CHRONIC INFLAMMATION

Chronic Inflammation
An immune reaction to "mild" but
persistent
antigen
producing
a
proliferation of lymphocytes and plasma
cells.
There is usually no pain, redness,
swelling, or warmth.
Scarring and persistence of etiologic
agent is common.

Causes of chronic inflammation

Prolonged exposure to non-degradable:
Partially toxic substances are either endogenous lipid
components which result in atherosclerosis or
exogenous substances such as silica, asbestos.
Progression from acute inflammation:
Persistent suppuration is result from un-collapsed
abscess cavities, foreign body materials (dirt, cloth,
wool, etc), sequesterum in osteomylitis, or a
sinus/fistula from chronic abscesses.

Autoimmuniy:
Autoimmune diseases such as rheumatoid arthritis and
systemic
lupus
erythematosis
are
chronic
inflammations

Chronic Inflammation
Time course:
Greater than 48 hours (weeks, months, years)
Cell type
Mononuclear cells (Primarily Macrophages,
Lymphocytes, Plasma cells), giant cells &
fibroblast.
Chronic inflammation classified into:
Diffuse
Focal (granuloma)
Other cells in chronic inflammation:
Lymphocytes: Plasma cells: Eosinophils:

Cells of chronic inflammation

(1) Monocytes and Macrophages
Monocytes and Macrophages are the prima Dona
(primary cells) in chronic inflammation.
Macrophages are phagocytic Cs, derived from
circulating blood monocytes or tissue histocyte).
Macrophages arise from the common precursor cells in
the bone marrow, which give rise to blood monocytes.
These cells are then diffusely scattered in various parts
of the body, in the liver (Kupffer cells), spleen, lymph
nodes (sinus histiocytes), lungs (alveolar macrophages),
brain (microglia), skin (Langerhans cells), etc.
Macrophages are scavenger cells of the body.

(2) giant cell

Inflammatory
giant
cells
are
multinucleated cells that result from:
1- The fusion of macrophages.
2-Giant cells may form by mitotic
division of the macrophages nuclei
without division of the cytoplasm.
i -Langhans giant cell type: it is large
cells with multiple nuclei (arranged
peripherally). It is situated specially
in tuberculous lesions.
ii- Foreign body giant cell type:
large cells with multiple nuclei are
placed centrally or scattered in the
cytoplasm as F.B granulomas

(3) Other cells in chronic inflammation

1. T-Lymphocytes are primarily involved in cellular
immunity with lymphokine production, and they are
the key regulator and effector cells of the immune
system.
2. B-lymphocytes and Plasma cells produce antibody
directed either against persistent antigen in the
inflammatory site or against altered tissue components.
3.Mast cells and eosinophils appear predominantly in
response to parasitic infestations & allergic reactions.
4. Fibroblast is cell of connective tissue origin synthesis
the collagen fibers in case of fibrosis or cirrhosis

Classification of chronic inflammation

Chronic inflammation can be classified into the following
two types based on histologic features:

1) Non specific chronic inflammation:

This involves a diffuse accumulation of macrophages and
lymphocytes at site of injury that is usually productive with
new fibrous tissue formations. E.g. Chronic cholecystitis.
2) Specific inflammation (granulomatous inflammation):.
Granulomatous inflammation is characterized by the
presence of granuloma. A granuloma is a microscopic
aggregate of epithelioid cells.

1- non specific chronic inflammation

Different irritants can produce inflammatory
reactions of the same microscopic picture. So
etiology cant be identified from reaction.
Follows acute inflammation e.g. chronic abscess
Gross
Decrease of organ size
Pale in color
.Hard in consistency

Microscopic picture
Lymphocytes, plasma cells, and macrophages
infiltration
Proliferation of fibroblasts collagen fibers
Thickening of blood vessels wall
Tissue necrosis
Complications of Chronic Inflammation
Fibrosis and scarring
.Persistence of etiologic

2- Specific inflammation
(granulomatous inflammation)
Each irritant produces a specific inflammatory reaction
& so etiology can be identified from reaction e.g.
tuberculosis, bilharziasis

Foreign body
Tuberculosis (Tb)
Fungal infections
Schitosomiasis

Granulomas

Granulomatous Inflammation

Factors necessary for granuloma formation:

Presence of indigestible organisms or particles
(T.B, mineral oil, etc)
Cell mediated immunity (T cells)
Microscopic Features of
granulomatous
inflammation
Lymphocytes
Fibroblasts
Collagen
Macrophages
Plasma cells, giant cells, eosinophils

Foreign Body Granuloma

Tuberculosis (Tubercle)