Makindo Medical Notes

Overview of Granulomatous Diseases

Granulomatous diseases are characterized by the formation of granulomas, which are small areas of inflammation caused by the collection of immune cells. Granulomas form as a protective response to foreign substances that the immune system is unable to eliminate. These diseases can be caused by infections, autoimmune conditions, and other inflammatory processes.

Characteristics of Granulomas

• Structure:
  • Granulomas are composed of macrophages, often surrounded by lymphocytes, and sometimes contain multinucleated giant cells.
  • Central necrosis can be seen in some granulomas, termed caseating granulomas, whereas non-caseating granulomas lack this central necrosis.
• Formation:
  • Granulomas form when the immune system attempts to isolate and contain foreign substances that it cannot eliminate.
  • This involves the aggregation of macrophages, which differentiate into epithelioid cells and sometimes fuse to form giant cells.

Common Granulomatous Diseases

• Tuberculosis:
  • Caused by Mycobacterium tuberculosis infection.
  • Characterized by caseating granulomas with central necrosis.
  • Common symptoms include chronic cough, fever, night sweats, and weight loss.
• Sarcoidosis:
  • An autoimmune disease characterized by non-caseating granulomas.
  • Commonly affects the lungs, lymph nodes, eyes, and skin.
  • Symptoms can vary widely but often include cough, shortness of breath, and skin lesions.
• Granulomatosis with Polyangiitis (GPA):
  • A type of vasculitis that causes granulomas and inflammation of blood vessels.
  • Commonly affects the respiratory tract and kidneys.
  • Symptoms include sinusitis, nosebleeds, cough, haematuria, and renal impairment.
• Leprosy:
  • Caused by Mycobacterium leprae infection.
  • Characterized by granulomas in the skin, nerves, and respiratory tract.
  • Symptoms include skin lesions, numbness, and muscle weakness.
• Histoplasmosis:
  • Caused by the fungus Histoplasma capsulatum.
  • Granulomas commonly form in the lungs and lymph nodes.
  • Symptoms can range from mild respiratory symptoms to severe disseminated disease.
• Cryptococcosis:
  • Caused by the fungus Cryptococcus neoformans.
  • Granulomas commonly form in the lungs and brain.
  • Symptoms include cough, chest pain, and in severe cases, meningitis.
• Cat-Scratch Disease:
  • Caused by Bartonella henselae infection.
  • Characterized by granulomas in the lymph nodes.
  • Symptoms include swollen lymph nodes, fever, and fatigue.

Diagnosis

• Clinical Evaluation:
  • Assessment of symptoms and medical history.
  • Physical examination, focusing on affected organs.
• Imaging Studies:
  • Chest X-rays or CT scans to detect granulomas in the lungs.
  • MRI or CT scans for detecting granulomas in other organs.
• Laboratory Tests:
  • Blood tests to check for signs of infection, inflammation, or autoimmune activity.
  • Specific tests for infections (e.g., TB skin test, serology for fungal infections).
• Biopsy:
  • Obtaining a tissue sample from the affected area for histological examination.
  • Identification of granulomas and determination of whether they are caseating or non-caseating.

Treatment

• Infectious Granulomatous Diseases:
  • Antibiotics or antifungal medications to treat underlying infections.
  • Long-term antibiotic therapy for tuberculosis and leprosy.
• Autoimmune Granulomatous Diseases:
  • Corticosteroids to reduce inflammation and suppress the immune response.
  • Immunosuppressive drugs for long-term management.
• Symptomatic Treatment:
  • Analgesics and anti-inflammatory drugs for pain and inflammation.
  • Supportive care for organ-specific symptoms (e.g., oxygen therapy for lung involvement).

Summary

Granulomatous diseases are characterized by the formation of granulomas, which are small areas of inflammation caused by the collection of immune cells. These diseases can be caused by infections, autoimmune conditions, and other inflammatory processes. Common granulomatous diseases include tuberculosis, sarcoidosis, granulomatosis with polyangiitis, leprosy, histoplasmosis, cryptococcosis, and cat-scratch disease. Diagnosis involves clinical evaluation, imaging studies, laboratory tests, and biopsy. Treatment depends on the underlying cause and may include antibiotics, antifungal medications, corticosteroids, and immunosuppressive drugs.