1. TUBERCULOSIS

2.  Definition: chronic infective granuloma affecting nearly all body systems but mainly the lungs.  Predisposing factors: A) Environmental b) Personal factors  Causative Agents: T.B. bacilli

3.  Structure o f T.B. bacilli: Carbohydrate, lipid and protein (tuberculoprotein)  Types of TB Bacilli: Human type Human type Bovine type Bovine type

4. Primary tuberculosis (childhood type)  Methods of infections: 1- Inhalation. 2- Ingestion 3- Direct contact.  Sites of primary complex: 1- lung. 2- Intestine 3- Tonsils 4- Skin 5- Nose (rare site).

5. Reaction of the body against bacilli Proliferative reaction (tubercle formation)

6.  N/E of tubercle: Small, 1-3 mm, with central yellow caseation and grey periphery.  M/E of tubercle: Central caseating material (structureless eosinophilic material, epithelioid cells, macrophages, Langhan ’ s giant cells, lymphocytes and peripheral fibroblastic reaction.

7.  The constituents of primary complex: 1. Parenchymatous lesion 2. Tuberculous lymphangitis 3. Tuberculous lymphadenitis

8.  Fate of primary complex: 1- Good fate: Healing 2- Bad fate: spread: 1.Local. 2.Lymphatic. 3.Hematogenous 4.Natural passage.

9. Secondary tuberculosis Adult hood type  Methods of infection: 1. Endogenous by reactivation of dormant focus. 2. Exogenous by inhalation or ingestion.  Sites: Any site, mainly the lung & intestine are affected.

10.  Reaction of the body against bacilli in secondary infection. 1.Proliferative reaction in solid organs. 2.Exudative reaction in serous sacs and sometimes in soft parenchymatous organs.

11.  Fate of secondary T.B: 1. Good fate: Healing. 2. Bad fate: Extension and spread: 1.Local. 2.Natural passages. 3.Blood (rare) 4.Lymphatic.

12. Tuberculoma  Definition: Tumor-like tuberculous lesion formed of inspissated caseating material surrounded by fibrous capsule  Sites: Lung, brain, kidney, and spinal cord.

13. Miliary Tuberculosis  Definition: acute hematogenous dissemination of large dose of T.B bacilli with wide spread involvement of multiple organs.  NAKED EYE EXAMINATION: Multiple, scattered, uniform, small size (3mm) tubercles separated from each other by normal tissue and not surrounded by area of congestion and present on outer and cut surface of organs.

14.  MICROSCOPIC EXAMINATION: They are related to blood vessels are poorly developed tubercle with central necrosis and absent giant cells.

16. Miliary T.B of the lung

17. Pulmonary T.B

18. Lung is a favorable site for T.B. (easy inhalation and aeration). Lung is a favorable site for T.B. (easy inhalation and aeration).  Predisposing Factors: Decrease immunity Decrease immunity contact with patients contact with patients Silicosis Silicosis congenital heart diseases. congenital heart diseases.

19. Primary Pulmonary Tuberculosis  Primary pulmonary complex: Consists of 3 parts: 1. Parenchymatous lesion (Ghon ’ s focus). 2. Tuberculous lymphangitis. 3. Tuberculous lymphadenitis.

21. Ghon ’ s focus

22. Ghon ’ s triad

23.  Fate: 1. Good fate: Healing. 2. Bad fate: Spread.

24. SECONDARY PULMONARY T.B  Sources of Infection: 1. Reactivation of dormant focus. 2. Exogenous by inhalation.  Site: Apical or subapical Apical or subapical More in Rt. Lung than left lung. More in Rt. Lung than left lung.

25. The Morphological Feature: Simon ’ s focus (Assman- Simon ’ s focus) Chronic apical lesion formed by fusion of many tubercles. Not associated with lymphangitis or lymphadenitis. Chronic apical lesion formed by fusion of many tubercles. Not associated with lymphangitis or lymphadenitis.

26. M/P of pulmonary T.B

27. T.B bacilli detected by bacteriologic examination

28.  The Fate: A. Regression (good fate) B. progressive lesion (Bad Fate) 1. Cavitary Tuberculosis 2. Chronic fibrocaseous pulmonary tuberculosis 3. Acute tuberculous bronchopneumonia & acute caseous pneumonia.

29. Chronic fibrocaseous pulmonary tuberculosis  Naked Eye and Pathogenesis: 1. Mother cavity. 2. Daughter cavities (acinar lesions). 3. Insignificant hilar lymphadenopathy.  Microscopic examination: Extensive caseation necrosis form multiple Caseating tubercles healing by fibrosis, epithelialization of cavities, calcification.

30.  Complications: 1- Local tissue destruction: Hemoptysis. Hemoptysis. Spontaneous pneumothorax. Spontaneous pneumothorax. Pyopneumothorax. Pyopneumothorax. 2ry Amyloidosis. 2ry Amyloidosis.

31. 2- Peptic ulcer: 20% of cases; related to stress. 3- Fibrosis: of the lung, bronchus & pleura leads to bronchiectasis and pulmonary hypertension and cor- pulmonale. 4- Spread.

32. Caseating lung T.B