Chest x-ray of Ghon's complex of active tuberculosis

Ghon's complex is a

lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classif ...

seen in the

lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of ...

that is caused by

tuberculosis Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, ...

. The lesions consist of a

Ghon focus A Ghon focus is a primary lesion usually subpleural, often in the mid to lower zones, caused by ''Mycobacterium'' bacilli (tuberculosis) developed in the lung of a nonimmune host (usually a child). It is named for Anton Ghon (1866–1936), an Au ...

along with pulmonary

lymphadenopathy Lymphadenopathy or adenopathy is a disease of the lymph nodes, in which they are abnormal in size or consistency. Lymphadenopathy of an inflammatory type (the most common type) is lymphadenitis, producing swollen or enlarged lymph nodes. In cl ...

within a nearby pulmonary

lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that includ ...

. A Ghons complex retains viable

bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were am ...

, making them sources of long-term

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...

, which may reactivate and trigger secondary tuberculosis later in life. In countries where cow

milk Milk is a white liquid food produced by the mammary glands of mammals. It is the primary source of nutrition for young mammals (including breastfed human infants) before they are able to digest solid food. Immune factors and immune-modulat ...

infected with ''

Mycobacterium bovis ''Mycobacterium bovis'' is a slow-growing (16- to 20-hour generation time) aerobic bacterium and the causative agent of tuberculosis in cattle (known as bovine TB). It is related to ''Mycobacterium tuberculosis'', the bacterium which causes tub ...

'' has been eliminated (due to culling of infected cows and

pasteurization Pasteurization or pasteurisation is a process of food preservation in which packaged and non-packaged foods (such as milk and fruit juices) are treated with mild heat, usually to less than , to eliminate pathogens and extend shelf life. ...

), primary tuberculosis is usually caused by ''

Mycobacterium tuberculosis ''Mycobacterium tuberculosis'' (M. tb) is a species of pathogenic bacteria in the family Mycobacteriaceae and the causative agent of tuberculosis. First discovered in 1882 by Robert Koch, ''M. tuberculosis'' has an unusual, waxy coating on it ...

'' and almost always begins in the lungs. Typically, the inhaled

bacilli Bacilli is a taxonomic class of bacteria that includes two orders, Bacillales and Lactobacillales, which contain several well-known pathogens such as ''Bacillus anthracis'' (the cause of anthrax). ''Bacilli'' are almost exclusively gram-positi ...

implant in the distal airspaces of the lower part of the upper lobe or the upper part of the lower lobe, usually close to the

pleura The pulmonary pleurae (''sing.'' pleura) are the two opposing layers of serous membrane overlying the lungs and the inside of the surrounding chest walls. The inner pleura, called the visceral pleura, covers the surface of each lung and dips b ...

. As sensitization develops, a 1 to 1.5 cm area of gray-white

inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...

with consolidation emerges, known as the

. In most cases, the center of this focus undergoes

caseous necrosis Caseous necrosis or caseous degeneration () is a unique form of cell death in which the tissue maintains a cheese-like appearance.Robbins and Cotran: Pathologic Basis of Disease, 8th Ed. 2010. Pg. 16 It is also a distinctive form of coagulative nec ...

Tubercle In anatomy, a tubercle (literally 'small tuber', Latin for 'lump') is any round nodule, small eminence, or warty outgrowth found on external or internal organs of a plant or an animal. In plants A tubercle is generally a wart-like projection ...

bacilli, either free or within

phagocyte Phagocytes are cells that protect the body by ingesting harmful foreign particles, bacteria, and dead or dying cells. Their name comes from the Greek ', "to eat" or "devour", and "-cyte", the suffix in biology denoting "cell", from the Greek ...

s, drain to the regional nodes, which also often caseate. This combination of

parenchymal lung lesion Parenchyma () is the bulk of functional substance in an animal organ or structure such as a tumour. In zoology it is the name for the tissue that fills the interior of flatworms. Etymology The term ''parenchyma'' is New Latin from the word π ...

and

nodal involvement Nodal homolog is a secretory protein that in humans is encoded by the ''NODAL'' gene which is located on chromosome 10q22.1. It belongs to the transforming growth factor beta superfamily (TGF-β superfamily). Like many other members of this super ...

is referred to as the Ghon complex. During the first few weeks, there is also lymphatic and

hematogenous dissemination Bloodstream infections (BSIs), which include bacteremias when the infections are bacterial and fungemias when the infections are fungal, are infections present in the blood. Blood is normally a sterile environment, so the detection of microbe ...

to other parts of the body. In approximately 95% of cases, development of

cell-mediated immunity Cell-mediated immunity or cellular immunity is an immune response that does not involve antibodies. Rather, cell-mediated immunity is the activation of phagocytes, antigen-specific cytotoxic T-lymphocytes, and the release of various cytokines ...

controls the infection.

Differentiation

The Ghon complex undergoes progressive

fibrosis Fibrosis, also known as fibrotic scarring, is a pathological wound healing in which connective tissue replaces normal parenchymal tissue to the extent that it goes unchecked, leading to considerable tissue remodelling and the formation of perma ...

, often followed by radiologically detectable

calcification Calcification is the accumulation of calcium salts in a body tissue. It normally occurs in the formation of bone, but calcium can be deposited abnormally in soft tissue,Miller, J. D. Cardiovascular calcification: Orbicular origins. ''Nature M ...

(Ranke complex), and despite seeding of other organs, no lesions develop. Although they are often confused, Ranke complex and Ghon complex are not synonymous. The Ranke complex is an evolution of the Ghon complex (resulting from further healing and calcification of the lesion). The Ghon complex is named after Austrian pathologist

Anton Ghon Anton Ghon (1 January 1866 – 23 April 1936) was an Austrian pathologist and bacteriologist. He is best known for his research on tuberculosis (Ghon's complex). Biography Ghon was born on January 1, 1866, in Villach. From 1884 to 1890, Ghon ...

; the Ranke complex is named in honour of German pulmonologist

Karl Ernst Ranke Karl Ernst Ranke (29 January 1870 in Munich – 9 November 1926 in Munich) was a German internist, pediatrician and pulmonologist known for his research of tuberculosis. He was the son of anthropologist Johannes Ranke (1836–1916). In 1896 h ...

.Ghon's primary lesion
at

Who Named It ''Whonamedit?'' is an online English-language dictionary of medical eponyms and the people associated with their identification. Though it is a dictionary, many eponyms and persons are presented in extensive articles with comprehensive bibliograp ...

References

{{Gram-positive actinobacteria diseases Gross pathology Lung disorders Tuberculosis