Path Week 9: Inflammation, Infections, Aids, And Amyloidosis

Front 1

Speed, duration, and types of cells involved in Acute inflammation

Back 1

Rapid onset (minutes), short duration (hours days), leukocytes, neutrophils.

Front 2

What types of things cause acute inflammation

Back 2

1) Infection and microbial toxins
2) Necrosis via ischemia, trauma, or injury
3) Foreign body
4) Hypersensitivity Rx

Front 3

What type of things cause chronic inflammation without ever being acute first

Back 3

1) Rheumatoid arthritis
2) Atherosclerosis
4) TB
5) Persistent infection from certain organisms and viruses
6) Immune mediated inflammatory (autoimmune/allergic)
7) Prolonged exposure to toxic agents.

Front 4

Serous inflammation

Back 4

Type of acute inflammation. Thin fluid from plasma or secreted mesothelial cells lining a cavity (effusion). Blister is an ex.

Front 5

Fibrinous Inflammation

Back 5

Type of acute inflammation. Increased vasc permiability, allows large molecules like fibrinogen to get into extravascular space and deposit fibrin. Occurs with large vascular leak or procoagulant stimulus (ex cancer cells). Fibrin over time makes scar.

Front 6

Suppurative inflammation

Back 6

Type of acute inflammation. Purulent. Lots of pus, neutrophils, liquefactive necrosis, and edema. Bacteria usually gram + cocci or gram - rod via release of chemo-attractants. An abscess is this type of inflammation.

Front 7

Abscess

Back 7

Type of suppurative acute inflammation. Is a localized collection of purulent inflammatory tissue. Have central necrosis of leukocytes and tissue surrounded by neutrophils and vascular dilation and fibroblastic proliferation. Will heal with fibrosis and scar.

Front 8

Ulcer

Back 8

Type of acute inflammation. Produced by shedding of inflamed necrotic tissue. Occur near a surface like mouth, gut, GI, skin.

Front 9

Granulomatous Inflammation

Back 9

Type of chronic inflammation. Is a circumscribed collection of epitheliod histiocytes. Can have surrounding lymphocytes and giant cells. Can be caused by:
-TB and leprosy
-Sarcoidosis
-cat scratch disease
-lymphogranuloma inguinale
-brucellosis
-syphilis
-histoplasma
-berrylliosis
-Rx to lipids
-Foreign body
-Chron disease
-Shistosome egg

Front 10

Causes of pneumonia in aids patients

Back 10

Most common cause is Pneumocystis jiroveci. Can also be caused by:
-candida
-cytomegalovirus
-Crypto
-histoplama
-herpes
-mycobacteria
-Toxo
-papoviruses

Front 11

Candidas infection in aids patients

Back 11

Most common fungal infection in aids patients. Usually in mouth (get flush), vagina, and esophagus.

Front 12

Cytomegalovirus in aids patients

Back 12

Causes retinitis, esohphagitis, colitis, and multiple mucosal ulcerations.

Front 13

Herpes simplex virus in Aids patients

Back 13

Causes mucocutaneous ulcerations of the mouth, esophagus, external genitalia, or perianal region.

Front 14

Mycobacterial infections in aids patients

Back 14

Can get infected with M.avium. 1/3 of all AIDs deaths are due to TB.

Front 15

CNS infection in AIDS patients

Back 15

Cryptococcus can cause meningitis.
Toxo can cause meningitis and CNS mass lesions.
JC virus (a papovirus) can cause progressive multifocal leukoencephalopathy.

Front 16

What causes tumors in aids patients

Back 16

An ocogenic DNA virus. Infection cant be contained in aids patients.

Front 17

What causes Kaposi Sarcoma in AIDS patients

Back 17

HHV-8 infection, found in all types if KS. Virus encodes for proteins which interfere with p53 and RB suppressor pathways. However, HHV-8 needs a cofactor, which HIV provides.

Front 18

What is present in Kaposi sarcoma in aids patients

Back 18

Prolif of spindle-shaped cells with features of endothelial and smooth muslces cells with vascular spaces. Cells produce pro-inflammatory and angiogenic factors. Unlike reg KS, aids kind have wide spread skin, mucus, GI, lymphnode, and pulmonary disease. More aggressive in general.

Front 19

Non-hodgikins lymphoma in aids patients

Back 19

120x more common in aids patients than general pop, especially if CD4 is low.

Front 20

Systemic lymphoma in aids patients.

Back 20

Caused by EBV, is 80% of aids related lymphomas. Hits lymph nodes, CNS, GI, salivary glands, and lungs

Front 21

Primary CNS lymphoma in aids patients

Back 21

Caused by EBV, 1000x more likely in aids patients than general pop.

Front 22

Body cavity based primary effusion lymphoma in aids patients

Back 22

Rare, linked to KSHV. Patients present with pleural, peritoneal, and pericardial effusion.

Front 23

Amyloid definition

Back 23

Randomly oriented protein fibrills that share physical and chemical properties. Are proteins misfolded into beta pleated sheets and deposited in the extracellular space. This can be because of excessive production of a protein (AL, AA) or it can be a mutated protein (TTR).

Front 24

AL

Back 24

Amyloid light chain. Called a primary amyloidosis, is most common. Caused by protein excess. Derived from Ig light chains made from a monoclonal plasma cell pop. Usually lambda light chains.

Front 25

AA

Back 25

Amyloid associated. Caused by protein excess. Made from a unique protein called SAA made by the liver. Protein production increases during inflammation as part of acute phase response of chronic. Associated with rheumatoid arthritis, ankylosing spondylitis, Crohn disease, ulcerative colitis, and in skin-poppers.

Front 26

TTR

Back 26

Also called familial or hereditary amyloidosis. Amyloid caused by mutated Transthyretin, a serum protein that binds and transports thyroxine and retinol. Deposits in peripheral nerve. Can also get cardiac symptoms.
There is also a senile cardiac amyloidosis where amyloid is deposited in the heart but TTR has normal conformation. Get restrictive cardiomyopathy and arrhythmia.

Front 27

Amyloidosis presentation via light and electron microscope

Back 27

By light, extracellular hyaline pink deposits stain with congo red stain and if viewed with polarized light, have apple green appearance.
By electron microscopy, made of continuous, non branching fibrils

Front 28

Amyloidosis gross appearance of organs involved

Back 28

Organ is firm and waxy

Front 29

Organs often involved in amyloidosis

Back 29

Kidney, if glomerulus, get protienuria.
Heart leads to congestive heart failure, restrictive cardio myopathy, and arrhythmias.
Tongue becomes enlarged (teethmarks on the periphery are a giveaway) can affect speach and swallowing.
GI can cause malabsorbtion, diarrhea, and disturbance.
Also can involve liver, spleen, and thyroid.

Front 30

How is amyloidosis diagnosed?

Back 30

Based on histology.

Front 31

Why is amyloidosis harmful

Back 31

Deposits itself in the place of normal tissue. Damage can also be related to interaction with receptors for advanced glycation end-products (RAGE), oxidative stress, and apoptosis.