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CHRONIC INFLAMMATION
CHRONIC INFLAMMATION-DEFENSE AT
A PRICE

   PROLONGED DURATION

   WKS TO MONTHS

        ACTIVE INFLAMMATION,
        TISSUE DESTRUCTION AND
        REPAIR
ALL occurs SIMULTANEOUSLY
CAUSES

   PERSISTENT INFECTION
         Eg:TB,SYPHILIS
         LOW TOXICITY
         EVOKE DELAYED HYPERSENSITIVITY REACTION
   PROLONGED EXPOSURE TO TOXIC AGENTS
         ENDO-TOXIC LIPIDS IN ATHEROMA
         EXO-SILICOSIS,
   AUTOIMMUNE:caused by excessive and
    inappropriate activation of the immune system
         Eg. RA,MS,IBD, Br. Asthma
FEATURES
   MONONUCLEAR INFILTRATIION-
    MACROPHAGES,LYMPHOS,PLASMA CELLS


   TISSUE DESTRUCTION

   ATTEMPTS AT HEALING:
      angiogenesis+ fibrosis
Chronic infl.                                  Acute infl.
collection of chronic inflammatory cells (*)   alveolar spaces filled with neutrophils
destruction of parenchyma                      Congested blood vessels
fibrosis, (arrows)
CELLS-MACROPHAGES
   KEY ROLE

   PART OF MONOCYTE PHAGOCYTE SYSTEM

   ORIGIN IN BM    BLOOD MONOCYTES
    TISSUE MACROPHAGES

   TISSUE MACROPHAGES-MICROGLIA,KUPFFER
    CELLS,ALVEOLAR MACROPHAGES,OSTEOCLASTS
CELLS-MACROPHAGES
   AFTER 48 HRS EMIGRATE INTO SITE OF
    INFLAMMATION

   ACTIVATION
       BY CYTOKINES(IFN GAMMA), ENDOTOXINS
       INCREASE IN SIZE, MORE LYSOSOMAL ENZYMES,
        INCREASED METABOLIC ACTIVITY
       WIDE VARIETY OF BIOLOGICALLY ACTIVE SUB
CELLS-MACROPHAGES

 IF IRRITANT PERSISTS MACROS ACCUMULATE




     RECRUITMENT   LOCAL PROLIF   IMMOBILIZATION
CELLS-MACROPHAGES
   PRODUCTS OF MACROPHAGES

      ELIMINATION   OF MICROBES

      TISSUE   INJURY-PROTEASES,NO,AA METABOLITES

      FIBROSIS
CELLS-OTHERS
   LYMPHOCYTES
        BOTH IN IMMUNE AND NON IMMUNE
        TWO WAY INTERACTION WITH MACRO


   PLASMA CELLS
        FROM ACTIVATED B-LYMPHOS
        tertiary lymphoid organs: long standing R.A.
   EOSINOPHILS
        IMMUNE,PARASITIC d/t MBP
        EOTAXIN
GRANULOMATOUS INFLAMMATION

 It is a cellular attempt to contain an offending agent
                  that is difficult to eradicate.
 A granuloma is a focus of chronic inflammation consisting
    of a microscopic aggregation of macrophages that are
     transformed into epithelium-like cells, surrounded by a
          collar of mononuclear leukocytes, principally
           lymphocytes and occasionally plasma cells.
GRANULOMATOUS INFLAMMATION-
EXAMPLES

   TB
   SARCOID
   SYPHILIS(GUMMA)
   CAT SCRATCH DISEASE
   LEPROSY
   BERYLLIOSIS
   HISTOPLASMA
   FOREIGN BODY
GRANULOMA
   EPITHELIOID CELLS
       ACTIVATED/MODIFIED  MACROPHAGES
       INDISTINCT CELL BORDERS
       PALE PINK CYTOPLASM
       VESICULAR NUCLEUS-SLIPPER SOLE SHAPED



   LYMPHOCYTES
       USUALLY FORM A CUFF AROUND EP CELLS
       MAY BE ADMIXED WITH PLASMA CELLS
GRANULOMA
   GIANT CELLS
         FUSION OF EPITHELIOID CELLS
         LANGHANS G.C-NUCLEUS IN PERIPHERY-HORSE SHOE MANNER
         FOREIGN BODY-HAPHAZARD ARRANGEMENT
         NO SP SIGNIFICANCE ABOUT UNDERLYING CAUSE


   FIBROSIS
         SURROUNDING LYMPHOS
         BURNT OUT-SCARRING
GRANULOMA
   TWO MAIN TYPES BASED ON PATHOGENESIS- FB
    (SUTURE,TALC) AND IMMUNE (TB)

   IMMUNE
      POORLY  DEGRADABLE AGENT
      CELL MEDIATED IMMUNITY
GRANULOMA
   CENTRAL NECROSIS IS SEEN IN SOME
    GRANULOMAS

   PROTOTYPE-TB
       CASEOUS NECROSIS
       GROSSLY-CHEESE LIKE
       MICRO-EOSINOPHILIC,AMORPHOUS GRANULAR DEBRIS
Granuloma
A granuloma: a collection of
epithelioid histiocytes
SYSTEMIC EFFECTS OF INFLAMMATION


   ACUTE PHASE RESPONSE OR SYSTEMIC
    INFLAMMATORY RESPONSE(SIRS)

   DUE TO CYTOKINES-TNF,IL-1
SYSTEMIC EFFECTS OF INFLAMMATION

                       FEVER

   IL-1 AND TNF ACT ON HYPOTHALAMUS

   PRODUCE PGs

   RESET TEMP AT HIGHER LEVEL

   HOW USEFUL??????
OSLER

“HUMANITY HAS BUT 3 GREAT
ENEMIES-FEVER ,FAMINE AND
WAR,OF THESE BY FAR THE
GREATEST ,THE MOST TERRIBLE IS
FEVER”
SYSTEMIC EFFECTS OF INFLAMMATION

                  ACUTE PHASE PROTEINS

   SYN IN LIVER,CIRCULATE IN PLASMA

   MANY FOLD INCREASE IN INFLAMMATION

   CRP,FIBRINOGEN,SAA

   POSSIBLE ROLE AS OPSONINS

   INCREASED ESR-DUE TO FIBRINOGEN
SYSTEMIC EFFECTS OF INFLAMMATION

                      LEUCOCYTOSIS

   INCREASED RELEASE FROM BM

   INCREASED PROLIFERATION FROM PRECUSORS

   NEUTROPHILIA-MOST BACTERIA

   LYMPHOCYTOSIS-VIRAL

   EOS-PARASITIC,ALLERGIC
SYSTEMIC EFFECTS OF INFLAMMATION


 ANOREXIA,SOMNOLENCE,DECREASED APPETITE

   SEV BACTERIAL INFECTION-SEPTIC SHOCK
IMPT TOPICS
   ESSAY
      CHEMICAL  MEDIATORS OF INFLAMMATION
      CELLULAR EVENTS OF INFLAMMATION

   SHORT TOPICS
      ADHESION  MOLECULES
      PHAGOCYTOSIS
      GRANULOMAS
      SYSTEMIC EFFECTS OF INFLAMMATION
      CELLULAR EVENTS OF INFLAMMATION
      VASCULAR EVENTS OF INFLAMMATION
      KILLING AND DEGRADATION

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5.chronic inflammation dr ashutosh kumar

  • 2. CHRONIC INFLAMMATION-DEFENSE AT A PRICE  PROLONGED DURATION  WKS TO MONTHS  ACTIVE INFLAMMATION,  TISSUE DESTRUCTION AND  REPAIR ALL occurs SIMULTANEOUSLY
  • 3. CAUSES  PERSISTENT INFECTION  Eg:TB,SYPHILIS  LOW TOXICITY  EVOKE DELAYED HYPERSENSITIVITY REACTION  PROLONGED EXPOSURE TO TOXIC AGENTS  ENDO-TOXIC LIPIDS IN ATHEROMA  EXO-SILICOSIS,  AUTOIMMUNE:caused by excessive and inappropriate activation of the immune system  Eg. RA,MS,IBD, Br. Asthma
  • 4. FEATURES  MONONUCLEAR INFILTRATIION- MACROPHAGES,LYMPHOS,PLASMA CELLS  TISSUE DESTRUCTION  ATTEMPTS AT HEALING: angiogenesis+ fibrosis
  • 5. Chronic infl. Acute infl. collection of chronic inflammatory cells (*) alveolar spaces filled with neutrophils destruction of parenchyma Congested blood vessels fibrosis, (arrows)
  • 6. CELLS-MACROPHAGES  KEY ROLE  PART OF MONOCYTE PHAGOCYTE SYSTEM  ORIGIN IN BM BLOOD MONOCYTES TISSUE MACROPHAGES  TISSUE MACROPHAGES-MICROGLIA,KUPFFER CELLS,ALVEOLAR MACROPHAGES,OSTEOCLASTS
  • 7.
  • 8. CELLS-MACROPHAGES  AFTER 48 HRS EMIGRATE INTO SITE OF INFLAMMATION  ACTIVATION  BY CYTOKINES(IFN GAMMA), ENDOTOXINS  INCREASE IN SIZE, MORE LYSOSOMAL ENZYMES, INCREASED METABOLIC ACTIVITY  WIDE VARIETY OF BIOLOGICALLY ACTIVE SUB
  • 9.
  • 10.
  • 11. CELLS-MACROPHAGES IF IRRITANT PERSISTS MACROS ACCUMULATE RECRUITMENT LOCAL PROLIF IMMOBILIZATION
  • 12. CELLS-MACROPHAGES  PRODUCTS OF MACROPHAGES  ELIMINATION OF MICROBES  TISSUE INJURY-PROTEASES,NO,AA METABOLITES  FIBROSIS
  • 13. CELLS-OTHERS  LYMPHOCYTES  BOTH IN IMMUNE AND NON IMMUNE  TWO WAY INTERACTION WITH MACRO  PLASMA CELLS  FROM ACTIVATED B-LYMPHOS  tertiary lymphoid organs: long standing R.A.  EOSINOPHILS  IMMUNE,PARASITIC d/t MBP  EOTAXIN
  • 14.
  • 15. GRANULOMATOUS INFLAMMATION It is a cellular attempt to contain an offending agent that is difficult to eradicate. A granuloma is a focus of chronic inflammation consisting of a microscopic aggregation of macrophages that are transformed into epithelium-like cells, surrounded by a collar of mononuclear leukocytes, principally lymphocytes and occasionally plasma cells.
  • 16. GRANULOMATOUS INFLAMMATION- EXAMPLES  TB  SARCOID  SYPHILIS(GUMMA)  CAT SCRATCH DISEASE  LEPROSY  BERYLLIOSIS  HISTOPLASMA  FOREIGN BODY
  • 17. GRANULOMA  EPITHELIOID CELLS  ACTIVATED/MODIFIED MACROPHAGES  INDISTINCT CELL BORDERS  PALE PINK CYTOPLASM  VESICULAR NUCLEUS-SLIPPER SOLE SHAPED  LYMPHOCYTES  USUALLY FORM A CUFF AROUND EP CELLS  MAY BE ADMIXED WITH PLASMA CELLS
  • 18. GRANULOMA  GIANT CELLS  FUSION OF EPITHELIOID CELLS  LANGHANS G.C-NUCLEUS IN PERIPHERY-HORSE SHOE MANNER  FOREIGN BODY-HAPHAZARD ARRANGEMENT  NO SP SIGNIFICANCE ABOUT UNDERLYING CAUSE  FIBROSIS  SURROUNDING LYMPHOS  BURNT OUT-SCARRING
  • 19. GRANULOMA  TWO MAIN TYPES BASED ON PATHOGENESIS- FB (SUTURE,TALC) AND IMMUNE (TB)  IMMUNE  POORLY DEGRADABLE AGENT  CELL MEDIATED IMMUNITY
  • 20. GRANULOMA  CENTRAL NECROSIS IS SEEN IN SOME GRANULOMAS  PROTOTYPE-TB  CASEOUS NECROSIS  GROSSLY-CHEESE LIKE  MICRO-EOSINOPHILIC,AMORPHOUS GRANULAR DEBRIS
  • 22. A granuloma: a collection of epithelioid histiocytes
  • 23.
  • 24.
  • 25. SYSTEMIC EFFECTS OF INFLAMMATION  ACUTE PHASE RESPONSE OR SYSTEMIC INFLAMMATORY RESPONSE(SIRS)  DUE TO CYTOKINES-TNF,IL-1
  • 26. SYSTEMIC EFFECTS OF INFLAMMATION FEVER  IL-1 AND TNF ACT ON HYPOTHALAMUS  PRODUCE PGs  RESET TEMP AT HIGHER LEVEL  HOW USEFUL??????
  • 27. OSLER “HUMANITY HAS BUT 3 GREAT ENEMIES-FEVER ,FAMINE AND WAR,OF THESE BY FAR THE GREATEST ,THE MOST TERRIBLE IS FEVER”
  • 28. SYSTEMIC EFFECTS OF INFLAMMATION ACUTE PHASE PROTEINS  SYN IN LIVER,CIRCULATE IN PLASMA  MANY FOLD INCREASE IN INFLAMMATION  CRP,FIBRINOGEN,SAA  POSSIBLE ROLE AS OPSONINS  INCREASED ESR-DUE TO FIBRINOGEN
  • 29. SYSTEMIC EFFECTS OF INFLAMMATION LEUCOCYTOSIS  INCREASED RELEASE FROM BM  INCREASED PROLIFERATION FROM PRECUSORS  NEUTROPHILIA-MOST BACTERIA  LYMPHOCYTOSIS-VIRAL  EOS-PARASITIC,ALLERGIC
  • 30. SYSTEMIC EFFECTS OF INFLAMMATION ANOREXIA,SOMNOLENCE,DECREASED APPETITE SEV BACTERIAL INFECTION-SEPTIC SHOCK
  • 31. IMPT TOPICS  ESSAY  CHEMICAL MEDIATORS OF INFLAMMATION  CELLULAR EVENTS OF INFLAMMATION  SHORT TOPICS  ADHESION MOLECULES  PHAGOCYTOSIS  GRANULOMAS  SYSTEMIC EFFECTS OF INFLAMMATION  CELLULAR EVENTS OF INFLAMMATION  VASCULAR EVENTS OF INFLAMMATION  KILLING AND DEGRADATION