This document discusses chronic inflammation. It describes chronic inflammation as inflammation of prolonged duration involving ongoing inflammation, tissue injury, and attempts at repair. Chronic inflammation is characterized by mononuclear cell infiltration, tissue destruction, and attempts at healing through fibrosis and angiogenesis. Macrophages are a key player in chronic inflammation by secreting cytokines, growth factors, enzymes, and other inflammatory mediators that drive both tissue injury and repair. Granulomatous inflammation is a distinctive pattern of chronic inflammation seen with certain infections and non-infectious conditions, where macrophages form aggregates surrounded by lymphocytes called granulomas in an attempt to control difficult to eradicate agents.

1. Chronic Inflammation
M
Dr. ANAND
Asst. Professor

2. • What is chronic inflamamtion
• General Features
• Sytemic effects of chronic inflammation
• Cells involved
• Types
• Granuloma

3. Chronic Inflammation
Chronic inflammation is inflammation
of prolonged duration
(weeks or months)
in which
inflammation, tissue injury, and attempts at repair
coexist, in varying combinations.

4. CAUSES OF CHRONIC INFLAMMATION
1.Persistent Infection
2. Immune-mediated
inflammatory diseases
3. Toxic Agents/FOREIGN
BODY

5. • DOES SURGERY ASSOCIATED WITH CHRONIC
INFLAMMATION
• YES
• HOW COME?
• SUTURE MATERIAL

6. GENERAL FEATURES

7. • MONONUCLEAR CELL INFILTRATION
• TISSUE DESTRUCTION//NECROSIS
• PROLIFERATIVE CHANGES
FIBROSIS ANGIOGENESIS

8. • CHRONIC INFLAMMATION ALWAYS ATTEMPTS
TO HEALING

9. FEATURES
Chronic inflammation is characterized by:
1. Infiltration with mononuclear cells, which include
macrophages, lymphocytes, and plasma cells
2. Tissue destruction, induced by the persistent
offending agent or by the inflammatory cells
3. Attempts at healing by connective tissue
replacement of damaged tissue, accomplished by
proliferation of small blood vessels (angiogenesis)
and, in particular, fibrosis.

11. • WHAT IS THE KEY PLAYER IN CHRONIC
INFLAMMATION??

12. • MACROPHAGE

13. • DOES MACROPHAGE DIRECTLY COMES TO
CHRONIC INFLAMMATION
• NO

14. • MONOCYTE
• MACROPHAGE

16. WHAT ARE THE PRODUCTS
SECRETED BY MACROPHAGES??

17. • CYTOKINES-IL1, IL-2
• INTERFERONS –Y
• GROWTH FACTORS- TGF, PDGF, FGF,EGF
• [TGF, PDGF------- to stimulate fibroblast]
• COMPLEMENT FACTORS[C]
• ENZYMES—Proteases, endonucleases,
elastases

18. • Chemotactic factors
• NO
• Collagenases

19. • ANY OTHER??
• LYMPHOKINES

20. • IS NORMAL LYMPHOCYTE SECRETES
LYMPHOKINES??
• CD4 Lymphocytes[[Th cells]

23. THE ROLES OF ACTIVATED
MACROPHAGES IN CHRONIC
INFLAMMATION :
1.Inflammatory Tissue Injury
2.Repair (Growth Factor Mediated)
Fig 2-24 (p72)

24. MACROPHAGE-LYMPHOCYTE
INTERACTIONS IN CHRONIC
INFLAMMATION :
Fig 2-25 (p73)

26. TYPES

29. GRANULOMATOUS INFLAMMATION
Granulomatous inflammation is a distinctive pattern
of chronic inflammation that is encountered in a
limited number of infectious and some
noninfectious conditions. Immune reactions are
usually involved in the development of
granulomas.
A granuloma is a cellular attempt to control an
offending agent that is difficult to eradicate.
.

30. • In this attempt there is often strong
activation of T lymphocytes leading to
macrophage activation, which can cause
injury to normal tissues

31. 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.

36. Types of Granulomas
I. Foreign body granulomas
II. Immune granulomas

37. Foreign body granulomas
Incited by relatively inert foreign bodies.
Typically, foreign body granulomas form around
material that are large enough to preclude
phagocytosis by a single macrophage and do not
incite any specific inflammatory or immune
response.
.

39. Immune granulomas
Caused by agents that are capable
of inducing an immune response
which produces granulomas
usually when the inciting agent is
poorly degradable or particulate.

46. Giant Cells
Older granulomas develop an enclosing rim of
fibroblasts and connective tissue.
Frequently, epithelioid cells fuse to form giant cells
in the periphery or sometimes in the center of
granulomas.
These giant cells may attain diameters of 40 to 50
μm.
peripherally (Langhans-type giant cell) or
haphazardly (foreign body–type giant cell).

49. • WHAT IS THE SHAPE OF EPITHELOID CELL
• ‘SOLE SHAPE’

50. SYSTEMIC EFFECTS OF CHRONIC
INFLAMMATION

51. • Chronic inflammation is associated with following systemic
features:
• 1. Fever. Invariably there is mild fever, often with loss
of weight and weakness.
• 2. Anaemia:chronic inflammation is accompanied by
anaemia of varying degree.
• 3. Leucocytosis. As in acute inflammation, chronic
inflammation also has leucocytosis but generally there
is relative lymphocytosis in these cases.
• 4. ESR. ESR is elevated in all cases of chronic
inflammation.

52. • Which of the following is always present in
chronic inflammation/
• A. Rubor
• B. Edema
• C. Leucocytosis
• D. Increased ESR

53. MORPHOLOGY

58. • DRAW A NEAT LABELLED DIAGRAM OF
GRANULOMA
• PATHOGENSIS OF GRANULOMA
• DIFFERENCE BETWEEN ACUTE &CHRONIC
INFLAMMATION