Anton Ghon and His Colleagues and Their Studies of the Primary Focus and Complex of Tuberculosis Infection and Their Relevance for the Twenty-First Century

Abstract

Anton Ghon is well known in the field of childhood tuberculosis, and the tuberculosis primary focus and complex are frequently called the Ghon focus and complex; this is largely the result of the wide publication of the English translation of his monograph <b>“</b>Der primäre Lungenherd bei der Tuberkulose der Kinder.” Ghon’s studies are frequently quoted, but precise details of his monograph are neglected, his results often misquoted, and his later publications virtually unknown. This review highlights aspects of Ghon’s anatomical pathology studies in children and adults not necessarily dying of tuberculosis but with signs of tuberculosis infection. Ghon found a single primary tuberculosis focus in approximately 80% of tuberculosis-infected children situated close to the pleura in two-thirds of cases. Cavitation of the focus was common, and lymphatic spread involved lymph nodes in the abdomen and neck in many children. Studies amongst adults and children frequently found the healed primary tuberculosis focus to be completely calcified without histological signs of tuberculosis activity; however, particularly in the presence of pulmonary tuberculosis, histological signs of tuberculosis activity were often found in the lymph nodes of the angulus venosus, despite apparent healing with extensive calcification. Both earlier studies and more recent investigations, with molecular biological tools, unavailable to Ghon and earlier researchers, have confirmed the presence of viable mycobacteria in apparently normal or healed thoracic nodes and also found molecular biological indications of viable mycobacteria in these nodes. As suggested by Ghon, lympho-haematogenous spread of tuberculosis may be more common than is usually appreciated.

Comparative pathology of experimental pulmonary tuberculosis in animal models

“…Regardless of the species, the lung granuloma is the hallmark of pulmonary tuberculosis ( 9 ). Its first description was made by Anton Ghon, an Austrian pathologist, who made significant contributions to the understanding of primary TB and its anatomical pathology in humans ( 10 , 11 ). It is known that Mtb infects alveolar macrophages, which release multiple cytokines to recruit additional macrophages, dendritic cells, and lymphocytes, leading to the formation of an early granuloma ( 9 ).…”

Serum Protein Electrophoresis Bands As Biomarkers for Drug-Sensitive Pulmonary Tuberculosis

“…A positive immune response can stop bacilli multiplication. If the tuberculin skin test is positive, it indicates there is an infection [ 7 ]. In some cases, as their immune response is decreased, the bacilli multiply and manifestations of disease occur in a few months.…”

Tuberculosis: The Past, the Present and the Future

“…In the next issues of Respiration , we shall return to the roots of the journal and highlight the topic of tuberculosis in a thematic review series, from the Ghon focus and its relevance today all the way to novel developments into the diagnosis and management of the disease [13]. Furthermore, we will put the very under-recognised entity of post-tuberculosis lung disease (PTLD) in the spotlight [14].…”

“…In the first review in the series, Peter Donald et al [13] critically review the work of Anton Ghon and how it aided our understanding of the disease. His ground-breaking publication, “The Primary Lung Focus of Tuberculosis in Children,” is still often referenced but not infrequently misquoted [15].…”

“…The work of Ghon and his contemporaries has aided us in understanding primary pulmonary tuberculosis, particularly its primary, often subpleural foci and the subsequent lympho-haematogenous spread. Many of the theories proposed by Ghon solely based on pathological observations were ultimately proved to be correct using modern molecular and imaging techniques [13].…”