病理学-传染病与寄生虫病
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leonine faces hypoesthetic or anesthetic
Lepromatous leprosy
LM:Skin lesions:
large amounts of lepra cells and a few lymphcytes infiltration enclose vessels and appendages Clear line (grenz zone )
Lepromatous leprosy (20%)
anergic immunity lepromin test (-)
Large amouts of bacilli infectious Acute deteriorate, poor prognosis Generally involved the skin, peripheral nerves,
Lack CD4+ TH1 cells at the margins but instead contain many CD8+ suppressor T cells
Lepromatous leprosy
Skin lesions:
Macular, papular, or nodular lesions form on the face, ears, back, extremites
Two morphologic patterns of tissue injury
1.
Obliterative endarteritis
2.
Gumma
Morphology
1. Obliterative endarteritis Perivascular inflammation
Lepromatous leprosy
Peripheral nerves：ulnar and peFra Baidu bibliotekoneal nerves
Symmetrically invaded with mycobacteria, with minimal inflammation
Loss of sensation and trophic changes. Lymph nodes: foamy histiocytes in the paracortical areas, with
Tuberculoid leprosy
Skin lesions
LM: tuberculoid granuloma
enclose blood vessles , cutaneous appendages and nerves extend to the basal cells of epidermis
Transmission
Mode:
sexual intercourse (>95%)
Acquired sypilis
transplacental transmission
Congenital sypilis
Pathogenesis
Traverse abraded skin and mucosa
Infectious diseases
Infectious Disease
Common Features
1. Etiology:
•
pathogenic microbes
•
parasites
2. Epidemiology
• source of infection
• route of transmission
Inadequate cellular and humoral immune response Relapse syphilis and tertiary syphilis
Latent syphilis
Morphology
May affect nearly any organ or tissue in the body
process Infectivity
Develop slowly Weak
Relative fast Strong
Sexually Transmitted Disease STD
Venereal Diseases, VD
five classic venereal diseases
Syphilis Gonorrhea chancroid granuloma inguinale lymphogranuloma venereum
enlargement of germinal centers
splenic red pulp Liver testes
Comparison
Incidence Immune response Skin lesion
Lepromin test Humoral antibody Involved tissue
Virulence is based on properties of its cell wall
✓ Human being seems to be the only victim
Transmission
Contained in secretion Respiratory pathway
Abrasion or wounds Taken up by macrophages disseminates through the blood
Tuberculoid leprosy
Peripheral neuropathy: rigid and swollen nerves
From small dermal nerves to nerve trunk N. auricularis magnus (耳大)，
N. auricularis posterior(耳后)
Enter lymph circulation
Travel through blood and reach various organs and tissue
Latent period: 10-90 days, average at 21 days
Pathogenesis
Scarce protein on surface (Weak antigenicity) Down-regulation of TH1 cells
Sexually Transmitted Disease, STD
In the past decade, the spectrum of sexually transmitted disease (STD) has widened considerably
Syphilis (Lues)
An important STD Multiple clinical presentations (thus designated the
Clinical course
Latant period: 2-4 years Cellular immunity Humoral immunity Lepromin test
Pathogenesis
A bipolar disease
tuberculoid leprosy (T-cell mediated immune response ) lepromatous leprosy (Immunity anergic)
anterior eye, upper airways, testes, lymph node, viscera
Lepromatous leprosy
large aggregates of lipid laden macrophages (lepra cells), often filled with masses of acid-fast bacilli
Types according to pathological changes
Tuberculoid leprosy Lepromatous leprosy Borderline leprosy Indeterminate leprosy
Tuberculoid leprosy (60-70%)
Tuberculoid leprosy
Skin lesions: macula or papula
gross: flat and red
irregular shapes with
indurated, elevated, hyperpigmented margins and
depressed pale centers
LM
Granulomatous inflammatory reactions
Fibrosis, absence of nerves
Tuberculoid leprosy
Clinical pathologic conference
Anesthesias, atrophy, contractures, paralysis, liable to trauma, autoamputation of fingers or toes,
Tuberculoid type
70% Intense Macula or papula, tuberculoid, few bacilli (+) (+/-) Limited to skin and nerves
Lepromatous type
20% Subdued Protuberant, large amount of bacilli (-) (+++) Extend to other organs
• susceptible population
3. Pathogenesis
•
entry cell
•
toxin /enzyme, vessel injury
•
immune response
Leprosy (麻风)
Introduction
History
Epidemiology Harm
Etiology
low infectivity good prognosis
Tuberculoid leprosy
Granuloma similar to hard tubercles
1. epithelioid macrophages 2. giant cells 3. without caseous necrosis 4. Peripheral: CD4+ Th1 IL-2 and IFN-γ 5. few surviving mycobacteria
great imposter) chronic and slowly progressive involve many vital organs in late period
Etiology
Pathogen: Spirochete Treponema pallidum
can not be cultured detectable by silver stains, darkfield examination
M. leprae
Discovered in Norway in1873 by Dr.
Armauer Hansen
Acid-fast obligate intracellular
bacterium Prefer low tempreture (32 to 34℃) and grow slowly
Lepromin test
Pathogenesis
Why leprosy runs varying courses in different persons?
Individuals who recognized certain M. leprae antigens and had no disease showed different alleles at the human Bcg locus which was verified to control responses to intracellular bacteria and parasites.
Intact cellular immune response Slow course, spanning decades Limited lesions Few bacilli within the lesion
Mainly involve skin and nerves Clinical feature: lepromin test (+)
Lepromatous leprosy
LM:Skin lesions:
large amounts of lepra cells and a few lymphcytes infiltration enclose vessels and appendages Clear line (grenz zone )
Lepromatous leprosy (20%)
anergic immunity lepromin test (-)
Large amouts of bacilli infectious Acute deteriorate, poor prognosis Generally involved the skin, peripheral nerves,
Lack CD4+ TH1 cells at the margins but instead contain many CD8+ suppressor T cells
Lepromatous leprosy
Skin lesions:
Macular, papular, or nodular lesions form on the face, ears, back, extremites
Two morphologic patterns of tissue injury
1.
Obliterative endarteritis
2.
Gumma
Morphology
1. Obliterative endarteritis Perivascular inflammation
Lepromatous leprosy
Peripheral nerves：ulnar and peFra Baidu bibliotekoneal nerves
Symmetrically invaded with mycobacteria, with minimal inflammation
Loss of sensation and trophic changes. Lymph nodes: foamy histiocytes in the paracortical areas, with
Tuberculoid leprosy
Skin lesions
LM: tuberculoid granuloma
enclose blood vessles , cutaneous appendages and nerves extend to the basal cells of epidermis
Transmission
Mode:
sexual intercourse (>95%)
Acquired sypilis
transplacental transmission
Congenital sypilis
Pathogenesis
Traverse abraded skin and mucosa
Infectious diseases
Infectious Disease
Common Features
1. Etiology:
•
pathogenic microbes
•
parasites
2. Epidemiology
• source of infection
• route of transmission
Inadequate cellular and humoral immune response Relapse syphilis and tertiary syphilis
Latent syphilis
Morphology
May affect nearly any organ or tissue in the body
process Infectivity
Develop slowly Weak
Relative fast Strong
Sexually Transmitted Disease STD
Venereal Diseases, VD
five classic venereal diseases
Syphilis Gonorrhea chancroid granuloma inguinale lymphogranuloma venereum
enlargement of germinal centers
splenic red pulp Liver testes
Comparison
Incidence Immune response Skin lesion
Lepromin test Humoral antibody Involved tissue
Virulence is based on properties of its cell wall
✓ Human being seems to be the only victim
Transmission
Contained in secretion Respiratory pathway
Abrasion or wounds Taken up by macrophages disseminates through the blood
Tuberculoid leprosy
Peripheral neuropathy: rigid and swollen nerves
From small dermal nerves to nerve trunk N. auricularis magnus (耳大)，
N. auricularis posterior(耳后)
Enter lymph circulation
Travel through blood and reach various organs and tissue
Latent period: 10-90 days, average at 21 days
Pathogenesis
Scarce protein on surface (Weak antigenicity) Down-regulation of TH1 cells
Sexually Transmitted Disease, STD
In the past decade, the spectrum of sexually transmitted disease (STD) has widened considerably
Syphilis (Lues)
An important STD Multiple clinical presentations (thus designated the
Clinical course
Latant period: 2-4 years Cellular immunity Humoral immunity Lepromin test
Pathogenesis
A bipolar disease
tuberculoid leprosy (T-cell mediated immune response ) lepromatous leprosy (Immunity anergic)
anterior eye, upper airways, testes, lymph node, viscera
Lepromatous leprosy
large aggregates of lipid laden macrophages (lepra cells), often filled with masses of acid-fast bacilli
Types according to pathological changes
Tuberculoid leprosy Lepromatous leprosy Borderline leprosy Indeterminate leprosy
Tuberculoid leprosy (60-70%)
Tuberculoid leprosy
Skin lesions: macula or papula
gross: flat and red
irregular shapes with
indurated, elevated, hyperpigmented margins and
depressed pale centers
LM
Granulomatous inflammatory reactions
Fibrosis, absence of nerves
Tuberculoid leprosy
Clinical pathologic conference
Anesthesias, atrophy, contractures, paralysis, liable to trauma, autoamputation of fingers or toes,
Tuberculoid type
70% Intense Macula or papula, tuberculoid, few bacilli (+) (+/-) Limited to skin and nerves
Lepromatous type
20% Subdued Protuberant, large amount of bacilli (-) (+++) Extend to other organs
• susceptible population
3. Pathogenesis
•
entry cell
•
toxin /enzyme, vessel injury
•
immune response
Leprosy (麻风)
Introduction
History
Epidemiology Harm
Etiology
low infectivity good prognosis
Tuberculoid leprosy
Granuloma similar to hard tubercles
1. epithelioid macrophages 2. giant cells 3. without caseous necrosis 4. Peripheral: CD4+ Th1 IL-2 and IFN-γ 5. few surviving mycobacteria
great imposter) chronic and slowly progressive involve many vital organs in late period
Etiology
Pathogen: Spirochete Treponema pallidum
can not be cultured detectable by silver stains, darkfield examination
M. leprae
Discovered in Norway in1873 by Dr.
Armauer Hansen
Acid-fast obligate intracellular
bacterium Prefer low tempreture (32 to 34℃) and grow slowly
Lepromin test
Pathogenesis
Why leprosy runs varying courses in different persons?
Individuals who recognized certain M. leprae antigens and had no disease showed different alleles at the human Bcg locus which was verified to control responses to intracellular bacteria and parasites.
Intact cellular immune response Slow course, spanning decades Limited lesions Few bacilli within the lesion
Mainly involve skin and nerves Clinical feature: lepromin test (+)