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Spinal TB and Syphilis, Congenital Syphilis …
Spinal TB and Syphilis
Spinal/Vertebral Tuberculosis
What cause Spinal Tuberculosis (POTTS DISEASE) ?
Spinal TB is caused by Mycobacterium Tuberculosis.
What is the Pathogenesis of Spinal Tb ?
The Mycobacterium is haemtogenously spread
It follows from either progressive primary TB or secondary TB.
The mycobacteria gain access to the spine via the blood and tend to locate near the epiphysis of the bone or in the vertebral bodies.
Necrotizing Granulomatous Inflammation ensues.
Describe the pathological Macroscopic and Microscopic findings of Spinal TB
Macroscopic Findings:
Narrowing of intervertebral disc space
Destruction of the anterior parts of the adjacent vertebra.
Collapse of vertebral bodies.
PARAvertebral abscess.
Angular Deformity (Kyphosis)
Microscopic Findings:
Central caseous Necrosis
Granulomatous Inflammation sometimes Multi-Nucleated Giant Cells will be present.
What are the complications of Spinal Tuberculosis ?
The complications of Spinal Tuberculosis include:
Spinal cord compression resulting in Paresis and Paralysis.
Kyphosis resulting in cardiorespiratory compromise.
Tuberculosis meningitis (very uncommon)
Paravertebral Cold Abscess
The Paravertebral abscess is known as the Psoas Abscess.
It is not a true abscess.
What does the Psoas Abscess contain ?
Psoas abscess contains necrotising granulomatous inflammation.
Where is the Psoas Abscess located ?
Psoas abscess is located on the Psoas Muscle which extends from beneath the fascia of Psoas muscle to below the inguinal ligament,
Caseous necrosis tracks down the muscle and into the pelvis.
Patient presents pelvic or abdominal mass /hip pain.
Central Nervous System Tuberculosis
Tuberculosis Meningitis
What is the pathogenesis of Tuberculosis meningitis ?
TB Bacilli is haematogenously spread following from Pulmonary TB .
TB bacilli aggregate in the paraventricular region of the brain, and form a coalescing granulomas, known as Rich's focus.
Bacilli enter the Cerebrospinal fluid and spread through the CSF, resulting in TB meningitis.
What are the Macroscopic and Microscopic Features of TB Meningitis ?
Macroscopic:
Lesions at the base of the brain
Grey white discoloration of the brain.
Small Tubercles
Turbid (thick) CSF resulting in spider web appearance.
Microscopic;
Granulomas, Caseous Necrosis
Lymphocytes, Fibrin
Obliterate small vessels.
What are the complications of TB meningitis ?
Hydrocephalus due to the obstruction of the 4th ventricle.
Cerebral infarct (Stroke) due to occlusion (Blockage) of blood vessels.
Tuberculosis Encephalitis
What is Tuberculosis Encephalitis ?
TB Encephalitis is a condition where multiple small nodules or single large tuberculoma form within the parenchyma of the brain.
Mass lesion.
What are the macroscopic and microscopic findings of Tuberculosis Encephalitis ?
Macroscopic:
Lesions are areas of caseous necrosis.
Microscopic
Lesions consist of coalescing necrotizing granulomas.
List the complications of TB Encephalitis
Seizures
Space occupying lesion with brain herniation.
Syphilis
What is Syphilis ?
Syphilis is a bacterial infection caused by Spirochete-Treponema Pallidum.
How is Syphilis Transmitted ?
Syphilis is transmitted via Sexual transmission, and Transplacental spread.
What cells are associated with Syphilis ?
The main cells associated with Syphilis are Plasma cells and Fibrosis is often present.
How is Syphilis detected ?
Syphilis is detected using the a Histochemical stain called the Warthin-Starry stain and other modalities such as PCR.
List the types of Syphilis
Primary Syphilis
Secondary Syphilis
Tertiary Syphilis
Primary Syphilis
What is Primary Syphilis ?
Lesions of primary syphilis occur at the areas of sexual contact.
Lesions usually become apparent 3 weeks after initiating infection.
What are the main features of Primary Syphilis ?
Chancre, a painless ulcer.
Lymphadenopathy
Spirochaetemia
Secondary Syphilis
What are the features of secondary Syphilis ?
The features of Secondary Syphilis are:
Condylomata lata: Large, moist, smooth warts.
They develop in areas of sexual contact.
Alopecia
Snail tract ulcers in mouth
Lymphadenopathy
Tertiary Syphilis
*What is Tertiary Syphilis?*
Tertiary syphilis occurs when the infection has not been treated for many years.
List the Types of tertiary Syphilis
These are:
Cardiovascular Syphilis
Neurosyphilis
Gumma
Cardiovascular Syphilis
Damage to the Vasa Vasora.
Vasa vasora are small vessels that supply blood to walls of large arteries, supply blood to 2/3 of Aorta.
What is the pathogenesis of the cardiovascular Syphilis ?
Aortitis will occur due to the occlusion of Vasa Vasorum, loss of elastin, fibrosis, will result in tree bark appearance.
Aortic Arch Aneurysms
Aortic Regurgitation(fall back of blood into LV)
Left Ventricular Hypertrophy and globular dilation (Cor bovinum).
Coronary Artery Stenosis, resulting in ischeamia and infarction.
Neurosyphilis
What is Neurosyphilis ?
Neurosyphilis can manifest is several ways:
Tabes Dorsalis which is the degeneration of posterior columns of spinal cord.
Meningovascular Syphilis
Meningeal and Parenchymal arteritis with occlusion
Secondary areas of infarction.
Meningeal fibrosis, which results in a block in CSF flow, resulting in Hydrocephalus.
General Paresis which is grey matter degeneration, paresis and dementia.
Gumma
What is Gumma ?
Gumma occurs in the Liver, Testis and Bone.
It is firm rubbery masses, that contain granuloma with central coagulative necrosis.
Congenital Syphilis
List the features of congenital syphilis
Large pale Placenta, 50% weight of fetus.
Hydrops Fetalis
Fibrosis - Lungs, pancreases, liver, spleen, heart.
Osteochondritis (rat bitten appearance)
Rhintis (Snuffles)
Deformed Nasal bridge