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GRANULOMATOUS INFLAMMATION
BY:
DR. RITU MATHUR
(POST GRADUATE STUDENT)
(DEPTT. OF PERIODONTICS)
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CONTENTS
Definition
Pathogenesis
Causes
Mechanism of granuloma formation
Types of granuloma
Tuberculosis
Leprosy Sarcoidosis
Conclusion
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DEFINITION:
Granulomatous inflammation is a distinctive pattern of
chronic inflammatory reaction.
What is a granuloma
! granuloma is a microscopic aggregation of
macrophages that are transformed into epithelium"li#e
cells surrounded by a collar of mononuclear
leu#ocytes$ principally lymphocytes and occasionally
plasma cells.
.
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%pithelioid cells fuse to form giant
cells containing &' or more nuclei.
The nuclei arranged either
peripherally (Langhans-type giant
cell) or hapha*ardly (foreign body-type
giant cell).
These giant cells can be found either
at the periphery or the center of the
granuloma
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CAUSES
Bacterial
Tuberculo! (M"cob#c$er!u% $uberculo!)
Le&ro" (M"cob#c$er!u% le&r#e)
S"&'!l!$!c u%%# (Tre&oe%# ll!*u%)
C#$+cr#$c' *!e#e
Ber"ll!o!
Parasitic
Sc'!$oo%!#! (Sc'!$oo%# %#o!, S. '#e%#$ob!u%,
S. -#&o!cu%)
Fungal
H!$o&l#%# c#&ul#$u%
Bl#$o%"co!
Cr"&$ococcu eoor%#
Cocc!*!o*e !%%!$!
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Inorganic Metals or Dusts
S!l!co!
Ber"ll!o!
Foreign Body
Su$ure, bre#$ &ro$'e!, /#cul#r r#$
Unknown
S#rco!*o!
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MECHANISM OF
GRANULOMA FORMATION
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Granuloma:
bacilli are inhaled by drolets
Bacteria are hagocytosed by!acrohages
"#ter a!assing substances that they
cannot digest$ !acrohages lose
their !otility$ accu!ulate at the site
o# in%ury and trans#or! the!sel&es
into nodular collections' the
(ranulo!a
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" locali)ed in*a!!atory
resonse recruits !ore
!ononuclear cells
The granulo!a consists o# a
kernel o# in#ected
!acrohages surrounded by
#oa!y !acrohages and a ring
o# ly!hocytes and a +brous
cu, -contain!ent hase.
/ontain!ent usually
#ails when the
i!!une status o# the
atient changes' the
granulo!a caseates$
rutures and sills
into the airway
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T0PE1 OF (2"NU3OM"1:
Foreign bodygranulo!as0 or%1'e %#$er!#l uc' #$#lc, u$ure, or o$'er
2ber #re l#re eou' $o&reclu*e &'#oc"$o! b"# !le %#cro&'#e.
I!!une granulo!as0c#ue* b" !oluble r$!cle
$'#$ #re c#ble o !*uc!# cell+%e*!#$e* re&oe
E: $uberculo!
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ORAL CA3ITY
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S4IN
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LUNGS
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TUBERCULOSIS
Mycobacterium
5+67%!cro%e$er ! le$'.
S$ruc$ru#ll" r#% &o!$!/e bu$ #lo co$#! l#re #%ou$ o l!&!* !
$'e cell 1#ll:%#8! $'e% #c!* #$.
No $o9!
No &ore
Obl!#$e Aerob!c
El!c!$ r#ulo%#$ou !#%%#$!o
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M+C,-!CT%/0M T0-%C0L,S/S
Tuberculo! ! # c'ro!c co%%u!c#ble *!e#e !
1'!c' $'e lu #re $'e &r!%e $#re$ , #l$'ou' #"
or# %#" be Iec$e*
TYPES
Pr!%#r" TB
Seco*#r"TB
Prore!/e &ul%o#r" TB
M!l!#r" TB
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P"T4O(ENE1I1
The course of tuberculosis depends on age and immune
competence !1D total burden of the organisms
Tuberculous Infection2 refers to gro3th of the organism in aperson$3hether there is symptomatic disease or not.
Active Tuberculosis4 refers to infection manifested by tissue
destruction"""""symptomatic disease.
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PRIMARY TUBERCULOSIS
Pr!%#r" $uberculo! ! $'e or% o *!e#e $'#$ *e/elo&! # &re/!oul" ue9&oe* #* ue!$!;e* &ero.
Tuberculo! ! # $"&e o *el#"e* $!ue '"&ere!$!/!$"
$o $'e $uberculou b#c!llu 1'!c' el!c!$ # cell+%e*!#$e*!%%ue re&oe 1'!c' 1!ll re!$ $'e ro1$' #*&re#* o $'e %"cob#c$er!u%.
T'! '"&ere!$!/!$" re#c$!o &ro*uce $'e $'olo!c
e#$ure o $uberculo! ! !%%uoco%&e$e$!*!/!*u#l, !.e. r#ulo%#, c#e#$!o, c#/!$"or%#$!o.
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I c'#r#c$er!;e* b":
(hon Focus 55555 lu le!o o
&r!%#r" TB,!/ol/e u&&er
e%e$ o $'e lo1er lobe or
lo1er e%e$ o $'e u&&er lobe.
(hon co!le65++++ co%b!#$!o o
# &er!&'er#l 'o ocu #*
!/ol/e* %e*!#$!#l or '!l#r
l"%&'o*e.
M!croco&!c#ll" $'e cl#!c le!o o
TB ! # c#eou r#ulo%#
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SECONDARY TUBERCULOSIS
I $'e $$er o *!e#e $'#$ #r!e ! # &re/!oul"e!$!;e* 'o$.
I uu#ll" # re#c$!/#$!o o *or%#$ &r!%#r" le!o
1'e $'e 'o$ re!$#ce ! lo1ere*.
Or e9oeou re!ec$!o b" # '!' *oe o /!rule$b#c!ll! 1'!c' occur %ore co%%ol" ! e*e%!c #re#.
Ol"
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COMPLICATIONS OF SECONDARY TB
Sc#rr! >c#lc!2c#$!o
S&re#* $o o$'er #re#
Pleur#l 2bro!>#*'e!o
Ru&$ure o c#eou le!o
I%&l#$#$!o o b#c$er!#! $'e l#r"9 +++'o#ree
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MILIARY TUBERCULOSIS
Occur 1'e or#!% *r#! $'rou' l"%&'#$!c !$o $'el"%&'#$!c *uc$, 1'!c' e%&$" !$o $'e /eou re$ur $o$'e r!'$ !*e o $'e 'e#r$ #* 'ece !$o $'e&ul%o#r" #r$er!e.
I*!/!*u#l le!o #re e!$'er %!croco&!c or %#ll, /!!ble(5+%%) oc! o "ello1+1'!$e cool!*#$!o c#$$ere*$'rou' $'e lu rec'"%#.
M!l!#r" le!o %#" e9* #* co#lece $o "!el* #l%o$$o$#l cool!*#$!o o l#re re!o or e/e 1'ole lobeo $'e lu.
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?!$' &rore!/e &ul%o#r" $uberculo!, $'e &leur#lc#/!$" ! !/#r!#bl" !/ol/e*, #* erou leurale,usions$tuberculous e!ye!a, or obliterati&e+brous leuritis%#" *e/elo&.
M!l!#r" $uberculo! ! %o$ &ro%!e$ ! : $'e l!/er, boe %#rro1, &lee, #*re#l, %e!e, 8!*e", #llo&!# $ube, #* e&!*!*"%!.
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TUBERCULIN TEST
I$ ! # cl#!c e9#%&le o *el#"e* '"&ere!$!/!$".
T'e tuberculin reaction, ! &ro*uce* b" $'e !$r#cu$#eou!-ec$!o o $ubercul!, # &ro$e!+l!&o&ol"#cc'#r!*e co%&oe$o $'e $ubercle b#c!llu.
I # &re/!oul" e!$!;e* !*!/!*u#l, re**e! #* !*ur#$!o o$'e !$e #&&e#r ! @ $o 65 'our, re#c' # &e#8 ! 5 $o 5'our, #* $'ere#$er lo1l" ub!*e.
Mor&'olo!c#ll", *el#"e* $"&e '"&ere!$!/!$" ! c'#r#c$er!;e* b"$'e #ccu%ul#$!o o %ooucle#r cell #rou* %#ll /e! #*/eule, &ro*uc! # &er!/#cul#r cu .
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LEPROSY
M. lepraeis an acid"fast obligate
intracellular organism that gro3s
very poorly in culture
/nhaledM. leprae$ li#eM.tuberculosis$ is ta#en up by alveolar
macrophages and disseminates
through the blood$ but gro3s only in
tissues of the s#in and e5tremities.
Cell"mediated immunity is reflected
by delayed type hypersensitivity
reactions to dermal in6ections of a
bacterial e5tract called lepromin
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Leprosy is primarily a granulomatousdisease of theperipheral nervesand
mucosaof the upper respiratory tract4 s#in lesions are the primary
e5ternal sign
Leprosy may also be divided into the follo3ing types
arly and indeterminate leprosy Tuberculoid leprosy
!orderline tuberculoid leprosy
!orderline leprosy
!orderline lepromatous leprosy Lepromatous leprosy
"istoid leprosy
http://en.wikipedia.org/wiki/Granulomahttp://en.wikipedia.org/wiki/Peripheral_nervous_systemhttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Upper_respiratory_tracthttp://en.wikipedia.org/wiki/Tuberculoid_leprosyhttp://en.wikipedia.org/wiki/Borderline_tuberculoid_leprosyhttp://en.wikipedia.org/wiki/Borderline_leprosyhttp://en.wikipedia.org/wiki/Borderline_lepromatous_leprosyhttp://en.wikipedia.org/wiki/Lepromatous_leprosyhttp://en.wikipedia.org/wiki/Histoid_leprosyhttp://en.wikipedia.org/wiki/Histoid_leprosyhttp://en.wikipedia.org/wiki/Histoid_leprosyhttp://en.wikipedia.org/wiki/Lepromatous_leprosyhttp://en.wikipedia.org/wiki/Lepromatous_leprosyhttp://en.wikipedia.org/wiki/Borderline_lepromatous_leprosyhttp://en.wikipedia.org/wiki/Borderline_lepromatous_leprosyhttp://en.wikipedia.org/wiki/Borderline_lepromatous_leprosyhttp://en.wikipedia.org/wiki/Borderline_leprosyhttp://en.wikipedia.org/wiki/Borderline_tuberculoid_leprosyhttp://en.wikipedia.org/wiki/Borderline_tuberculoid_leprosyhttp://en.wikipedia.org/wiki/Borderline_tuberculoid_leprosyhttp://en.wikipedia.org/wiki/Tuberculoid_leprosyhttp://en.wikipedia.org/wiki/Tuberculoid_leprosyhttp://en.wikipedia.org/wiki/Upper_respiratory_tracthttp://en.wikipedia.org/wiki/Mucous_membranehttp://en.wikipedia.org/wiki/Peripheral_nervous_systemhttp://en.wikipedia.org/wiki/Granuloma -
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SARCOIDOSIS
#arcoidosis(fromsarcmeaning 7flesh7$ -oid$ 7li#e7$ and -osis$
7diseased or abnormal condition7)$ also called sarcoid$ !esnier-
!oec$ diseaseor!esnier-!oec$-#chaumanndisease $
/t is a syndrome involving abnormal collections of chronic
inflammatory cells (granulomas) that can form as nodules in
multiple organs.The granulomas that appear are usually not of
the caseating variety and are most often located in the lungs or
thelymph nodes$ but virtually any organ can be affected.
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CONCLUSION
Chronic inflammation is inflammation of prolonged duration
(weeks to years) in which continuing inflammation, tissue injury,
and healing, often by fibrosis occurs and involves comple5
interactions bet3een several cell populations and their secreted
mediators. 0nderstanding the pathogenesis of chronic inflammatory
reactions re8uires an appreciation of these cells and their biologic
responses and functions and also treatment modalities 3hich 3ill
differ according to the underlying or systemic cause of thegranulomatosis.
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REFERENCES
Te5tboo# of pathology 9 :arshmohan ( ;thedi)
obbins and cotran pathologic basis of disease
(
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