198. Clinical and morphological characteristics of primary, secondary, tertiary and congenital syphilis. Complications, causes of death.

- innate

- acquired (primary, secondary, tertiary)

The incubation period is 3 weeks

Primary syphilis:

morphological expression – primary syphilitic complex

primary syphilitic complex:

the primary affect is a solid chancre

lymphangitis

lymphadenitis

a hardening area is formed in the entrance gate, from which a rounded ulcer with a smooth lacquered (shiny) bottom, smooth, cartilaginous consistency, edges is formed in 1-2 weeks – this is a solid chancre. It's painless.

According to the diverting lymphatic sos to the regional lymph nodes, the primary complex is formed.

Secondary syphilis

It develops after 8-10 weeks, after the formation of a solid chancre. It is associated with the reproduction and circulation of the pathogen in the bloodstream.

Characterized by

catarrhal inflammation of all mucous membranes,

enlargement of several groups of lymph nodes (polyadenitis)

rashes on the skin and mucous membranes (syphilis) – roseoles, papules. Wastelands. They are rich in pathogen. And when the papules and pustules ulcerate, they enter the environment. During this period, the patient is dangerous to others.

During the healing of syphilis, a non-pigmented scar is formed.

Tertiary syphilis (visceral)

Characterized by:

granulomatous inflammation (gumma)

chronic male inflammation

vasculitis

gummas are a focus of specific granulomatous inflammation, up to 5-6 cm in size. They can be single or multiple. They are most often localized in the liver, lungs, skin and soft tissues.

Microscopically: there is a focus of necrosis in the center. The cat undergoes caliquation (liquefaction). Necrosis is surrounded by a ct infiltrate consisting of plasmacytes and lymphocytes.

The exodus of Gumma:

- scarring

- calcification

chronic male inflammation is localized in the liver and lungs. The walls of the aorta.

syphilitic mesartitis occurs b/ w 15-20 years from the moment of infection, the ascending part and the aortic arch are involved in the process. there is a retraction and bumps on the inner shell of the aorta, which gives it the appearance of shagreen skin.

Microscopically: CLT infiltrates from lymphatic and plasma clts are formed around vasa vasorum. CT infiltrates destroy elastic fibers and collagen fibers are formed in their place, as a result, an aortic aneurysm is formed in the patient.

Neurosyphilis

It occurs in the tertiary period. Highlight the shapes:

simple

gummous

the gummous formation of the gumm formation in the brain.

Neurosyphilis is characterized with xp meningitis in combination with xp endarthritis. As a result, obliteration of the lumen of the sos occurs with the development of dystrophic changes.

Progressive paralysis

in patients in the tertiary period, syphilis occurs as a result of a decrease in brain mass, thinning of the gyrus, atrophy of the subcortical nodes and cerebellum.

Microscopically: dystrophic and inflammatory changes in the brain tissue

Dorsal dryness

In this form of neurosyphilis, the spinal cord is affected. It is characterized by dystrophic changes that begin at the time of the posterior c.m., with a transition to the posterior pillars and posterior roots of the c.m., which thin out and the myelin sheath collapses.

199. Sepsis: definition of the concept, difference between sepsis and other infectious diseases. Local and general changes in the body in sepsis.

Sepsis is an infectious disease characterized by hematogenous generalization of a pyogenic infection with damage, primarily to the cardiovascular system, with the development of multiple organ failure in the final stage of the disease.

The difference between sepsis and other infectious diseases:

1.Etiological- sepsis can be caused by various microorganisms (except

viruses).

2.Epidemiological- sepsis is not contagious.

3.Clinical features: stenciling of the course, lack of cyclicity, different timing of the course, etc.

4. Immunological feature - immunity is not produced.

5. Pathoanatomical features: the changes do not have specific features.

Local and general changes in the body in sepsis:

Local changes develop at the site of infection (entrance gate) or at a distance from it. A septic focus is formed — the focus of purulent inflammation, sometimes there is no septic focus. From the septic focus, the infection spreads rapidly through the lymphatic and blood vessels. The spread of infection through the lymphatic system leads to lymphangiitis, lymphothrombosis and lymphadenitis, and its spread through the circulatory system (through the veins) leads to phlebitis and thrombophlebitis. Purulent thrombophlebitis often occurs, which leads to the melting of blood clots and thrombobacterial embolism.

The general changes in sepsis are characterized by dystrophy, inflammation and hyperplasia. Various types of dystrophy and necrobiosis develop in parenchymal organs (liver, kidneys, myocardium, muscles, central nervous system), which often end in necrosis. Inflammatory changes are represented by inter—daily processes - inter-daily septic nephritis, hepatitis, myocarditis. Acute polypous ulcerative endocarditis occurs on the valves of the heart with melting of the tissue and detachment of the valves. Inflammation occurs in the vessels (vasculitis), which causes multiple hemorrhages. Hyperplasia in sepsis is observed mainly in hematopoietic and lymphatic (immunocompetent) tissues. Bone marrow hyperplasia of flat bones occurs. The yellow bone marrow of tubular bones turns red, the number of white blood cells increases in the blood, sometimes young forms of white blood cells appear — a leukemoid reaction. Hyperplasia of the lymphatic tissue leads to an increase in the lymph nodes, the spleen, which is not only enlarged, but also flabby, has a red color on the incision and gives an abundant scraping of the pulp — septic spleen. Hyperplasia in the histiocyte-macrophage system causes an increase in the liver. Due to the hemolytic effect of some bacterial toxins, hemolytic jaundice occurs in sepsis.