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Features of the development of the inflammatory reaction, depending on the localization of inflammation, the reactivity of the organism, the nature of the etiological factor. The role of age in the development of inflammation

Regardless of the localization of the inflammatory process and the origin of the etiological factor, a standard complex of vascular and tissue changes always occurs in the zone of acute inflammation. The reaction of the tissues to the action of the damaging factor is of a phasic nature and is manifested by alteration, exudation and proliferation. Simultaneously with tissue disorders, a complex of vascular changes occurs in the form of short-term spasm, arterial, venous hyperemia and stasis.

The intensity of the development of certain phases of vascular and tissue changes to a certain extent depends on the reactivity of the organism and the localization of the inflammatory process.

In the case of a normal reactivity of the organism, a normergic inflammatory reaction occurs, characterized by the adequacy of the intensity of the development of inflammation to the strength of the altering factor.

In the case of reduced reactivity (children of the first years of life, the elderly, persons weakened by previous diseases), a hypoergic inflammatory reaction occurs when, against the background of an intense altering effect, there is a slight inflammation.

In persons with increased or qualitatively altered immunological reactivity, the development of violent hyperergic inflammatory reactions in response to the action of a weaker alterating factor.

Regarding the peculiarities of the development of the inflammatory process depending on its localization in various tissues, it should be noted that alterative inflammation is characterized by a predominance of dystrophic and necrotic shifts and is most often observed in parenchymal organs (myocardium, liver, kidneys, skeletal muscle). Exudative inflammation is characterized by the predominance of the reaction of the microcirculation system, mainly of its venular part, over the processes of alteration and proliferation. At the same time, intensive exudation of plasma, its soluble low molecular weight components, as well as leukocyte emigration, exudative inflammation often develops in serous cavities in cases of pleurisy, pericarditis, arthritis, etc., less frequently in parenchymal organs.

Proliferative or productive inflammation is characterized by the predominance of the reproduction of the cellular elements of the affected tissue, as well as intensive micro-or macrophage lymphocytic infiltration of an organ or tissue. The productive inflammation proceeds, as a rule, is long and has chronic character. However, in some cases it can be acute, for example granulomatous inflammation in typhoid and typhus, vasculitis of various etiologies.

Productive inflammation may be of a "specific" and "non-specific" nature. With the so-called specific productive inflammation, the cellular composition of the exudate, the cycle and duration of the process are determined by the characteristics of the biological properties of the pathogen. Specific inflammation for the most part has the character of the so-called infectious granuloma-nodules, consisting of elements of granulation tissue.

Inflammation as a standard non-specific complex of vascular and tissue changes begins to gradually form in the embryonic period.

And in the early stages of embryogenesis, inflammation as a typical pathological process does not yet develop. During the formation of the blastula, embryo and trophoblast, the action of exogenous stimuli of an infectious nature either results in the death of the embryo or partial damage to these structures. Moreover, in case of continuation of the development of the embryo, multiple congenital malformations of both the embryo itself and its provisional organs may occur (V.V. Serov, V.S.Paukova, 1995). In 1951, Greg syndrome was described due to the development of measles rubella in pregnant women, especially in the first trimester of pregnancy.

At the same time, there are multiple congenital malformations of the organs of ectodermal histogenesis (eye germs, organs of hearing, brain) and mesodermal origin (heart, kidneys and other organs).

The productive component of the inflammatory response, especially from the mesenchymal elements of the hematopoietic and stromal series, begins to form at the end of embryogenesis and in the early period of fetogenesis, when further differentiation of organ tissues occurs. Exposure to infectious pathogens on fruit maternal organism and results during this period the formation of so-called mezenhimatozov a myeloid tissue proliferation, diffuse liver fibrosis, spleen and congenital syphilis, fibroelastosis myocardial fibrosis, pancreatic stromal in conjunction with the growth of adipose tissue.

In the late fetal period, corresponding to 28 weeks of pregnancy, when the formation of most fetal organs is completed, inflammation is characterized not only by an alterative-proliferative nature, but also by the addition of a microcirculatory reaction.

A characteristic feature of the inflammatory process in the fetal period is the lack of effective local protection mechanisms that ensure the formation of barriers, and therefore there is a rapid generalization of infection and areactive necrosis in various organs and mucous membranes with the development of multiple mucosal erosions. The formation of extensive necrosis followed by the occurrence of diffuse gliosis in the brain is noted when the fetus is infected with the herpes virus type 2, and when the toxoplasmosis occurs, numerous cysts containing granular balls and pseudocysts appear in the brain.

At the same time, these infections show signs of generalization of the process in the form of foci of necrosis in parenchymal organs.

Infection of the fetus is often characterized by the formation of granulomas, which, as a rule, are not of a “specific” character (V.S. Serov, V.S. Paukova, 1995).

In congenital tuberculosis, granulomas do not contain typical Langhans cells and epithelioid cells; they are characterized by intense caseous disintegration; on the periphery of the granulomas, myelocytic and monocytic barriers are formed. In congenital syphilis, the development of mesenchymatosis is combined with the formation of miliary granulomas, devoid of giant and plasma cells.

Thus, the inflammatory reaction begins to form in the early fetal period in the form of so-called "proliferative" mesenchymatosis in combination with congenital malformations.

In the late fetal period, alterative-proliferative changes prevail in the zone of inflammation, there are foci of necrosis, granulomas are formed, containing significant amounts of pathogens. However, during this period of fetal development, specific immunological defense mechanisms and local resistance mechanisms have not yet been sufficiently formed. Phagocytosis is incomplete, and therefore the zone of inflammation does not perform the barrier function, does not ensure the elimination of the pathogen, which leads to rapid generalization of the infection, the development of multiple foci of necrosis in various organs and tissues (Gurevich PS, Barsukov VS, 1982).

Regarding the peculiarities of the development of inflammation in newborns, a unique nosological form of pathology, the so-called newborn phlegmon, should be noted. The disease is induced by streptococcal and staphylococcal microflora, children of the first month of life are ill. The process is localized in the lumbar, sacral areas, on the chest, back, in the axillary and occipital areas.

Inflammation begins in the depths of the dermis, around the sweat glands and then goes to the surrounding tissues. A rapidly spreading area of ​​hyperemia occurs on the skin, which soon becomes a bluish tinge, the epidermis peels off for a considerable distance and undergoes necrosis. The inflammatory reaction is necrotic in nature, necrosis spreads to the muscle tissue, and then to the periosteum and bone tissue. There is a slight leukocyte infiltration of tissues, purulent exudate is absent.

In children of the first 2-3 months of life, there is a lack of phagocytosis due to the immaturity of the receptor apparatus of phagocytic membranes, the lack of a sufficient number of opsonins and chemoattractants, which are, in particular, complement and immunoglobulins. In this regard, neutrophilic and monocytic barriers are not formed, ensuring the elimination of infectious pathogens due to the processes of killing and digestion in phagolysosomes, in contrast to such barriers in an adult.

In children of the first months of life, synthesis of plasma coagulation factors in the liver is insufficient, anticoagulant mechanisms predominate, therefore the effects of thrombosis in blood vessels and, accordingly, fixation of the pathogenic agent in the zone of its inoculation do not occur.

Thus, the peculiarities of the inflammatory process in children during the first months of life, mainly in preterm infants, are the tendency to generalize the process due to the lack of local protection mechanisms, the prevalence of alternative and productive components of inflammation, insufficient exudation processes and related protection mechanisms.

The insufficiency of the formation of local defense mechanisms, the tendency to generalize the infection, the development of a septic state during the development of inflammation may persist during the first years of life.

In the adolescent period, characterized by the change of milk teeth to permanent ones, certain changes in the immune and hormonal status of the child occur, which leads to the development of hyperergic inflammatory reactions such as urticaria, Quincke edema, bronchial asthma, etc.

In the pubertal period of the restructuring of the nervous, endocrine, immune systems of the body, often the area of ​​inflammation also does not adequately fulfill its barrier function, which leads to an increase in the development of diseases of an infectious-allergic or autoimmune nature.

In the elderly and senile age, all spheres of human activity are gradually suppressed, atrophic, dystrophic and sclerotic processes in internal organs predominate, immunological defense mechanisms and nonspecific resistance are reduced. Thus, in elderly and senile people, there is a deficiency of opsonizing factors, the migration capacity of neutrophils is suppressed, and their bactericidal activity is associated with age-related insufficiency of enzymatic systems. The decrease in phagocytic activity for the same reasons is peculiar to the mononuclear phagocytic system.

The lack of phagocytosis is the cause of long-term persistence in the body of viral and bacterial antigens, immune complexes, which causes a long course of the inflammatory process, often acquiring an immunocomplex nature.

With age, there is a decrease in the level of T-lymphocytes in the blood, the ability of T-lymphocytes to further differentiate into immune regulatory and killer cells against antigenic stimulation decreases, the reception of interleukins, providing intercellular interaction, is impaired, the production of interleukin-2, i.e. there are characteristic features of the development of immunodeficiency states and the resulting lack of defense mechanisms in the zone of the inflammatory process of an infectious nature.
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Features of the development of the inflammatory reaction, depending on the localization of inflammation, the reactivity of the organism, the nature of the etiological factor. The role of age in the development of inflammation

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