ANATOMICAL PATHOLOGY:
INFECTIOUS DISEASES
For case 303 (PBL):
• No restriction to reading
• No limit to learning
• Everything is ‘nice’ to know … even when it is voluminous
For this resource session:
• Consider: overlap/integration with Microbiology (and Pharmacology)
• What do we ‘need’ to know?
• What is appropriate for ‘age and stage’ of learning in 2022?
Your challenge:
• Reducing the volume without losing too much detail
• Minimum knowledge for ‘age and stage’ of learning
Remember:
• Pathology is hard work
• Medicine is hard work
• Becoming a doctor is hard work
….. Being a GOOD doctor is worth it
• The learning is progressive
• There are no shortcuts without repercussions
• You can work/learn smartly
• Integration reduces effort … but you must actively seek the overlap to
avoid unnecessary repetition across related disciplines
• Do not be defeated by apparent volume
How to ‘engage’ Robbins:
• First read the chapter like a novel from start to finish
• Visualise a ‘landscape’ of the content … first page of the chapter
• Construct a framework of headings and sub-headings (‘length and
breadth’) … first page of the chapter
• (Progressively) Populate with salient information (‘depth’)
• Review, reflect and revise
• Figures, tables and summaries become meaningful
• Look for the patterns and the ‘value’ or application of information …
makes it easier to understand and remember
Infectious Diseases
What do we know already?
•Infections cause cell injury ….
•Infections induce inflammation …
•Microbiology & Pharmacology
What’s new?
•Names of organisms
•Disease profiles
•Morphology
Infectious Diseases
Approach
•General principles
•Specific:
o Viruses
o Bacteria
o Fungi
o Parasites
Infectious Diseases: General Principles
Routes of entry:
•Skin
•GIT
•Respiratory tract
•Urogenital tract
NB: Host defences must be bypassed, overcome or compromised
Provide examples of each
Infectious Diseases: General Principles
Transmission:
•Contact (direct or indirect)
•Respiratory
•Faecal-oral
•Sex
•Vertical (mother-to-child)
•Insect/arthropod vectors
Provide examples of each
Infectious Diseases: General Principles
Immune evasion:
•Bypass host tissue barriers
•Evade host innate and adaptive immunity – how?
o Antigenic variation
o Inactivating antibodies or complement system
o Resist phagocytosis
o Suppressing host adaptive immune response
o Establish latency
Infectious Diseases: General Principles
Consider:
•Injurious effects of host immunity
•Immunodeficiency states
Infectious Diseases: General Principles
How micro-organisms cause disease:
•Interplay between microbial virulence factors and host responses
•Cause cell death/dysfunction by direct interaction with cell
•Injury due to local or systemic release of microbial products:
o Endotoxin
o Exotoxin
o Superantigens
•Pathogens can induce immune responses that cause tissue damage
…absence of immune response may ↓ tissue damage. However,
immune compromise permits expansion of opportunistic infections.
Infectious Diseases: General Principles
Sexually transmitted infections:
•Depend on direct contact
•Transmission from asymptomatic people
•Groups at ↑ risk
•STIs in children and sexual abuse
•Spread within urogenital tract
•One STI ↑ risk for additional STIs
•Vertical maternal-foetal transmission
Infectious Diseases: General Principles
Inflammatory responses to infection:
•Suppurative inflammation
•Mononuclear and granulomatous inflammation
•Cytopathic-Cytoproliferative reaction
•Tissue necrosis
•Chronic inflammation and scarring
Provide examples of each
Infectious Diseases: General Principles
Special techniques for diagnosing infectious agents:
•Microbiology and Virology
•Anatomical Pathology - Cell/Tissue diagnosis:
o Morphological alterations and cytopathic effects
o Histochemical stains
o Immunohistochemistry
o Molecular pathology
Infectious Diseases: Viruses
•Acute transient infections
•Latent infections
•Chronic productive infections
•Transforming infections
Infectious Diseases: Viruses
Acute transient infections:
•Measles
•Mumps
•Poliovirus
•West Nile virus
•Viral haemorrhagic fever
Consider organism, genetic diversity (if any), epidemiology, transmission,
route of entry, site of infection, spread, clinical presentation,
pathogenesis, immunology, diagnosis especially characteristic or
pathognomonic morphological alterations, treatment, complications and
outcomes
Example: Measles
•Acute viral infection
•Single-stranded RNA virus, paramyxovirus family, one serotype
•Vaccine-preventable ; epidemics in unvaccinated populations
•Mild, self-limited infections to severe systemic disease
•Antibody-mediated immunity protects against re-infection
•Transmitted by respiratory droplets
•Replicates in epithelial cells and leukocytes in respiratory tract and
spreads to local lymphoid tissues
•Viraemia and systemic dissemination to conjunctiva, skin, respiratory
tract, urinary tract, small blood vessels, lymphatic system, CNS
•Pathognomonic morphology: Koplik spots and Warthin-Finkeldy cells
•Complications: croup, pneumonia, diarrhoea, protein-losing
enteropathy, blindness (from keratitis) encephalitis, haemorrhagic rash,
SSPE, measles inclusion body encephalitis
Example: Measles: Integration/Overlap with Microbiology, Immunology &
Pharmacology
•Acute viral infection
•Single-stranded RNA virus, paramyxovirus family, one serotype
•Vaccine-preventable ; epidemics in unvaccinated populations
•Mild, self-limited infections to severe systemic disease
•Antibody-mediated immunity protects against re-infection
•Transmitted by respiratory droplets
•Replicates in epithelial cells and leukocytes in respiratory tract and spreads to local
lymphoid tissues
•Viraemia and systemic dissemination to conjunctiva, skin, respiratory tract, urinary
tract, small blood vessels, lymphatic system, CNS
•Pathognomonic morphology: Koplik spots and Warthin-Finkeldy cells (Anat Path)
•Complications: croup, pneumonia, diarrhoea, protein-losing enteropathy, blindness
(from keratitis) encephalitis, haemorrhagic rash, SSPE,
measles inclusion body encephalitis
Infectious Diseases: Anatomical Pathology Approach
•Read everything in Robbins … sorry, its unavoidable
•Identify considerable overlap with Microbiology (including immunology)
and Pharmacology
•Integrated learning for overlapping information … killing two birds with
one stone
•Specific to Anatomical Pathology: Focus on morphological alterations
(gross and microscopic) in organs, tissues, cells … and how the
morphology relates to route, transmission, spread, presentation and
treatment of infection as well as remission/progression of disease and
possible complications
•Selection of infections to study: Sorry, no shortcuts … but ‘safe’ doctors
must know what’s common and what’s serious
Infectious Diseases: Viruses
Latent infections:
•Herpes simplex viruses
•Varicella-Zoster virus
•Cytomegalovirus
Consider organism, genetic diversity (if any), epidemiology, transmission,
route of entry, site of infection, spread, clinical presentation,
pathogenesis, immunology, diagnosis especially characteristic or
pathognomonic morphological alterations, treatment, complications and
outcomes
Infectious Diseases: Viruses
Chronic productive infections:
•Continued viral replication leads to persistent viraemia
•HIV
•Hepatitis B
Consider organism, genetic diversity (if any), epidemiology, transmission,
route of entry, site of infection, spread, clinical presentation,
pathogenesis, immunology, diagnosis especially characteristic or
pathognomonic morphological alterations, treatment, complications and
outcomes
Infectious Diseases: Viruses
Transforming viral infections:
•Oncogenic – transform infected cells into benign or malignant tumour
cells
•Ebstein-Barr virus
Consider organism, genetic diversity (if any), epidemiology, transmission,
route of entry, site of infection, spread, clinical presentation,
pathogenesis, immunology, diagnosis especially characteristic or
pathognomonic morphological alterations, treatment, complications and
outcomes
Infectious Diseases: Bacteria
•Gram-positive
•Gram-negative
•Mycobacteria
•Spirochaetes
•Anaerobic bacteria
•Obligate intracellular bacteria
Infectious Diseases: Bacteria
Gram-positive
• Staphylococcal infections
• Streptococcal and enterococcal infections
• Diphtheria
• Listeriosis
• Anthrax
• Nocardia
Consider organism, genetic diversity (if any), epidemiology, transmission,
route of entry, site of infection, spread, clinical presentation,
pathogenesis, immunology, diagnosis especially characteristic or
pathognomonic morphological alterations, treatment, complications and
outcomes
Infectious Diseases: Bacteria
Gram-negative
• Neisserial infections
• Pertussis
• Pseudomonas
• Plague
• Chancroid
• Granuloma inguinale
Consider organism, genetic diversity (if any), epidemiology, transmission,
route of entry, site of infection, spread, clinical presentation,
pathogenesis, immunology, diagnosis especially characteristic or
pathognomonic morphological alterations, treatment, complications and
outcomes
Infectious Diseases: Bacteria
Mycobacteria
•Tuberculosis
•Mycobacterium avium complex
•Leprosy
Consider organism, genetic diversity (if any), epidemiology, transmission,
route of entry, site of infection, spread, clinical presentation,
pathogenesis, immunology, diagnosis especially characteristic or
pathognomonic morphological alterations, treatment, complications and
outcomes
Infectious Diseases: Bacteria
Spirochaetes
•Syphilis
•Lyme disease
Consider organism, genetic diversity (if any), epidemiology, transmission,
route of entry, site of infection, spread, clinical presentation,
pathogenesis, immunology, diagnosis especially characteristic or
pathognomonic morphological alterations, treatment, complications and
outcomes
Infectious Diseases: Bacteria
Anaerobic bacteria
•Abscesses caused by anaerobes
•Clostridial infections
Consider organism, genetic diversity (if any), epidemiology, transmission,
route of entry, site of infection, spread, clinical presentation,
pathogenesis, immunology, diagnosis especially characteristic or
pathognomonic morphological alterations, treatment, complications and
outcomes
Infectious Diseases: Bacteria
Obligate intracellular bacteria
•Chlamydial infections
•Rickettsial infections
Consider organism, genetic diversity (if any), epidemiology, transmission,
route of entry, site of infection, spread, clinical presentation,
pathogenesis, immunology, diagnosis especially characteristic or
pathognomonic morphological alterations, treatment, complications and
outcomes
Infectious Diseases: Fungi
•Yeast
•Molds
•Dimorphic fungi
Infectious Diseases: Fungi
Yeast
•Candidiasis
•Cryptococcosis
Consider organism, genetic diversity (if any), epidemiology, transmission,
route of entry, site of infection, spread, clinical presentation,
pathogenesis, immunology, diagnosis especially characteristic or
pathognomonic morphological alterations, treatment, complications and
outcomes
Infectious Diseases: Fungi
Molds
•Aspergillosis
•Zygomycosis/Mucormycosis
Consider organism, genetic diversity (if any), epidemiology, transmission,
route of entry, site of infection, spread, clinical presentation,
pathogenesis, immunology, diagnosis especially characteristic or
pathognomonic morphological alterations, treatment, complications and
outcomes
Infectious Diseases: Fungi
Dimorphic fungi
•Histoplasmosis
•Coccidiomycosis
•Blastomycosis
Consider organism, genetic diversity (if any), epidemiology, transmission,
route of entry, site of infection, spread, clinical presentation,
pathogenesis, immunology, diagnosis especially characteristic or
pathognomonic morphological alterations, treatment, complications and
outcomes
Infectious Diseases: Parasites
•Protozoa
•Metazoa
Infectious Diseases: Parasites
Protozoa
•Malaria
•Babesiosis
•Leishmaniasis
•African trypanosomiasis
•Chagas disease
Consider organism, genetic diversity (if any), epidemiology, transmission,
route of entry, site of infection, spread, clinical presentation,
pathogenesis, immunology, diagnosis especially characteristic or
pathognomonic morphological alterations, treatment, complications and
outcomes
Infectious Diseases: Parasites
Metazoa
•Strongyloidiasis
•Tapeworms: Cysticercosis and Hydatid disease
•Schistosomiasis
•Lymphatic filariasis
•Onchocerciasis
Consider organism, genetic diversity (if any), epidemiology, transmission,
route of entry, site of infection, spread, clinical presentation,
pathogenesis, immunology, diagnosis especially characteristic or
pathognomonic morphological alterations, treatment, complications and
outcomes
Infectious Diseases: Emerging Infectious Diseases
•New pathogens
•Re-emergence of known infectious agents
•Immunosuppression
•Microbial adaptation and drug resistance
•Agents of bioterrorism
What must you know at this ‘age and stage’ of learning?
At the very least:
• General principles of infectious diseases … must know
• Classification of microbial organisms/diseases … must know
• Names of related organisms … must know
• Recognise that pathogenesis relates to clinical features and
morphology … the journey begins … will improve and develop further
• Familiarity with general and specific morphological alterations … the
journey begins … will improve and develop further
• Recognise overlap with microbiology (and pharmacology) … and start
to integrate
• General pathology permeates systemic pathology … will require
integration
• Know how and when to revisit this chapter
What have we learned?
• ‘Core’ knowledge is readily identified within the volume
• Summarising significantly reduces the volume
• However, the ‘need’ to know requires the ‘nice’ to know
• Look for patterns, similarities, differences and exceptions
• Organisation and integration reduces volume
• Initial selection: What is common or current or serious?
Going forward:
• You now have the ‘length & breadth’ and an approach to develop
‘depth’ in infectious diseases through integration
• Supplement the framework with schematics, figures and tables
• Practical sessions/application will require this background theoretical
knowledge
• Compare and correlate with Microbiology & Pharmacology
