Tb,typhoid

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1. ULCERS OF INTESTINE INTESTINAL TYPHOID AND TUBERCULOSIS DR SRABANI CHAKRABARTI ASSOCIATE PROFESSOR DEPT OF PATHOLOGY , CNMC

2. Intestinal Ulcer due to infection BACTERIAL Typhoid ulcer- Salmonella typhi , paratyphi Tuberculosis ulcer - Mycobacterium tuberculosis,bovis Pseudomembranous colitis- Clostridium difficile PROTOZOAL amoebic ulcer- Entamoeba histolytica VIRAL CMV colitis cytomegalovirus

3. Topics TB of intestine Typhoid of intestine

4. INTESTINAL TUBERCULOSIS Tb is a chronic granulomatous disease caused by MYCOBACTERIUM TUBERCULOSIS mainly. It is a common type of extra-pulmonary TB. There are three main forms of intestinal tuberculosis - I primary 2 secondary 3 hyperplastic ceacal TB Most common abdominal Tb is ILEOCAECAL TUBERCULOSIS which is ulcerative type in most of the cases

5. 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.

6. Primary Intestinal Tb In primary TB predominant change is in regional mesenteric lymph node without any significant intestinal lesion. GROSS the lymph nodes are enlarged, matted and caseous . H/P MICROSCOPY Tuberculous granuloma with caseation necrosis .

7. SECONDARY TUBERCULOSIS Secondary TB occurs in a patient of active pulmonary TB who swallows the sputum and the lesion develops in intestine. Most common site of intestinal TB is terminal ileum. Hyperplastic caecal TB is a type of secondary TB where lesion is in caecum and ascending colon clinically the lesion presents as palpable mass.

8. Secondary tuberculosis MACROSCOPIC Lesions of intestine are prominent than lymph node. Large ulcer that is transverse to the long axis of bowel serous surface may show visible tubercle. Healed lesion may form transverse fibrous stricture and obstruction. H/P MICROSCOPY mucosa and submucosa show ulceration and typical granuloma of TB.

9. Gross appearance of TB intestine tubercle on serosal surface

10. microscopy of TB intestine

11. Typhoid fever Typhoid fever or enteric fever is an acute systemic disease caused by S . typhi and S. paratyphi . MODE OF TRANSMISSION Salmonella is ingested through contaminated food o r water Finger to mouth contact with faeces , urine or other secretion.

12. 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

13. Pathogenesis of typhoid fever

14. Clinical feature & complication typhoid CLINICAL FEATURE Fever continuous rise in temp step ladder pattern. Rose spots on chest and abdomen. Spleen is soft and palpable. Relative bradycardia . COMPLICATION intestinal perforation & haemorrhage encephalopathy, meningitis, myocarditis , cholecystitis . CARRIER STATE persistence of S.typhi in gall bladder or urinary tract.

15. 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.

16. Typhoid intestine MICROSCOPY mucosa - oval ulcer over peyer’s patch Lamina propria - macrophage containing bacteria RBC lymphocyte , plasma cell , neutrophil

17. DIFFERENCE BETWEEN TB AND TYPHOID ULCER OF INTESTINE Characteristics 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