by reddish clubs. 3) The abscesses show many acute & chronic inflammatory cells and they are surrounded by granulation tissue & fibrosis.  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Mycetoma(actinomycosis) Mycetoma Abscess Mutiple sinuses opening on Skin surface  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Fungal (Mycotic) Diseases Mycetoma pedis = Nocardiasis = Madura foot Definition :  Chronic infective suppurative granuloma caused by Nocardia fungus.  It is common in Madura in India. Gross:  The foot is inflamed and swollen.  The skin showed multiple sinuses discharging pus.  Fungus colonies are yellowish, brownish or blackish.  Destruction of all tissues affected including bone. Micro:  Chronic suppurative granuloma containing fungal colonies surrounded by many inflammatory cells.  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Madura foo  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Moniliasis = Candidiasis Definition :  Infection by Candida albicans fungus. Infection:  Endogenous as the organism is a commensal of the mouth, intestine & vagina.  Infection occurs in weak persons, immunosuppressed or with prolonged antibiotic therapy. Pathology:  Superficial candidiasis : it is characterized by oral thrush (whitish oral patches), vaginal lesions, interdigital infection and paronychia (nail lesions).  Eosophageal and intestinal candidiasis.  Disseminated candidiasis: in immunosuppressed persons and it is usually fatal.  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Histoplasmosis Definition :  Fungal infection by Histoplasma capsulatum. Infection:  Inhalation of spores from soil. Pathology:  Lungs, lymph nodes, liver and spleen are mainly affected.  Lesions consist of focal necrosis surrounded by lymphocytes, macrophages and occasional giant cells.  Fibrosis and dystrophic calcification may occur.  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Viral infections Viruses are obligatory intracellular parasites, containing either DNA or RNA. They are introduced into the body by:  Inhalation: influenza, measles.  Ingestion: virus A hepatitis, poliomyelitis.  Inoculation: AIDS and virus hepatitis B & C.  Bite of animal yellow fever and rabies. Pathological Features of Viral Infections: 1. Cellular degeneration and necrosis as in viral hepatitis. 2. Cellular proliferation as in warts. 3. Cellular inflammatory reaction with few giant cells as in measles. 4. Intracytoplasmic or intranuclear inclusion bodies as in rabies.  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Viral infection 1.Measles: Reddishmaculo-papular skin rash. Upper respiratory tract catarrh and giant cell pneumonia Lymphoid tissue hyperplasia 2. Cytomegalovirus Infection (CMV): multisystem affection in immunosuppressed persons. The manifestations include pneumonitis, hepatitis, enterocolitis, and retinochoroiditis. 3.German measles: Macular skin rash. Generalized lymph node enlargement and splenomegaly. Congenital malformations 4.Mumps:Inflammation and swelling of the parotid gland 5.Acquired Immuno-Deficiency Syndrome: AIDS  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Sum up  ‫كلية طب الفم‬ ‫واألسنان‬ General Pathology GDN202 Thank You