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Syphilis
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Syphilis has been called “the great pretender” because of the myriad of clinical manifestations it can produce. It is a chronic, systemic infection characterized by several stages. The immune response to T. pallidum plays a significant role in the manifestations of all stages of syphilis. Much of the pathology observed in the disease is attributable to vascular abnormalities caused by proliferative endarteritis that occurs in all stages of syphilis. The pathophysiology of the endarteritis is not known, although the scarcity of treponemes and the intense inflammatory infiltrate suggest that the immune response plays a role in the development of these lesions. Manifestations of syphilis are not altered by pregnancy.
The urinary tract and male reproductive system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Luis Beltran, Daniel M. Berney
The macroscopic appearances of the kidney are important in differentiating chronic pyelonephritic scarring from other types of renal scarring. Unlike other forms of chronic tubulointerstitial disease the pelvic and calyceal walls are thickened and distorted, their mucosa is granular or atrophic, with scarring of the pyramids and usually calyceal dilatation. In contrast to chronic glomerulonephritis the renal parenchyma shows asymmetrical scarring and shrinkage, these scars being close to the deformed calyces and found mainly at the upper and lower poles of the kidney. Microscopically the pelvic and calyceal mucosa may be thickened by granulation tissue. There is often submucosal fibrosis and an intense chronic inflammatory cell infiltrate, sometimes with lymphoid follicle formation. In the parenchymal scars there is tubular atrophy with thickening of the basement membranes, and the interstitium is infiltrated by inflammatory cells, mostly lymphocytes and plasma cells. In the late stages of the disease there is dense fibrosis with little active inflammation. The glomeruli in the scarred areas may appear normal but show a spectrum of abnormalities with concentric periglomerular fibrosis, ischaemic injury, fibrous obliteration, and hyalinization of glomerular tufts. Obliterative endarteritis affects the blood vessels. In non-scarred areas there may be compensatory hypertrophy, and vascular changes resulting from hypertension.
Rheumatoid arthritis
Published in Gabriel Virella, Medical Immunology, 2019
George C. Tsokos, Gabriel Virella
Histopathological studies of rheumatoid nodules show fibrinoid necrosis at the center of the nodule surrounded by histiocytes arranged in a radial palisade. The central necrotic areas are believed to be the seat of immune complex formation or deposition. When the disease has been present for some time, small brown spots may be noticed around the nail bed or associated with nodules. These indicate small areas of endarteritis.
Mechanisms of inflammatory responses to radiation and normal tissues toxicity: clinical implications
Published in International Journal of Radiation Biology, 2018
Masoud Najafi, Elahe Motevaseli, Alireza Shirazi, Ghazale Geraily, Abolhasan Rezaeyan, Farzad Norouzi, Saeed Rezapoor, Hamid Abdollahi
IR-induced gastritis is a serious complication in radiation therapy and can cause chronic gastric inflammation and bleeding. The initial injury is characterized by acute inflammation of gastric mucosa. Although the pathogenesis of radiation-induced gastritis is not fully understood, it is thought that increased levels of inflammatory cytokines and growth factors are involved in this process. Some evidences have shown that TNFα, IL-1β, IL-21, and cyclooxygenases play a key role in the development of gastritis (Li et al. 2006; Santos et al. 2012; Nishiura et al. 2013). The presence of Helicobacter pylori may be related to gastritis caused by radiation (Abrunhosa-Branquinho et al. 2015). Chronic radiation gastritis can cause the multiple telangiectasia and gastric bleeding usually during 2–7 months after treatment. It is thought that acute vasculopathy may be involved in obliteration of endarteritis that leading to mucosal ulceration and bleeding. A similar sign is seen in the rectum, intestine, and bladder following pelvic irradiation (Grover and Johnson 1997). The long term duration of these symptoms results in anemia and tumor progression. But taking appropriate drugs can relieve the complications effectively (Rodríguez-Lago et al. 2013).
Severe, non specific symptoms in non-typhoidal Salmonella infections in adult patients with sickle cell disease: a retrospective multicentre study
Published in Infectious Diseases, 2018
Romain Guery, Anoosha Habibi, Jean-Benoît Arlet, François Lionnet, Victoire de Lastours, Jean-Winoc Decousser, Jean-Luc Mainardi, Keyvan Razazi, Laurence Baranes, Pablo Bartolucci, Bertrand Godeau, Fréderic Galacteros, Marc Michel, Matthieu Mahevas
Clinical presentation of NTS during SCD appears to be non-specific in adult SCD population. Indeed, only one patient in our study had a typical presentation of NTS with febrile gastroenteritis at admission. The diagnosis of NTS is challenging during SCD because most patients were referred for a vaso-occlusive crisis or an acute chest syndrome; fever was absent in a quarter of cases and blood cultures were negative in one-third of cases. In such patients with only vaso-occlusive symptoms, a diagnosis of NTS bacteraemia and/or osteomyelitis can be difficult. Despite predisposition to vasculopathy, we did not find any infective endarteritis in our cohort unlike other NTS series of non-SCD adults [15]. By contrast with previous reports in children, gastroenteritis and recent travel to the tropics were rare [13]. It suggests that direct spread from the gut to the bloodstream might not be the predominant mechanism of dissemination. It has already been shown that immunocompromised patients often presented extra-intestinal salmonellosis without gastroenteritis [16]. Our study indicates that biliary tract could be the predominant source of infection among SCD adults including those with a history of cholecystectomy. This was consistent with the hypothesis of gallstones as a niche for chronic non-typhoidal Salmonella carriage [17]. Gall bladder or intra-hepatic pigment gallstones were found in more than 80% of adult SCD older than 30 years in a historical cohort of Brazil from 1995 to 2014 [18]. However, presence of cholelithiasis on imaging during the NTS course is not a true evidence of Salmonella carriage. Studies are needed to prove non-typhoidal Salmonella adherence on gallstones in SCD population. Cholecystectomy is now indicated in children with asymptomatic cholelithiasis by our national guidelines since 2009. This recommendation could partially explain the low prevalence of NTS in adults with SCD in our cohort.
Inflammation in neurocysticercosis: clinical relevance and impact on treatment decisions
Published in Expert Review of Anti-infective Therapy, 2021
Pedro T Hamamoto Filho, Gladis Fragoso, Edda Sciutto, Agnès Fleury
In both cases, infiltration of the arterial walls by lymphocytes, plasma cells, and eosinophils causes occlusive endarteritis, and consequently, a reduction in the diameter of the arteries. In addition, atheroma–like deposition resulting from disruption of the endothelium may occur, which in turn can participate in the blockage of the lumen of the arteries [110].