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Tb,typhoid

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Srabani chakrabarti

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ULCERS OF INTESTINE INTESTINAL TYPHOID AND TUBERCULOSIS DR SRABANI CHAKRABARTI ASSOCIATE PROFESSOR DEPT OF PATHOLOGY , CNMC
Tb,typhoid
Tb,typhoid
Tb,typhoid
Intestinal Ulcer due to infection BACTERIAL ï‚— Typhoid ulcer- Salmonella typhi ,paratyphi ï‚— Tuberculosis ulcer - Mycobacterium tuberculosis,bovis ï‚— Pseudomembranous colitis- Clostridium difficile PROTOZOAL ï‚— amoebic ulcer- Entamoeba histolytica VIRAL ï‚— CMV colitis cytomegalovirus
Topics ï‚—TB of intestine ï‚—Typhoid of intestine
INTESTINAL TUBERCULOSIS ï‚— Tb is a chronic granulomatous disease caused by MYCOBACTERIUM TUBERCULOSIS mainly. ï‚— It is a common type of extra-pulmonary TB. ï‚— There are three main forms of intestinal tuberculosis - I primary ï‚— 2 secondary ï‚— 3 hyperplastic ceacal TB ï‚— Most common abdominal Tb is ILEOCAECAL TUBERCULOSIS which is ulcerative type in most of the cases
Primary intestinal TB  MODE OF INFECTION  In pre- pasturisation era, ingestion of unpasturised cow’s milk infected with MYCOBACTERIUM BOVIS.  Due to pasturisation of milk and after eradication of tuberculosis in cattle nowadays primary intestinal TB is caused by MYCOBACTERIUM HOMINIS.
Primary Intestinal Tb ï‚— In primary TB predominant change is in regional mesenteric lymph node without any significant intestinal lesion. GROSS ï‚— the lymph nodes are enlarged, matted and caseous. H/P MICROSCOPY ï‚— Tuberculous granuloma with caseation necrosis.
SECONDARY TUBERCULOSIS ï‚— Secondary TB occurs in a patient of active pulmonary TB who swallows the sputum and the lesion develops in intestine. ï‚— Most common site of intestinal TB is terminal ileum. ï‚— Hyperplastic caecal TB is a type of secondary TB where lesion is in caecum and ascending colon clinically the lesion presents as palpable mass.
Secondary tuberculosis MACROSCOPIC ï‚— Lesions of intestine are prominent than lymph node. ï‚— Large ulcer that is transverse to the long axis of bowel ï‚— serous surface may show visible tubercle. ï‚— Healed lesion may form transverse fibrous stricture and obstruction. H/P MICROSCOPY ï‚— mucosa and submucosa show ulceration and typical granuloma of TB.
Tb,typhoid
Gross appearance of TB intestine tubercle on serosal surface
microscopy of TB intestine
Typhoid fever Typhoid fever or enteric fever is an acute systemic disease caused by S . typhi and S. paratyphi. MODE OF TRANSMISSION ï‚— Salmonella is ingested through contaminated food or water ï‚— Finger to mouth contact with faeces, urine or other secretion.
pathogenesis typhoid fever ingestion via water or food in ileum penetrates mucosa ,and invades REGIONAL L. NODE carried via lymphatic and blood to RE system - multiplies in G.B discharged in intestine involves P.PATCH of intestine ,multiplies and passes to intestine and stool
Pathogenesis of typhoid fever
Tb,typhoid
Clinical feature & complication typhoid CLINICAL FEATURE ï‚— Fever continuous rise in temp step ladder pattern. ï‚— Rose spots on chest and abdomen. ï‚— Spleen is soft and palpable. ï‚— Relative bradycardia. COMPLICATION ï‚— intestinal perforation & haemorrhage ï‚— encephalopathy, meningitis, myocarditis, cholecystitis. ï‚— CARRIER STATE persistence of S.typhi in gall bladder or urinary tract.
TYPHOID INTESTINE MACROSCOPY OF INTESTINAL LESION  most commonly in terminal ileum.  Peyer’s patches in the terminal ileum enlarges and shedding of mucosa produces TYPHOID ULCER which are oval ulcer with their long axis along the long axis of bowel.  Base of the ulcer is black due to sloughed mucosa.  the margins of the ulcer are slightly raised.  Fibrosis is not significant.
Typhoid intestine MICROSCOPY  mucosa - oval ulcer over peyer’s patch  Lamina propria -macrophage containing bacteria RBC lymphocyte , plasma cell ,neutrophil
Tb,typhoid
DIFFERENCE BETWEEN TB AND TYPHOID ULCER OF INTESTINE Characteristi cs Typhoid ulcer Tubercular ulcer Site SI involves peyer ’s patch anywhere in the intestine common in the i-c region orientation Longitudinal to the long axis as it involves peyer ’s patch Transverse to the long axis as it spreads via lymphatic which are arranged circumferentially Microscopy Lymphocyte and plasma cell Granuloma with central area of necrosis Perforation Common Not seen Haemorrhage Common Not seen stricture uncommon common

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Tb,typhoid

  • 1. ULCERS OF INTESTINE INTESTINAL TYPHOID AND TUBERCULOSIS DR SRABANI CHAKRABARTI ASSOCIATE PROFESSOR DEPT OF PATHOLOGY , CNMC
  • 5. Intestinal Ulcer due to infection BACTERIAL ï‚— Typhoid ulcer- Salmonella typhi ,paratyphi ï‚— Tuberculosis ulcer - Mycobacterium tuberculosis,bovis ï‚— Pseudomembranous colitis- Clostridium difficile PROTOZOAL ï‚— amoebic ulcer- Entamoeba histolytica VIRAL ï‚— CMV colitis cytomegalovirus
  • 7. INTESTINAL TUBERCULOSIS ï‚— Tb is a chronic granulomatous disease caused by MYCOBACTERIUM TUBERCULOSIS mainly. ï‚— It is a common type of extra-pulmonary TB. ï‚— There are three main forms of intestinal tuberculosis - I primary ï‚— 2 secondary ï‚— 3 hyperplastic ceacal TB ï‚— Most common abdominal Tb is ILEOCAECAL TUBERCULOSIS which is ulcerative type in most of the cases
  • 8. Primary intestinal TB ï‚— MODE OF INFECTION ï‚— In pre- pasturisation era, ingestion of unpasturised cow’s milk infected with MYCOBACTERIUM BOVIS. ï‚— Due to pasturisation of milk and after eradication of tuberculosis in cattle nowadays primary intestinal TB is caused by MYCOBACTERIUM HOMINIS.
  • 9. Primary Intestinal Tb ï‚— In primary TB predominant change is in regional mesenteric lymph node without any significant intestinal lesion. GROSS ï‚— the lymph nodes are enlarged, matted and caseous. H/P MICROSCOPY ï‚— Tuberculous granuloma with caseation necrosis.
  • 10. SECONDARY TUBERCULOSIS ï‚— Secondary TB occurs in a patient of active pulmonary TB who swallows the sputum and the lesion develops in intestine. ï‚— Most common site of intestinal TB is terminal ileum. ï‚— Hyperplastic caecal TB is a type of secondary TB where lesion is in caecum and ascending colon clinically the lesion presents as palpable mass.
  • 11. Secondary tuberculosis MACROSCOPIC ï‚— Lesions of intestine are prominent than lymph node. ï‚— Large ulcer that is transverse to the long axis of bowel ï‚— serous surface may show visible tubercle. ï‚— Healed lesion may form transverse fibrous stricture and obstruction. H/P MICROSCOPY ï‚— mucosa and submucosa show ulceration and typical granuloma of TB.
  • 13. Gross appearance of TB intestine tubercle on serosal surface
  • 14. microscopy of TB intestine
  • 15. Typhoid fever Typhoid fever or enteric fever is an acute systemic disease caused by S . typhi and S. paratyphi. MODE OF TRANSMISSION ï‚— Salmonella is ingested through contaminated food or water ï‚— Finger to mouth contact with faeces, urine or other secretion.
  • 16. pathogenesis typhoid fever ingestion via water or food in ileum penetrates mucosa ,and invades REGIONAL L. NODE carried via lymphatic and blood to RE system - multiplies in G.B discharged in intestine involves P.PATCH of intestine ,multiplies and passes to intestine and stool
  • 19. Clinical feature & complication typhoid CLINICAL FEATURE ï‚— Fever continuous rise in temp step ladder pattern. ï‚— Rose spots on chest and abdomen. ï‚— Spleen is soft and palpable. ï‚— Relative bradycardia. COMPLICATION ï‚— intestinal perforation & haemorrhage ï‚— encephalopathy, meningitis, myocarditis, cholecystitis. ï‚— CARRIER STATE persistence of S.typhi in gall bladder or urinary tract.
  • 20. TYPHOID INTESTINE MACROSCOPY OF INTESTINAL LESION ï‚— most commonly in terminal ileum. ï‚— Peyer’s patches in the terminal ileum enlarges and shedding of mucosa produces TYPHOID ULCER which are oval ulcer with their long axis along the long axis of bowel. ï‚— Base of the ulcer is black due to sloughed mucosa. ï‚— the margins of the ulcer are slightly raised. ï‚— Fibrosis is not significant.
  • 21. Typhoid intestine MICROSCOPY ï‚— mucosa - oval ulcer over peyer’s patch ï‚— Lamina propria -macrophage containing bacteria RBC lymphocyte , plasma cell ,neutrophil
  • 23. DIFFERENCE BETWEEN TB AND TYPHOID ULCER OF INTESTINE Characteristi cs Typhoid ulcer Tubercular ulcer Site SI involves peyer ’s patch anywhere in the intestine common in the i-c region orientation Longitudinal to the long axis as it involves peyer ’s patch Transverse to the long axis as it spreads via lymphatic which are arranged circumferentially Microscopy Lymphocyte and plasma cell Granuloma with central area of necrosis Perforation Common Not seen Haemorrhage Common Not seen stricture uncommon common