Pathogenesis and pathologic anatomy of tularemia

The causative agent of tularemia enters the body through the skin, mucous membranes of eyes, respiratory tract, gastrointestinal tract. Infection is possible through a small abrasions, cuts, scratches, and even in the absence of apparent violations intact skin. Lymphogenous by the pathogen enters the various bodies that generate inflammatory infiltrates (granulomas) and necrotic foci. Granuloma is in the centre of epithelioid cells, on the periphery of lymphocytes, eosinophils, polymorphonuclear leukocytes and plasma cells undergoing further degeneration, necrosis and disintegration.
Accordingly entrance gate appear on the skin quickly nanaimoin papules, which soon izyaslau (primary affect). Ulcers are brown bottom, infiltrated by leukocytes and epitelialna cells. Primary affect can be absent. Regional input to the place of the gate lymph nodes increase up to 5-7 cm (primary bubo), painful, in future they can nagnaivatsya and be opened through the skin. Microscopically in the lymph nodes - proliferation of lymphoid cells, reticuloendothelial, granulomas. In neracionalnim lymph nodes may also occur inflammatory process (secondary bubny), but without suppuration. When pulmonary form develop small - and krupnooptovye bilateral pneumonia.
In addition bronchial and tracheal other lymph nodes, marked the defeat of bronchi and lung parenchyma with granulomas, phenomena necrobiosis and cheesy rebirth. In the alveoli - serous-fibrinous exudate. Perhaps abstsedirovanie in the later stages. When abdominal form in the stomach and intestines are formed mesenteric bubny with focal necrosis and ulceration. In generalized (primarily septic) form of Bubnov not. Spleen considerably increased under her capsule foci of necrosis, pulp her cherry-red color. Granulomas are formed in the liver, myocardium, kidneys, and brain.