Examples of Chronic Inflammation

• Tuberculosis Leprosy, Syphilis, Cat scratch

disease, Granuloma inguinale, Tularemia

• Fungal- Actinomycosis, Blastomycosis, Cryptococosis

• Parasitic- Schistosomiasis

• Sarcoidosis, Crohns, Foreignbody.

?

The

Organism?How it enters in the body?

Which organs are affected?

Changes in the organs, Gross & Microscopy Complications and

fates of disease

How to make a Diagnosis ?

Leprosy ~

Hansen’s disease

Mycobacterium leprae

less acid fast .

Transmission

Slow communicable

Incubation period – 3 yrs

Slow transmission

Route :

‘Direct contact’

Organs involved

Classification

Lepromatous

Tuberculoid

• T Lymphocytes

• IFN-Gamma • Macrophages • epitheloid • giant cells.

Modified Ridley &

Jopling’s classification

• TT – Tuberculoid polar• BT – Borderline tuberculoid• TI -- Tuberculoid indeinite• BB – Mid borderline• LI – Lepromatous indefinite• BL – Borderline lepromatous• LL – Lepromatous polar

Other types:

1.Pure neural2.Histoid3. Indeterminate

Lepromatous leprosy

Symmetrical,

Multiple,

Hypopigmented lesions

Leonine faces

Pts Immunity – down

Sensory deficit – less severe

Histology

Foamy cells in the dermis, separated from Epidermis by Clear zone

Tuberculoid leprosy

Single or few asymmetrical ,

Sensory impairment

HistologyTubercle,

dermal nerves,

No clear zone, few bacilli

Lab Diagnosis

To show the organism

Skin clipping

Stains-

ZN, Fite Faraco,

Gomori methenamine silver

Culture

9 Banded Armadilo

Reactions in Leprosy

Lepra type I

Lepra type II

Lepra type I

Upgrading reaction

Downgrading reaction

• TT – Tuberculoid polar• BT – Borderline tuberculoid• TI -- Tuberculoid indeinite• BB – Mid borderline• LI – Lepromatous indefinite• BL – Borderline lepromatous• LL – Lepromatous polar

Lepra type 2

Erythema nodosum Leprosum

In Lepromatous patient

after treatment

Tender nodules, fever, synovitis,

Lymphnode enlargement

Lepromin test

Not for Diagnosis

For classifying Leprosy

Depending on immune response.

24-48 Fernandez

3-4 wks Mitsuda reaction

Baba Amte

Actinomycosis

Mycosis…Is it a fungus?

No

Anaerobic

Bacteria

Actinomycetes israelii.

Commensal organism.

Endogenous infection.

Types depending on sites

CervicofacialThoracic

AbdominalPelvic