UNIVERSITY OF

KHARTOUM
institute of endemic
diseases

PATHOLOGY:

presentation of
assignment two
 prepared by:
ahmed abdirahman jama

supervised by:
prof. althahir Awad Gasim
(1) chronic inflammation ab
initio

example:

TUBERCULLOSIS
 INTRODUCTION
 chronic inflammation is body’s to injury and
tissue damage in prolonged duration:
weeks, months etc
 There are two main types of chronic
inflammation :
(1) chronic supervening on acute
(2) chronic ab initio : with no initial
acute phase
 Traditionally, chronic inflammation ab
initio is known (GRANULOMATOUS
INFLAMMATION).

 It is distinct type of chronic

inflammation there is focal collection of
activated macrophages called epithilliod
cells.
 It is consist of :
(1) epithelliod cells
(2) lymphocytes
(3) plasma cells and
(4) giant cells – formed by fusion
of
epithelliod cells.
Granuloma Langhans Giant cells
Cell

Lymphocytic Rim
e c rosis
se ous N
Ca

Epithelioid Macrophage
Types of granulomas

 Based on mechanism
 Immune granuloma : is cell mediated immune response a giant an
insoluble particle like microbe .
eg. Tuberculosis , fungal infections

 Foreign body granuloma: they result from a relatively inert

substances.
.
 Based on morphology:

 Caseating granuloma: there are areas

of caseous necrosis ( seen as cheesy
white areas) in the affected tissues
seen in case of tuberculosis.

 Non caseating : there is no central

caseation, it seen sarcoidosis and
fungal infection.
Granulomatous inflammation is
seen
 When an organism is of low
pathogenicity but excites an
immune response e.g.
 Mycobacterium tuberculosis
 Mycobacterium leprae

Fungus

Virus
 Parasite.
 EXAMPLE:

TUBERCULOSIS
 INTRODUCTION
 Tuberculosis is a chronic infectious
disease caused by mycobacterium
of the “tuberculosis”. Mainly
mycobacterium tuberculosis and
mycobacterium bovis.
 Mycobacterium tuberculosis is :
 Rod-shaped

 Slow-growing bacterium

 Non-spore forming

 Thin aerobic bacterium

 Neutral in Gram’s staining

because of it’s content in

huge cell-wall lipids .
 Sings and symptoms
 When disease is quite advanced,
sings and symptoms that arose
include:
 Loss of weight

 Loss of energy

 Poor appetite

 Fever

 Productive cough

 Night sweets.
Types of tuberculosis
 Pulmonary tuberculosis :
 it is most initial infections either

may develop of sings and

symptoms discribed before or not.
 That is seen to chest X-ray and

50%-60% of disease can return to

it.
 Pleural tuberculosis
 it may occur in 10% of people who

have lung disease from

tuberculosis. Also it occurs from
rupture of diseased area into the
pleural space, that is between
lung and abdominal cavity. These
peoples non productive cough,
chest pain and fever. The disease
may go away and then come back
at the later date.
 Miliary tuberculosis:
 In a minority of the people with

weakened immune system. Tb

bacteria may spread through
their blood to various parts of
the body and produces the
mensioned sings and
symptoms but cough and
difficult breathing is less
common.
 About 15% of people may develop
tuberculosis in an organ other than
their lungs. The most common sites
include the following:
 Lymph nodes
 Genitourinary tract

 Bone and joint sites

 Meninges and

 Gastrointestinal tract lining.

 Image credit : http://sitemaker.umich.edu/medchem13/files/tb.htm
TB Brain – Caudate n.
Prostate TB
TB Intestine
TB Peritonitis + liver Miliary
TB
Testes TB Orchitis.
Adrenal TB - Addison Disease
Systemic Miliary TB
Transmission
 Pulmonary tuberculosis is a disease of
respiratory transmission, Patients with
the active disease (bacilli) expel them
into the air by:
 coughing,
 sneezing,
 shouting,
 or any other way that will expel bacilli into the
air
Tb?
 Peoples that have:
 HIV infections
 Low socio-economic diseases

 Alcoholism

 Homelessness

 Over crowded living condition

 Any disease that weakened immune

system.
 Migration country with high rate of

infections of Tb.
 Health care workers.
 EPIDIMIOLOGY
 GLOBAL INCIDENCE AND PREVELENCE
 The world health organization(WHO)

estimates that one-third of the global

community is infected M.tuberculosis.
 In 2000, the estimation was 8-9 millions

incident cases 3 million of them was dead

due to Tb occurred world-wide.
Tuberculosis: Global
epidemiology

1.7 billion people

8.4 million cases, 1.9 million deaths each year

 WHO TB fact sheet 2005
2 billion people ,equal to a third of world's population,
are infected with TB bacilli.
2 million people die every year due to TUBERCULOSIS

TB is curable but kills 5000 people everyday.

98% of TB deaths are in developing world affecting

mostly young adults in their most productive years

Global TB incidence is still growing at 1% a year .

TB is a worldwide pandemic; though the highest rates

per capita are in Africa, half of all new cases are in 6

asian countries(Bangladesh, China, India, Indonesia,
Pakistan, Philippines)
 Diagnosis of TB
 Clinical features are not confirmatory.
 Zeil Nielson Stain - 1x104/ml, 60% sensitivity
 Release of acid-fast bacilli from cavities intermittent.
 3 negative smears to assure low infectivity*
 Culture most sensitive and specific test.
 Conventional Lowenstein Jensen media 3-6 wks.
 Automated techniques within 9-16 days
 PCR is available, but should only be performed by
experienced laboratories
 PPD for clinical activity / exposure sometime in life.
 PPD Tuberculin Testing
 Sub cutaneous
 Weal formation
 Itching – no scratch.
 Read after 72 hours.
 Induration size.
 5-10-15mm (non-ende)
 < 72 hour is not diag*
 +ve after 2-4 weeks.
 BCG gives + result.
 PREVENTION
 By far the best way to prevent
tuberculosis is to diagnose infectious
cases rapidly and administer
appropriate treatment until cure.
Additional strategies include BCG
vaccination and treatment of persons
with latent tuberculosis infection who
are at high risk of developing active
disease.
 Prevention
 Maintain good personal and environmental
hygiene.
 Adopt a healthy lifestyle, i.e., have balanced
diet, adequate exercise and rest.
 Keep hands clean and wash hands properly.
 Wash hands when they are dirtied by
respiratory secretions e.g. after sneezing.
 Cover nose and mouth while sneezing or
coughing and dispose of nasal and mouth
discharge properly.
 Seek treatment promptly if symptoms similar to
tuberculosis appear, particularly persistently
cough for more than one month.
 Receive BCG immunization according to
immunization schedule. (Please refer to
programme of immunization)
In spite of several
advances Tuberculosis
continues to be a difficult
disease
‫الصحة تاج فوق رؤوس الصحاء ل‬
‫يراها إل المرضى‬

‫“الحمد ل على الصحة و العافية”‬

‫‪ .‬شكرًا بحسن إستماعتكم‬