Chronic Inflammation

It arises in the following setting

Progression of acute inflammation-1 Persistant infection e.g. in TB,-2 syphilis prolong exposure to potentially-3 toxic material Autoimmune disease-4

The inhaled silica produces an inflammatory reaction that is marked by

. prominent fibrosis. Dense pink collagen is seen in the center

Characterized by
Infiltration with mononuclear inflammatory cells-1 Tissue destruction induce by inflammatory cells-2

(Repair (angiogenesis & fibrosis- 3

Chronic inflammatory cells

Macrophage-1 It is monocyte in the extravascular tissue, it become larger & has phagocytic ability

Macrophage activated by
Bacterial endotoxin- 1 Mediators produce during acute-2 inflammation cytokines secreted by sensitized T-3 lymphocyte Extracellular proteins e.g.-4 fibronectin

Activated macrophage has

larger size- 1 more lysosomal enzyme- 2 more active metabolism- 3 Greater ability to kill ingested-4 organisms

Activated macrophage secrete

Proteaseses- 1 Complement components e.g.C1-C5-2 & coagulation factors V, VIII Cytokines like IL-1, TNF as well as-3 .growth factors .Nitric oxide- 4

Chronic inflammatory cells

Lymphocytes- 2 types B &T both migrate into 2# inflammatory site via adhesion molecules .& chemokines T Lymphocytes can be activated by IL-## 1 & TNF secreted from activated macrophage

Chronic inflammatory cells

Plasma cell-3 Activated B-lymphocyte which produce antibodies against antigens in the inflammatory site

Granulomatous Inflammation
A pattern of chronic inflammation characterized by aggregation of activated macrophage which have enlarged, squamous cell-like (appearance (epithelioid

Epithelioid cells around the center of a granuloma. they have lots of pink cytoplasm similar to squamous epithelial cells. Their nuclei tend to be long and

.stringy

Granulomatous Inflammation seen in

Bacterial infection e.g. TB,-1 Leprosy ,Syphilis Parasitic infection e.g.-2 Schistosomiasis Fungal infection e.g. Histoplasma-3 Foreign body e.g. suture material-4 Inorganic metals e.g. Silicosis- 5 Unknown e.g. Sarcoidosis- 6

Systemic effects of inflammation

Fever:-cytokines like IL-1 &TNF- 1 both produce by WBCs & other cells in response to infection they act on thermoregulatory center of the hypothalamus via local production of PG-E

Systemic effects of inflammation

Leukocytosis ( increase WBCs)- 2 result from the release of cells from bone marrow cause by IL-1 & TNF