Chronic Granulomatous Inflammation

Chronic Granulomatous Inflammation

Question 1. Define and classify inflammation.
Answer:

Inflammation is defined as the local response of living mammalian tissues to injury due to any agent.

It is a body defense reaction in order to eliminate or limit the spread of injurious agent as well as to remove the consequent necrosed cells and tissues.

Classifiation of Inflammation

Depending on the defense capacity of the host and duration of response, inflammation is classified as acute or chronic.

Acute inflammation: It is of short duration and represents the early body reaction, resolves quickly and is usually followed by healing. Sometimes the acute inflammatory response may be quite severe and is termed as fulminant acute inflammation.

Chronic inflammation: It is of longer duration and occurs after delay, either after the causative agent of acute inflammation persists for long time or the stimulus is such that it in- duces chronic inflammation from the beginning. A variant, chronic active inflammation is the type of chronic inflammation in which during the course of the disease there are acute exacerbations of activity.

Chronic granulomatous inflammation

In some of instances, term subacute inflammation is used for the state of inflammation between acute and chronic.

Question 2. Write a short note on examples of chronic granulomas.
Or
Write briefly on chronic granulomatous inflammation.
Answer:

Granuloma is defined as a circumscribed tiny lesion, about 1 mm in diameter composed predominantly of a collection of modified macrophages called epitheliod cells and rimmed at the periphery by lymphoid cells.

Types of Granulomas

1. Infectious granulomas

• Tuberculosis: It is associated with the formation of caseating granulomas, i.e. granulomas showing presence of central granular debris with loss of all cellular detail and higher positivity for acid fast bacilli or non-caseating granulomas, i.e. absence of caseation and low positivity for acid fast bacilli.
• Leprosy: It is caused by Mycobacterium leprae. Noncaseating granulomas are typically seen with or without acid fast lepra bacilli in the macrophages.
• Syphilis: It is caused by Treponema pallidum. Gumma formation is the disease’s hallmark. Gumma is histopathologically characterized by a central necrotic area without loss of cellular outline; plasma cell infitrate with a wall of histiocytes.
• Cat scratch disease: It is caused by a Gram-negative bacillus. It typically shows rounded or stellate granulomas containing central granular debris and large number of neutrophils.
• Deep fungal infections: Fungal granulomas are caused by organisms like Histoplasma and Blastomyces and are typically suppurative, i.e. granulomas with neutrophilic inflammation.

Granuloma formation

2. Non­infectious or immune granulomas: Granulomas form in response to the persistent presence of nondegradable or particulate material, which incites an immune response. These are usually non-caseating epithelioid cell granulomas. Examples include sarcoidosis and hypersensitivity pneumonitis.

3. Foreign body granulomas: They are formed as a response to foreign bodies like talc, suture and intravenous drugs. The foreign material can be identified in the center of the granuloma or within the foreign body giant cells which have a haphazard distribution of nuclei unlike Langhans giant cell.