Phagocytosis

Phagocytosis a process of engulfment of solid particulate material by the cells. There are two types of
phagocytic cells-polymorphonuclear neutrophils, also known asmicrophagesand monocytes, also known as
macrophages. Phagocytosis involvesthree distict steps are recognition and attachment, engulfment and killing.

Recogonition and attachment of the particle/microbe to be ingested by the leukocyte. Many microbes are coated
with naturally occurring factor in the serum called opsonins, which facilitate recognition by the phagocytic
cells. Opsonins are recognized by receptors on theleukocytes, and opsonization of the particles markedly
enhances the efficiency of phagocytosis.

Engulfment: The leukocytes/phagocytic cells extend pseudopods around the particle to be engulfed, and
subsequently form a phagocytic vacuole or phagosome. This is followed by fusion of the membrane of the
phagosome with that of the lysosome, leading to formation of a phagolysosome. The contents of the granules of
the polymorphonuclear cells are secreted into the phagolysosome.

Killing or degradation: This stage involves the killingof bacteria by a number of bactericidal mechanisms, like
oxygen dependent bactericidal mechanism, oxygen independent bactericidal mechanism and nitric oxide
mechanism. In all these processes there in production of reactive oxygen species, which can kill the bacteria
directly. The killed organisms are eventually degraded by hydrolases and other lysosomal enzyme.

Chemical mediators of inflammation:

The chemical mediators of the inflammation are either derived from the cells(cell derived) or from the plasma
(plasma derived).

Effects of acute inflammation:

Acute inflammation has local and systemic effects, which may be both beneficial and harmful.

Beneficial effects of inflammation:

 Dilution of toxins, such as those produced by bacteria and allows them to be carried away by lymphatics
thereby stimulating immune response.

 Entry of antibodies, due to increased vascular permeability.

 Transport of drugs such as antibiotics to the site where bacteria are multiplying.

 Fibrin formation from exuded fibrinogen, which serves as a matrix for granulation tissue formation.

 Delivery of nutrients and oxygen, which are essential for repair and healing, byincreased blood flow
through the area.

Harmful effects of inflammation:

 Digestion of normal tissues: Enzymes such as collagenases and proteases may digest normal tissues,
resulting in their destruction; for example, in type III hypersensitivity reactions, in some types of
glomerulonephritis and in abscess cavities.
  Swelling: The swelling of acutely inflamed tissues maybe harmful; for example the swelling of
epiglottis due to hemophilus influenza in children may obstruct the airway resulting in death. Acute
meningitis or cerebral abscess may raise the intracranial pressure to the point where blood flow in the
brain is impaired, resulting in ischemic damage to the brain.

 Inappropriate inflammatory response: Such as those which occur in type I hypersensitivity reactions
where the provoking environmental antigen otherwise poses no threat to the individual. Such allergic
inflammatory responses may be life-threatening, for example, extrinsic asthma.

Morphological forms of acute inflammation:

Acute inflammation may manifest in varied morphological forms. An inflamed organ is referred to by adding
the suffix ‘itis’ to its name; for example, acute appendicitis, acute salpingitis and acute pancreatitis. Few
morphological varieties of acute inflammation are as listed below;

1. Ulcer: It is a localized breach in the surface epithelium of an organ due to inflammation. Common sites
of ulceration are skin and mucosa of gastrointestinal tract. Initially there is vasodilation and infiltration
by polymorphs, which is later replaced by lymphocytes, plasma cells and macrophages and subsequently
heals by scarring.

2. Abscess formation: An abscess is formed when there is tissue necrosis due to intense neutrophilic
infiltration in the inflamed tissue. A cavity is formed, which is called abscess and contains purulent
exudates. This process of abscess formation is called suppuration.

3. Bacterial infection of blood: There are mainly three conditions-bacteremia wherein there is presence of
small number of bacteria in the blood, which do not multiply significantly, septicemia means presence
of highly pathogenic, rapidly multiplying bacteria in the blood stream, and pyemia refers to circulation
of minute septic thrombi in the blood, which lodge at distant sites and lead to development of septic
infarcts and pyemic abscesses.

4. Celllulitis: It is an inflammation of soft tissues caused by the release of substances like hyaluronidases
by the bacteria.

5. Pseudomembranous inflammation: It is an inflammatory response of mucosal surfaces. Due to

denudation of the epithelium, plasma usually exudes on the surface where it coagulates and forms a false
membrane together with the necrosed epithelium.