课件：年春季临床医学传染病结核病.ppt

参考资料 结核病防治百题问答（R52-448991） Brief Summary Tuberculosis is a granulomatous, chronic infection caused by Mycobacterium tuberculosis. The infection is most often limited to the lung and bronchial lymph nodes, but it may spread to other organs ( ) via hematogenous dissemination. Primary pulmonary tuberculosis is manifested by the primary complex, which consists of an intraparenchymal granulomatous lesion, usually located subpleurally in the midsection of the lungs, and hilar lymphadenopathy. In most cases, this infection resolves spontaneously. Brief Summary Secondary pulmonary tuberculosis is reinfection, or, more often, reactivation of a latent but incompletely healed primary infection. The lesions of secondary tuberculosis are classically apical. Cavitary tuberculosis is extensive necrosis of the parenchymal lesion, leading to loss of the parenchyma and bleeding from severed vessels. Military tuberculosis is characterized by numerous minute nodules resulting from hematogenous dissemination. Homework What does the presence of collagen fibers suggest? How does the morphology of tuberculosis differ in the immunocompetent vs. the immunosuppressed host? What are the causes of caseous necrosis ? How does caseous necrosis differ from coagulative necrosis under the microscope? What is the origin of epithelioid cells? THANK YOU SUCCESS * * 可编辑 浸润性肺结核：病变较局限于肺上叶，有空洞形成，并有肺实变 浸润型肺结核：肺泡内浆液、单核细胞、淋巴细胞、少数中性粒细胞。 慢性纤维空洞性肺结核：显示结核空洞。 洞壁分三层 病灶沿支气管播散，形成大小不等，散在分布于上下肺叶的新旧病灶。 周围组织纤维化，胸膜明显增厚，厚壁空洞 广泛纤维化→硬化型肺结核 大叶性干酪性肺炎 小叶性干酪样肺炎 肺组织内大片干酪样坏死。 肺泡腔内大量的炎性渗出物，渗出物及巨噬细胞胞浆内大量抗酸杆菌。 结核球：孤立的有纤维包裹、境界分明的球形干酪样坏死灶，直径约2～5cm。 脾粟粒性结核：切面大量灰白色结节 全身粟粒性结核病 肉眼：各器官密布结核结节。 镜下：增生性（结核结节或 渗出、坏死性病变。 肺切面密布灰白或灰黄色粟粒大小的结节 粟粒样结节显露于肺膜表面 粟粒性肺结核：增生为主，可有坏死。 （一）肠结核病 原发性：少见，常于小儿，饮用不洁牛 奶感染，肠原发综合征。 继发性：多见，常继发于空洞型肺结核， 由下咽含菌痰液引起。 好发部位：85%发生于回盲部。 1．溃疡型 ：多见 结核杆菌→肠壁淋巴组织→结核结节→坏死 →溃疡。 病理：带状，与肠轴垂直，边缘不齐，底部坏死， 其下为肉芽组织。浆膜面见纤维素渗出和 灰白结核结节。 转化：愈合疤痕形成和收缩→