Chapter 15
communicable disease
2004.2
Communicable disease,
Pathogen body Infectious disease
source of infection
Pathogen route of transmission
crowd easy to feel
Pathology of Tuberculosis
Overview
Pulmonary tuberculosis
Extra-pulmonary tuberculosis
Overview
Infects one third of world population!
8 million new case every year!
2 million deaths due to TB every year!
320 million!China
Since 1985 incidence is increasing in world
AIDS,Diabetes,Immunosuppressed patients.
Drug resistance,over crowding,malnutrition
WHO 1995
Koch
World TB Day 2004
Every Breath Counts
Stop TB Now!
Directly observed therapy shortcourse
Etiological factor and
pathogenesis
Mycobacterium tuberculosis
M,tuberculosis (air) & M,bovis (milk)
Aerobic,no toxins,no spore,non motile
Mycolic acid in bacterial wall - Acid &
Alcohol fast (AFB)
Pathogenesis
Type IV hypersensitivity - Granuloma
Escape killing by macrophages
Mycolic acid wax coat
Cord Factor - surface glycolipid
Fundamental morpholog
appearance
Exudation,
Necrosis,caseous necrosis
Proliferation,tuberculous granuloma
Caseous necrosis
Gross,yellow,delicate,like cheese
Microscopy,coagulative necrosis
Prognosis,fibrosis
Liquefaction
Absorption
Tuberculous Granuloma,
Gross,0.1mm,grey, translucent
Microscopy, caseous necrosis、
epithelioid cells, langhans giant
cells, lymphocytes,plasma cells,
and fibroblasts.
Prognosis, fibrosis
Fundamental Prognosis
Healing
absorption,resolution
fibrosis,calcification
Progressive
infiltration：
dissemination：
lymphatic pathway,first
hematogenous pathway,first
airway,second
Pulmonary tuberculosis
Primary Tuberculosis
Secondary Tuberculosis
Pulmonary tuberculosis of
hematogenous dissemination
Primary Tuberculosis
In Non Immunized individuals (Children)
Primary Tuberculosis:
? Children-type,intial infection
? Primary complex
? Self Limited disease,95%
?Primary Progressive TB(5%)
? 10% of adults,Immunosuppressed individuals
? Common in malnourished children
? Miliary TB and Meningitis.
Primary complex
the lower part of the upper lobe or the
upper part of the lower lobe
1-1.5cm area of gray-white
tuberculosis lymphangitis
hilar lymphonode tuberculosis
Primary Complex
Secondary Tuberculosis
Post Primary in immunized individuals.
Adult-type;reactivation or reinfection
Apical lobes or upper part of lower lobes
Caseation,cavity,granuloma
Pulmonary or extra-pulmonary
Local or systemic/Miliary
Local-type
infiltration-type
chronicity-type
tuberculoma
caseous pneumonia
tuberculous pleuritis
Local-type （ non-activation）
apex of lung
0.5-1cm,proliferation
prognosis
infiltration-type
infiltration under clavicle
caseous necrosis+inflammation near lesion
prognosis
chronicity-type
Cavitation +fibrosis
（ 上重下轻, 上旧下新 ）
caseous necrosis
tuberculosis granulation tissue
connective tissue
fibrosis,connective tissue
proliferation
chronic pulmonary heart disease
tuberculoma
isolated
fibrosis
phanero-boundary
caseous necrosis
D>2cm
caseous pneumonia
a sheet of caseous necrosis
tuberculous pleuritis
proliferation
exudation
infiltration-type
chronicity
-type
tuberculoma caseous
pneumonia
Local-type
Pulmonary tuberculosis of
hematogenous dissemination
Extra-pulmonary
tuberculosis
tuberculosis of intestine
digestive tract
type ulcer-type
proliferation-type
prognosis
tuberculous peritonitis
Like tuberculous pleuritis
tubercular meningitis
hematogenous pathway
exudation+ tuberculous granuloma
base of skull
tuberculosis of genitourinary system
tuberculosis of kidney
hematogenous pathway
tuberculosis cavity
tuberculosis of ureter tuberculosis of bladder
tuberculosis of joint and bone
“cold abscess”
tuberculosis of lymph node
Lymph node of neck
tuberculous granuloma+caseous necrosis
prognosis
Bacillary Dysentery
etiological factor:
dysentery bacillus
colon
fundamental lesion:
纤维素性炎 (伪膜性炎 )
Gross:
pseudo-membran
ulcer
Microscopy:
cellulose exudation
neutrophilic infiltration
constitution necrosis
Typing:
acute type
chronicity type
toxic type
Prognosis:
fully recover from an illness
deteriorate
Typhoid Fever
concept:
acute proliferation inflammation
mononuclear phagocyte system
(Intestinal tract)
etiological factor,typhoid
G+
Bile
antigenicity of thallus→ check of serolog
endotoxin→ typhoid
mononuclear phagocyte system
fundamental lesion:
acute inflammation
typhoid granuloma
typhoid cell：
phagocyte, erythrocyte,cell
fragment,typhoid
typhoid granuloma (typhoid nodule)
structure:typhoid cell
intestines lesion:
ileo-inferior segment
(aggregated lymphoid nodules and
solitary lymphatic nodule)
staging
marrow swelling staging
Gross,lymphoid tissue →
mucosa bossing
Microscopy, typhoid nodule
necrosis staging
Gross:degeneration and necrosis
Microscopy, coagulative necrosis
ulcer staging
Gross,ulcer
Microscopy,
healing staging
granulation tissue→
fully recover
Other Lesion:
mesenteric lymph node tumefaction
hepatosplenomegaly
cholecyst
Prognosis,
fully recover
complication:
hemorrhage of intesting→
hemorrhagic shock
intestinal perforation
bronchitis
Chapter 16
parasitic disease
2005.2
Entamoeba Histolytica
overview
concept
ameba human body
deteriorate inflammation
Etiological factor and pathogenesis
amoebiasis
trophont,cyst
intestinal amebiasis
Fundamental morpholo appearance,
cecum,ascending colon
necrotic inflammation
——liquefaction necrosis
Gross, blotch→ round ulcer
cut——flask shape
Microscopy:liquefaction necrosis、
a small quantity Lymphocyte
Prognosis:Complication
intestinal hemorrhage
intestinal perforation
intestinal obstruction
amebic liver abscess
schistosomiasis
overview
concept
Schistosome
Etiological factor and pathogenesis
worm
allergic reaction
Fundamental morpholog appearance
eosinophilic abscess
Hoeppli Phenomena
Charcot-leyden crystal
Gross:gray yellow,millet nod
Microscopy:fresh worm、
coagulation necrosis、
eosinophil
chronicity 虫卵结节
Gross:
Microscopy:calcification worm、
epithelioid cell、
foreign body giant cel,fibrocyte
Prognosis,scar tissue
Intestinal schistosomiasis
Hepatic schistosomiasis
Sexually Transmissible Diseaseby
concept,sex contact
Gonorrhea
etiological factor,gonococcus
route of transmission:
external genital organs,urethra
acute purulent inflammation
Condyloma Acuminata
HPV6\11 tapy
sex contact infection
external genital organs
gross,nipple
microscopy,
koilicytotic cell
epithelia papillary hyperplasia,
prickle cell layerIncreased thickness,
keratinization,Excessive cornificatio
上皮角下延
neutrophilic infiltration
detect HPV
(immunohistochemistry,
situ hybridization)
Syphilis
treponema pallidum
coitus (>95%)
blood transfusion
vertica
fundamental lesion:
endarteritis obliterans and periangiitis
syphilis granuloma (gumma)
plasmacyte
Staging:
Ⅰ,
Gross,硬性下疳
Microscopy,endarteritis
obliterans and periangiitis
Ⅱ,
Gross,total body syphilid
Microscopy,endarteritis
obliterans and periangiitis、
lymphocyte and plasmacyte
Ⅲ,
gumma
A I D S
black death of twenty century
super cancer in the world
AIDS
Acquired immunodeficiency syndrome
human immunodeficiency virus (HIV)
1981——first infection in the worldAmerican
1985——China
4990,0000——developing country
3700,0000—— African
100,0000——2001,China
over 8200 people die from AIDS every day
World AIDS Day
1 December
World AIDS Day 2003
Etiological factor and pathogenesis
HIV retrovirus
1983 French Montagnier et al
adeno-associated virus
1984 American Gallo et al
人类嗜 T淋巴细胞病毒 Ⅲ 型
1986
human immunodeficiency virus
Origin of dissemination
1985 Essex and Kanki green Monkey
of African SIV
1988 Herbert Ratner,epidemic
Poliomyelitis Vaccine” themry
1991,malaria” themry
“Graft of testis” themry
route of transmission
Sex 70%
blood
Vertical transmission
pathogenesis
HIV
CD4+T M?
cellular immunity and
humoral immunity defect
morpholog appearance
immune system
Follicle proliferation：
Warthin-Finkeldey
lymph node Lymphocytopenia,Small
vessels and Fibrous
protein type proliferation
Lymphocyte extinction
infection,opportunistic infection
Neoplasm
non-Hodgkin lymphoma
（ NHL）
Kaposi sarcom
communicable disease
2004.2
Communicable disease,
Pathogen body Infectious disease
source of infection
Pathogen route of transmission
crowd easy to feel
Pathology of Tuberculosis
Overview
Pulmonary tuberculosis
Extra-pulmonary tuberculosis
Overview
Infects one third of world population!
8 million new case every year!
2 million deaths due to TB every year!
320 million!China
Since 1985 incidence is increasing in world
AIDS,Diabetes,Immunosuppressed patients.
Drug resistance,over crowding,malnutrition
WHO 1995
Koch
World TB Day 2004
Every Breath Counts
Stop TB Now!
Directly observed therapy shortcourse
Etiological factor and
pathogenesis
Mycobacterium tuberculosis
M,tuberculosis (air) & M,bovis (milk)
Aerobic,no toxins,no spore,non motile
Mycolic acid in bacterial wall - Acid &
Alcohol fast (AFB)
Pathogenesis
Type IV hypersensitivity - Granuloma
Escape killing by macrophages
Mycolic acid wax coat
Cord Factor - surface glycolipid
Fundamental morpholog
appearance
Exudation,
Necrosis,caseous necrosis
Proliferation,tuberculous granuloma
Caseous necrosis
Gross,yellow,delicate,like cheese
Microscopy,coagulative necrosis
Prognosis,fibrosis
Liquefaction
Absorption
Tuberculous Granuloma,
Gross,0.1mm,grey, translucent
Microscopy, caseous necrosis、
epithelioid cells, langhans giant
cells, lymphocytes,plasma cells,
and fibroblasts.
Prognosis, fibrosis
Fundamental Prognosis
Healing
absorption,resolution
fibrosis,calcification
Progressive
infiltration：
dissemination：
lymphatic pathway,first
hematogenous pathway,first
airway,second
Pulmonary tuberculosis
Primary Tuberculosis
Secondary Tuberculosis
Pulmonary tuberculosis of
hematogenous dissemination
Primary Tuberculosis
In Non Immunized individuals (Children)
Primary Tuberculosis:
? Children-type,intial infection
? Primary complex
? Self Limited disease,95%
?Primary Progressive TB(5%)
? 10% of adults,Immunosuppressed individuals
? Common in malnourished children
? Miliary TB and Meningitis.
Primary complex
the lower part of the upper lobe or the
upper part of the lower lobe
1-1.5cm area of gray-white
tuberculosis lymphangitis
hilar lymphonode tuberculosis
Primary Complex
Secondary Tuberculosis
Post Primary in immunized individuals.
Adult-type;reactivation or reinfection
Apical lobes or upper part of lower lobes
Caseation,cavity,granuloma
Pulmonary or extra-pulmonary
Local or systemic/Miliary
Local-type
infiltration-type
chronicity-type
tuberculoma
caseous pneumonia
tuberculous pleuritis
Local-type （ non-activation）
apex of lung
0.5-1cm,proliferation
prognosis
infiltration-type
infiltration under clavicle
caseous necrosis+inflammation near lesion
prognosis
chronicity-type
Cavitation +fibrosis
（ 上重下轻, 上旧下新 ）
caseous necrosis
tuberculosis granulation tissue
connective tissue
fibrosis,connective tissue
proliferation
chronic pulmonary heart disease
tuberculoma
isolated
fibrosis
phanero-boundary
caseous necrosis
D>2cm
caseous pneumonia
a sheet of caseous necrosis
tuberculous pleuritis
proliferation
exudation
infiltration-type
chronicity
-type
tuberculoma caseous
pneumonia
Local-type
Pulmonary tuberculosis of
hematogenous dissemination
Extra-pulmonary
tuberculosis
tuberculosis of intestine
digestive tract
type ulcer-type
proliferation-type
prognosis
tuberculous peritonitis
Like tuberculous pleuritis
tubercular meningitis
hematogenous pathway
exudation+ tuberculous granuloma
base of skull
tuberculosis of genitourinary system
tuberculosis of kidney
hematogenous pathway
tuberculosis cavity
tuberculosis of ureter tuberculosis of bladder
tuberculosis of joint and bone
“cold abscess”
tuberculosis of lymph node
Lymph node of neck
tuberculous granuloma+caseous necrosis
prognosis
Bacillary Dysentery
etiological factor:
dysentery bacillus
colon
fundamental lesion:
纤维素性炎 (伪膜性炎 )
Gross:
pseudo-membran
ulcer
Microscopy:
cellulose exudation
neutrophilic infiltration
constitution necrosis
Typing:
acute type
chronicity type
toxic type
Prognosis:
fully recover from an illness
deteriorate
Typhoid Fever
concept:
acute proliferation inflammation
mononuclear phagocyte system
(Intestinal tract)
etiological factor,typhoid
G+
Bile
antigenicity of thallus→ check of serolog
endotoxin→ typhoid
mononuclear phagocyte system
fundamental lesion:
acute inflammation
typhoid granuloma
typhoid cell：
phagocyte, erythrocyte,cell
fragment,typhoid
typhoid granuloma (typhoid nodule)
structure:typhoid cell
intestines lesion:
ileo-inferior segment
(aggregated lymphoid nodules and
solitary lymphatic nodule)
staging
marrow swelling staging
Gross,lymphoid tissue →
mucosa bossing
Microscopy, typhoid nodule
necrosis staging
Gross:degeneration and necrosis
Microscopy, coagulative necrosis
ulcer staging
Gross,ulcer
Microscopy,
healing staging
granulation tissue→
fully recover
Other Lesion:
mesenteric lymph node tumefaction
hepatosplenomegaly
cholecyst
Prognosis,
fully recover
complication:
hemorrhage of intesting→
hemorrhagic shock
intestinal perforation
bronchitis
Chapter 16
parasitic disease
2005.2
Entamoeba Histolytica
overview
concept
ameba human body
deteriorate inflammation
Etiological factor and pathogenesis
amoebiasis
trophont,cyst
intestinal amebiasis
Fundamental morpholo appearance,
cecum,ascending colon
necrotic inflammation
——liquefaction necrosis
Gross, blotch→ round ulcer
cut——flask shape
Microscopy:liquefaction necrosis、
a small quantity Lymphocyte
Prognosis:Complication
intestinal hemorrhage
intestinal perforation
intestinal obstruction
amebic liver abscess
schistosomiasis
overview
concept
Schistosome
Etiological factor and pathogenesis
worm
allergic reaction
Fundamental morpholog appearance
eosinophilic abscess
Hoeppli Phenomena
Charcot-leyden crystal
Gross:gray yellow,millet nod
Microscopy:fresh worm、
coagulation necrosis、
eosinophil
chronicity 虫卵结节
Gross:
Microscopy:calcification worm、
epithelioid cell、
foreign body giant cel,fibrocyte
Prognosis,scar tissue
Intestinal schistosomiasis
Hepatic schistosomiasis
Sexually Transmissible Diseaseby
concept,sex contact
Gonorrhea
etiological factor,gonococcus
route of transmission:
external genital organs,urethra
acute purulent inflammation
Condyloma Acuminata
HPV6\11 tapy
sex contact infection
external genital organs
gross,nipple
microscopy,
koilicytotic cell
epithelia papillary hyperplasia,
prickle cell layerIncreased thickness,
keratinization,Excessive cornificatio
上皮角下延
neutrophilic infiltration
detect HPV
(immunohistochemistry,
situ hybridization)
Syphilis
treponema pallidum
coitus (>95%)
blood transfusion
vertica
fundamental lesion:
endarteritis obliterans and periangiitis
syphilis granuloma (gumma)
plasmacyte
Staging:
Ⅰ,
Gross,硬性下疳
Microscopy,endarteritis
obliterans and periangiitis
Ⅱ,
Gross,total body syphilid
Microscopy,endarteritis
obliterans and periangiitis、
lymphocyte and plasmacyte
Ⅲ,
gumma
A I D S
black death of twenty century
super cancer in the world
AIDS
Acquired immunodeficiency syndrome
human immunodeficiency virus (HIV)
1981——first infection in the worldAmerican
1985——China
4990,0000——developing country
3700,0000—— African
100,0000——2001,China
over 8200 people die from AIDS every day
World AIDS Day
1 December
World AIDS Day 2003
Etiological factor and pathogenesis
HIV retrovirus
1983 French Montagnier et al
adeno-associated virus
1984 American Gallo et al
人类嗜 T淋巴细胞病毒 Ⅲ 型
1986
human immunodeficiency virus
Origin of dissemination
1985 Essex and Kanki green Monkey
of African SIV
1988 Herbert Ratner,epidemic
Poliomyelitis Vaccine” themry
1991,malaria” themry
“Graft of testis” themry
route of transmission
Sex 70%
blood
Vertical transmission
pathogenesis
HIV
CD4+T M?
cellular immunity and
humoral immunity defect
morpholog appearance
immune system
Follicle proliferation：
Warthin-Finkeldey
lymph node Lymphocytopenia,Small
vessels and Fibrous
protein type proliferation
Lymphocyte extinction
infection,opportunistic infection
Neoplasm
non-Hodgkin lymphoma
（ NHL）
Kaposi sarcom
