1. Chronic Granulomatous
Inflammation
Prepared by: Rana Ahsan Javed
Roll No. 255
3rd Year MBBS

2. Chronic Inflammation
► Definition:
 Inflammation of prolonged duration in which active inflammation,
tissue injury and the healing proceed simultaneously
 Endogenous (Atherosclerosis)
► Causes:
► Persistent Infections
 Ex. Treponema palladium (causative organism of syphilis)
 Organism of low toxicity and evoke an immune reaction =
delayed hypersensitivity
► Prolonged Exposure to toxic Agents,
 Exogenous (Silicosis)
► Autoimmunity
 Ex. Autoimmune diseases

3. Definition:
► Granulomatous inflammation is a distinctive pattern of
chronic inflammatory reaction
► It is a protective response to chronic infection or foreign
material, preventing dissemination and restricting
inflammation.
► Some autoimmune diseases such as rheumatoid arthritis
and Crohns disease are also associated with granulomas.

4. Granuloma:
► Epithelioid cells fuse to form giant cells containing 20 or
more nuclei.
► The nuclei arranged either peripherally (Langhans-type
giant cell ) or
► haphazardly (foreign body-type giant cell).
► These giant cells can be found either at the periphery or
the center of the granuloma.

7. Granulomatous inflammation
► Types of Granulomatous Inflammation
► 1. Immune granulomas
 Caused by insoluble particles that are capable of inducing a cell-
mediated immune response
 Macrophages are transformed into Epitheloid cells and
multinucleate giant cells
 Examples:
► Bacteria
 Tuberculosis *** (high incidence due to drug resistant stains)
 Leprosy
► Parasites
 Schistosomiasis (3 types)
► Fungi
 Histoplasmosis
 Blastomycosis

8. Histoplasmosis Granuloma

9. Granulomatous inflammation
2. Foreign Body Granulomas
Don’t incite either an inflammatory or immune response.
Epitheloid cells and giant cells are apposed to the surface and
encompass the foreign body.
The foreign body is usually found in the center of the granuloma.
Examples:
Metal/Dust
Berylliosis
Silicosis
Foreign body
Splinter
Suture

11. ► 3. Sarcoidosis
 Bad systemic disease, probably autoimmune
disease
 Etiologic agent is unknown

12. Sarcoidosis Granuloma.

15. Infectious causes:
► Bacteria
 Tuberculosis
 Leprosy
► Parasites
 Schistosomiasis
► Fungi
 Histoplasmosis
 Blastomycosis
► Metal/Dust
 Berylliosis
 Silicosis

16. Foreign body aspiration
Berrylliosis

18. ► Granuloma:
bacilli are inhaled by droplets
► Bacteria are phagocytosed by
alveolar macrophages
► After amassing substances that
they cannot digest, macrophages
lose their motility, accumulate at
the site of injury and transform
themselves into nodular
collections; the Granuloma
► A localized inflammatory response
recruits more mononuclear cells
► The granuloma consists of a
kernel of infected macrophages
surrounded by foamy
macrophages and a ring of
lymphocytes and a fibrous cuff
(containment phase)
► Containment usually fails when
the immune status of the patient
changes; the granuloma caseates,

20. ► 2-10micrometer in length.
► Struntrually gram positive but also containslarge
amount of lipids in the cell wall:making them
acid fast.
► No toxins
► No spores
► Obligate Aerobic
► Elicit granulomatous inflammation.

21. TUBERCULOSIS
► Primary TB
► SecondaryTB
► Progressive pulmonary TB
► Miliary TB

22. ► PATHOGENESIS
► The course of tuberculosis depends on age and
immune competence AND total burden of the
organisms
► Tuberculous Infection : refers to growth of the
organism in a person,whether there is
symptomatic disease or not.
► Active Tuberculosis ; refers to infection
manifested by tissue destruction-----symptomatic
disease.

23. Multiplication of the organism inside the
alveolar macrophage
processing& presentation of the antigen on
the surface
A clone of sensitized T-cells proliferate,
produce gamma INT.
Activation of the
macrophages(augmenting their capacity to kill

26. Clinical and pathologic implications of
primary tuberculosis
1] Development of resistance to the infection.
2] The foci of scarring may harbor viable bacilli
for life and act as a nidus for reactivation.
3] The disease may develop into progressive
primary tuberculosis in immunocompro-
mised patients such as AIDS patients,
elderly, and malnourished children.

28. Tuberculin Test
► It is a classic example of delayed
hypersensitivity.
► The tuberculin reaction, is produced by the
intracutaneous injection of tuberculin, a
protein-lipopolysaccharide component of the
tubercle bacillus.

29. Gram stain Most bacteria
Acid fast stain Mycobacteria, nocardiae (modified)
Silver stains Fungi, legionellae, pneymocytosis
Period acid-Schiff Fungi, amebae
Mucicarmine Cryptococci
Giemsa Campylobacteria, leishmaniae, malaria,
parasites
Antibody probes Viruses, rickettsiae
Culture All classes
DNA probes Viruses, bacteria, protozoa
Polarizing
microscope Foreign body