Tuberculosis MUST PDF

Content: Granuloma- Tuberculosis general- Pulmonary tuberculosis- Intestinal tuberculosis- Tuberculous peritonitis- Pott’s disease Target students: 301- FHB102- Dent 202 Final term BY: ASS. PROF. MAHMOUD TAG  GRANULOMA It is a chronic specific inflammation. It is an organ...

Content: Granuloma- Tuberculosis general- Pulmonary tuberculosis- Intestinal tuberculosis- Tuberculous peritonitis- Pott’s disease Target students: 301- FHB102- Dent 202 Final term BY: ASS. PROF. MAHMOUD TAG  GRANULOMA It is a chronic specific inflammation. It is an organized collection of macrophages and other inflammatory cells around a pathogen in a circular form. Granuloma occurs when the immune system try to surround a pathogen that is not able to eliminate it. Granuloma causes necrosis and replacement of the original tissue by fibrosis.  Tuberculosis Chronic infective granuloma caused by bacteria called tubercle bacilli (Mycobacterium tuberculosis). Methods of infection: Inhalation by coughing or sneezing of active TB patient Ingestion of contaminated milk Host bacteria interaction in tuberculosis M. tuberculosis is able to reproduce inside the macrophage Macrophages are unable to present antigen to lymphocytes Bacteria can become dormant, resulting in latent infection If macrophages present the bacterial antigen to lymphocytes; immune response is activated with cytokines production and tissue necrosis  Risk groups and symptoms Risk groups: AIDS –Overcrowding-Malnutrition-Close contact with active patients-Smoking-Alcohol Symptoms: Chronic cough(hemoptysis), fever, night sweats and weight loss. The historical term "consumption" came about due to the weight loss.  Tuberculosis TB Bacilli Caseation necrosis Mechanisms of caseation (causes): Hypersensitivity: it occurs between lymphokines secreted by T lymphocytes / Macrophages and antigen of tubercle bacilli (tuberculoprotein). Ischemic necrosis: due to endarteritis obliterans. Immune reaction against TB Tubercle (tuberculous granuloma) Tubercle is the basic unit of tuberculosis. It is a microscopic structure consists of collection of chronic inflammatory cells, caseation necrosis and fibrosis around the tubercle bacilli. It is considered as the reaction of tissues against T.B bacilli.  Tuberculosis Caseating tubercle Langah’s Giant cell TB Bacilli inside Giant cell and Epithelioid granuloma Caseating TB lymph node Miliary tuberculosis Miliary tuberculosis: large number of mycobacterium tuberculosis travel through the blood and widely spread all over the body Immunity and Hypersensitivity in TB Immunity: is cell mediated through macrophages, epithelioid cells and giant cells which engulf the bacteria and try to prevent spread (Tubercle formation). Hypersensitivity: is due to lymphokines secreted by sensitized T lymphocytes/Macrophages causing (Caseation necrosis).  Primary tuberculosis Ghon’s focus Primary complex Primary pulmonary complex The triad of Ghon’s focus, tuberculous lymphangitis, and tuberculous lymphadenitis of the regional lymph nodes Secondary pulmonary tuberculosis Second infection or reactivation Adult type of tuberculosis Apical cavitation Lymph nodes are not involved Hemoptysis: Coughing of blood Pneumothorax: air in pleura Right sided heart failure due to lung fibrosis Amyloidosis: deposition of insoluble protein Secondary pulmonary tuberculosis  Intestinal tuberculosis Primary intestinal tuberculosis Primary intestinal complex: Tubercles at payer’s patches TB Ulcer Tuberculous lymphangitis Tabes mesenterica Fate Intestinal tuberculosis Tuberculous peritonitis/Tabes mesenterica  Secondary intestinal tuberculosis Tubercles in the Peyer’s patches at terminal ileum Tuberculous ulcers a) Multiple b) Undermined edges c) Soft caseous floor d) Transverse e) Heals by fibrosis. No lymphangitis and no lymphadenitis  Tuberculous peritonitis It is a secondary type of tuberculosis which occurs commonly in children Wet or ascetic type: The reaction is mainly exudative Dry or adhesive type: The reaction is mainly proliferative (cellular- tubercle forming) Tuberculous peritonitis  Pott’s disease Causes: secondary by blood Sites: cervical- thoracic- lumbar Pathological feature: kyphosis- Cold abscess- Paraplegia Pott’s disease