|Year : 2016 | Volume
| Issue : 2 | Page : 287-289
Eponyms in Tuberculosis
Prema Saldanha1, Julian Saldanha2
1 Department of Pathology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India
2 Surgeon and Resident Medical Officer, Department of Internal Medicine, Government Wenlock District Hospital, Mangalore, Karnataka, India
|Date of Web Publication||20-Dec-2016|
Department of Pathology, Yenepoya Medical College, Deralakatte, Mangalore - 575 018, Karnataka
Source of Support: None, Conflict of Interest: None
Tuberculosis is an ancient disease which has been extensively studied by various scientists. Many have the tuberculous lesions named after them for which they will be remembered forever. This article gives details of the contributions of these scientists who we should never forget.
Keywords: Eponyms, Robert Koch, tuberculosis
|How to cite this article:|
Saldanha P, Saldanha J. Eponyms in Tuberculosis. Arch Med Health Sci 2016;4:287-9
Tuberculosis (TB) is an infectious disease which has been present in human beings since antiquity. It is a chronic and long drawn-out complicated infection. Several medical scientists have contributed greatly to the understanding of this disease and their names have become immortalized in the history of medicine.
The bacillus causing TB, Mycobacterium tuberculosis (MTB), was identified and described on 24 March 1882 by Robert Heinrich Herman Koch. He was a German physician and pioneering microbiologist. As the founder of modern bacteriology, he is known for his role in identifying the specific causative agents of TB, cholera, and anthrax and for giving experimental support for the concept of infectious disease (Koch postulates). He received the Nobel Prize in Physiology/Medicine in 1905 for the discovery of MTB, which is also known as “Koch's bacillus.” He is also known for the Koch phenomenon/reaction described below. He has been acclaimed as the “Father of the scientific study of TB.”
TB is spread by inhalation and generally affects the lungs (pulmonary TB), but can also affect other parts of the body (extrapulmonary TB), which may coexist with pulmonary TB. The primary site of infection in the lungs, generally located in either the upper part of the lower lobe, or the lower part of the upper lobe of the lung is known as the “Ghon focus.” Anton Ghon was an Austrian pathologist. Ghon was a specialist in the field of bacteriology, and it is remembered for his work with meningitis and TB. His name is lent to Ghon focus/Ghon lesion, which is a primary infection associated with TB, as well as the Ghon's complex, which includes the Ghon focus and the surrounding lymph nodes with the draining lymphatics.,,,,
When a Ghon's complex undergoes fibrosis and calcification, it is called a Ranke complex.,,, Karl Ernst Ranke was a German internist, pediatrician, and pulmonologist known for his research of TB. He is remembered for introducing the hypothesis that lung TB develops in three stages – referred to as Ranke Dreistadienlehre (also known as “Ranke's stages of TB”). This historical classification of TB was by clinical and pathological aspects and with respect to the immunological reaction – (i) primary complex; (ii) generalization by hematogenous spread (stage of allergy); (iii) isolated organ TB (necrotizing/fibrosing) with tendency to spread (stage of relative immunity). His name is also associated with the so-called “Ranke complex.”
Hematogenous spread to apex of upper lobe resulting in a post primary infective lesion which heals with scarring is known as “Simon's focus.”,, The lesion is subpleural and appears as a fibronodular patch or ill-defined reticular shadow in the upper lung fields on chest X-ray. The focus is named after Georg Simon, a German pediatrician.
Simon foci may become reactivated and develop into Assman (Assmann) foci/centers. The term Assman focus is particularly used for infraclavicular foci/infiltrates. The term Assman center is no longer used. It is named after Herbert Assmann, a German internist. His work concerns roentgen diagnostics, research on TB, diseases of the joints, and various other fields in internal medicine, including neurology.
“Puhl's lesion/nodule” is the term for isolated lesion of chronic pulmonary TB in the apex of the lung. The lesion is also referred to as “ Aschoff-Puhl reinfection More Details or exogenous reinfection.” Hugo Puhl, a German pathologist worked with Karl Albert Ludwig Aschoff. Aschoff made important studies on appendicitis, gallstones, jaundice, scurvy, and thrombosis, and wrote classical histological descriptions of rheumatic conditions. He is particularly remembered for recognizing the phagocytic activity of cells found in diverse tissues and named them the reticuloendothelial system.
A caseating metastatic focus in the wall of a pulmonary vein (subintimal location) is called the “Weigert focus.” Carl/Karl Weigert was a German pathologist who assisted Cohnheim in many of his researches. He is credited with the discovery of vascular TB and was the first to demonstrate how tuberculous material could enter the bloodstream.
Rasmussen's aneurysm is a pulmonary artery aneurysm adjacent to or within a tuberculous cavity. It occurs in up to 5% of patients with such lesions. It may lead to rupture and hemorrhage causing hemoptysis. It is named after Fritz Valdemar Rasmussen.
The hematogenous transmission can also spread infection to more distant sites, such as peripheral lymph nodes, the kidneys, the brain, bones, liver, and blood vessels. All parts of the body can be affected by the disease, though for unknown reasons, it rarely affects the heart, skeletal muscles, pancreas, or thyroid.
A “Rich focus” is a tuberculous granuloma occurring on the cortex of the brain that ruptures into the subarachnoid space, causing tuberculous meningitis. Arnold Rice Rich was an American pathologist. Rich had broad interests in medicine. Among his many contributions, he classified jaundice, helped understand the formation of bile pigment, studied the relationship between hypersensitivity and immunity, especially in TB and discovered the phagocytic function of the Gaucher cell, the hallmark of Gaucher's disease. The other condition named after Rich is the Hamman–Rich syndrome.
The “Simmond's focus” is seen in the liver. Morris Simmonds was a physician, but his chief interest was pathology and he worked under the pathologist Arnold Ludwig Gotthilf Heller. Simmonds special fields of interest were the male genital apparatus and the endocrine glands. Simmonds was a collaborator in Karl Albert Ludwig Aschoff's textbook “Pathologische Anatomie.”
Arthritic TB of the spine is known as Pott's disease, Pott's syndrome, Pott's caries, Pott's curvature, David's disease. Pott's disease is named after Sir Percivall Pott  who was a surgeon in London. He was also the first scientist to demonstrate that a cancer may be caused by an environmental carcinogen. TB of the spine had previously been known to the ancients and Hippocrates had described it. It was also described by the French physician Jean Pierre David.
Histologically, TB is characterized by the presence of caseous necrosis and granulomata composed of epithelioid histiocytes and multinucleated giant cells called Langhans giant cells  (also known as Pirogov-Langhans cells). Langhans giant cells are named after Theodor Langhans, a German pathologist. Langhans was a professor of pathological anatomy at the University of Bern. Nikolay Ivanovich Pirogov (Pirogoff) was a prominent Russian scientist, medical doctor, pedagogue, public figure, and it is considered to be the founder of field of surgery. Apart from his developed foot amputation techniques, several anatomical structures are named after him, such as the Pirogoff angle, the Pirogoff aponeurosis, and the Pirogoff triangle.
The high lipid content of MTB accounts for its unique staining characteristics. Using histological stains on tuberculous samples, one can identify MTB under a microscope. Since MTB retains certain stains even after being treated with acidic solution, it is classified as an acid-fast bacillus. The most common acid-fast staining techniques are the Ziehl–Neelsen stain and the Kinyoun stain, which dye acid-fast bacilli a bright red that stands out against a blue background. Auramine-rhodamine staining with fluorescence microscopy is also used. The Ziehl–Neelsen stain, also known as the acid-fast stain, was first described by two German doctors: The bacteriologist Franz Ziehl  and the pathologist Friedrich Carl Adolf Neelsen. Joseph James Kinyoun was founder and first director of the United States' Hygienic Laboratory, the predecessor of the National Institutes of Health. He is best known now for the dissemination of the Kinyoun modification of the Ziehl-Neelsen stain for Acid-fast bacteria.
The Mantoux test or Mendel-Mantoux test (also known as the Pirquet test) is a screening tool for TB. The tuberculin reaction was first described by Robert Koch. The test was first developed and described by the German physician Felix Mendel. It is named after Charles Mantoux, a French physician, who built on the work of Koch and Clemens Peter Freiherr von Pirquet. Pirquet was an Austrian scientist and pediatrician best known for his contributions to the fields of bacteriology and immunology.
The French physician and bacteriologist, Léon Charles Albert Calmette  and the French veterinarian, Jean-Marie Camille Guérin  worked together at the Pasteur Institute and achieved the first genuine success in immunization against TB in 1906, using attenuated bovine-strain TB. It was called Bacilli Calmette–Guérin (BCG) vaccine and was first used on humans in 1921 in France.
Thus, this chronic disease has been studied extensively over the years with a lot of advancement in the understanding of the disease. It is apt to pay our respects to the stalwarts in this field.
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