Pathological anatomy of TUBERCULOSIS As.-prof. V.Voloshyn According prof Ya. Bodnar

Tuberculosis Tuberculosis is the chronic specific infectious disease which is caused by tuberculosis mіkobacterias and characterized by the defeat of all human’s organs, but more frequent lungs. This disease has undulating motion with the duty of acute condition and remission.

Etiology Mіkobacteria of tuberculosis, which was opened by Koch in 1882 year, is the exciter of illness. Distinguish four its varieties: human; bovine; bird; cold-blooded.

Pathogeny Overwhelming ways of infection: Air-drop (through respiratory way) Alimentary (through mouth & stomach way) Origin, course (перебіг) and consequence (result) of illness depends from organism reactivity.

Clinic–morphologic forms of tuberculosis Basic clinical forms: Tubercular intoxication in children and teenagers; Tuberculosis of breathing organs; Tuberculosis of other organs and systems. Basic morphological forms: Primary; Secondary; Haematogenic

Description of tubercular process Localization and prevalence (поширеність): In lungs in the lobules; In other systems according to localization; Phases: Infiltration, disintegration, insemination, dissolving, scarring, calciphication. Selection (excretion) of bacteria: BK+, BK-

Primary tuberculosis A primary tubercular complex is a morphological expression of primary tuberculosis and consists of primary tubercular affect, lymphangitis and specific lymphadenitis.

Variants of course (перебіг) of primary tubercular complex: healing; progress; chronic motion.

Healing of primary tubercular complex Healing of primary complex regardless (independently) of its localization begins from dissolving of perifocal inflammation. The calciphicated and ossiphicated healed origins of primary affects have name the focus of Ghon’s. Sclerosis along the lymphangitis and sclerosis of the primary destroyed lymphatic nodes be going on at the same time. Mіkobacterias is saved in the Ghon’s focuses many years (tens of years) and predetermine unsterile immunity .

Forms of progress of primary tuberculosis growth of primary affect; haematogenic spreading (generalization); lymphogenic spreading (generalization); intracanalicular spreading (generalization); mixed spreading.

Charts of progress forms of primary tuberculosis Lymphglandular generalization. Tubercular bronchadenitis. Growth of primary affect Hematogenic generalization.

Chronic flowing of primary tuberculosis It is observed in those cases, when a primary affect heals over, but in a lymphglandular complex processes of cicatrization change with acutening. It cause sensibilisation of organism. In reply to it there are the paraspecific displays in the inner organs.

Morphology of paraspecific displays of tuberculosis Diffuse or knot proliferation of lymphocytes and macrophages, hyperplasia of hemopoetic organs, fibrinoid changes of connecting tissue, arterioles, dysproteinosis amyloidosis sometimes. The paraspecific reaction in joints at the chronic flowing of primary tuberculosis is known as the rheumatism of Ponsie.

Causes of death Death at progress of primary tuberculosis mainly comes from tubercular meningitis, peritonitis, or generality defeat of internal organs. At timely treatment the focuses encapsulate, but they can be the source of development of hematogenic tuberculosis

Secondary tuberculosis Tuberculosis which arises up after past primary tuberculosis with a some immunity, although can be unstable immunity. Reason of him is repeated superinfection, or reactivation of process in the place of selection in the lungs after primary tuberculosis.

Features of the secondary tuberculosis it is localized only in lungs; has intracanalicular distribution from an apex to basis; specific inflammation is absent in lymphatic nodes; the changing of clinico-morphologic phases is its clinico-morphologic forms

Morphogeny of the secondary tuberculosis Ghon’s focus Simon's focus Ashoff-Pool's focus Abrikosov's focus

Clinico-morphologic forms Fibrotic-focus TB Infiltratic-pneumonitic of Assman-Redeker Acute focus TB

Clinico-morphologic forms Tuberculoma Acute cavernous. Fibrotic cavern. Cirrotic TB Lobitis. Caseous pneumonia

Morphology of chronic cavity (cavern) The wall of cavity is dense. Morphologically distinguish three layers in it's wall: necrotizing (piogenic), is rich by leucocytes; tubercular granulation tissue; connective tissue.

Hematogenic tuberculosis Hematogenic tuberculosis arises up in persons which clinically got better (recovered) from primary tuberculosis, but there is an infection source in fully healed wound, enhanceable sensitiveness to the tuberculin is saved at a formed immunity to mycobacterium

Forms of hematogenic tuberculosis Generalized (Quick as lightning tubercular sepsis of Landuze); Dissimilar, with predominance of lungs defeat; Dissimilar, with predominance of extralungs damages

Generalized hematogenic tuberculosis Most heavy form. This one arises out from focuses of selection, which got in different organs in the period of progress of primary tuberculosis and did not manifestation long time. Inflammation shows up by the origin in the internalss of plural humps with predominance of necrosis above exudation & proliferation (quick as lightning tubercular sepsis), or by like millet humps with predominance of productive reaction (acute general miliary tuberculosis).

Hematogenic tuberculosis with the primary defeat of lungs This one arises up as a result of lung infecting from the focuses of selection, which localized mainly in genitals or lymphatic nodes. Mycobacteriums come in the lungs with the blood current that is why the defeat of lungs are bilateral mirror always.

Forms of hematogenic tuberculosis with the primary lungs defeat Distinguish an acute and a chronic forms. Miliary tuberculosis is the presence of shallow (small) humps, at presence of large – large niduses. At the chronic flowing the scarring of humps, development of emphysema, cavity and as a result hypertension of pulmonary circle of blood circulation is possible with development of pulmonary heart.

Hematogenic tuberculosis with the primary defeat of lungs

Hematogenic tuberculosis with predominance of extralungs damages Develops from focuses of selection, by carrying of exciter into any organ by a hematogenic way in the period of the primary infecting. It can be acute and chronic. Bones, urinary system, skin are damaged mainly.

Hematogenic tuberculosis with predominance of extralungs damages

Complication of tuberculosis Complications of tuberculosis are numerous: so meningitis, pleuritis, pericarditis, abscesses, perifocal inflammations can develop at primary tuberculosis; at secondary TB – is bleeding, pneumothorax, empyema of pleura, amyloidosis. Death mainly comes from the indicated complications, chronic insufficiency of pulmonary heart, uremia.

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