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Journal ArticleDOI

Skin tuberculosis as seen at Ga‐Rankuwa Hospital

01 Nov 1993-Clinical and Experimental Dermatology (Clin Exp Dermatol)-Vol. 18, Iss: 6, pp 507-515
TL;DR: The experience with cutaneous tuberculosis at Ga‐Rankuwa Hospital is reviewed, with a total of 92 cases of skin tuberculosis seen over the past 12 years, with Lupus vulgaris was the most common true infection and papulonecrotic tuberculid the mostCommon tuberculids.
Abstract: The experience with cutaneous tuberculosis at Ga-Rankuwa Hospital is reviewed. A total of 92 cases of skin tuberculosis was seen over the past 12 years. All recognized forms of cutaneous tuberculosis were encountered, plus some forms which were difficult to classify. Lupus vulgaris was the most common true infection and papulonecrotic tuberculid the most common tuberculid. The classification and pathogenetic mechanisms are briefly discussed.
Citations
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Journal ArticleDOI
TL;DR: Diagnosis of cutaneous tuberculosis is challenging and requires the correlation of clinical findings with diagnostic testing; in addition to traditional AFB smears and cultures, there has been increased utilization of PCR because of its rapidity, sensitivity and specificity.
Abstract: As we move into the 21st century, cutaneous tuberculosis has re-emerged in areas with a high incidence of HIV infection and multi-drug resistant pulmonary tuberculosis. Mycobacterium tuberculosis, Mycobacterium bovis, and the BCG vaccine cause tuberculosis involving the skin. True cutaneous tuberculosis lesions can be acquired either exogenously or endogenously, show a wide spectrum of morphology and M. tuberculosis can be diagnosed by acid-fast bacilli (AFB) stains, culture or polymerase chain reaction (PCR). These lesions include tuberculous chancre, tuberculosis verrucosa cutis, lupus vulgaris, scrofuloderma, orificial tuberculosis, miliary tuberculosis, metastatic tuberculosis abscess and most cases of papulonecrotic tuberculid. The tuberculids, like cutaneous tuberculosis, show a wide spectrum of morphology but M. tuberculosis is not identified by AFB stains, culture or PCR. These lesions include lichen scrofulosorum, nodular tuberculid, most cases of nodular granulomatous phlebitis, most cases of erythema induratum of Bazin and some cases of papulonecrotic tuberculid. Diagnosis of cutaneous tuberculosis is challenging and requires the correlation of clinical findings with diagnostic testing; in addition to traditional AFB smears and cultures, there has been increased utilization of PCR because of its rapidity, sensitivity and specificity. Since most cases of cutaneous tuberculosis are a manifestation of systemic involvement, and the bacillary load in cutaneous tuberculosis is usually less than in pulmonary tuberculosis, treatment regimens are similar to that of tuberculosis in general. In the immunocompromised, such as an HIV infected patient with disseminated miliary tuberculosis, rapid diagnosis and prompt initiation of treatment are paramount. Unfortunately, despite even the most aggressive efforts, the prognosis in these individuals is poor when multi-drug resistant mycobacterium are present. An increased awareness of the re-emergence of cutaneous tuberculosis will allow for the proper diagnosis and management of this increasingly common skin disorder.

224 citations

Journal ArticleDOI
TL;DR: Sixty‐three children out of a total of 199 patients seen with cutaneous tuberculosis during a 7‐year period were included in this study, and no difference in clinical presentation could be detected between the BCG vaccinated and unvaccinated children.
Abstract: Sixty-three children out of a total of 199 patients seen with cutaneous tuberculosis during a 7-year period were included in this study. Culture was positive in only four, and the diagnosis was based on clinical examination, tuberculin reaction, histopathology, and response to antitubercular therapy. Forty had lupus vulgaris (LV) and 23 scrofuloderma (SD). The lower half of the body was predominantly affected in those with LV, and keratotic and hypertrophic forms were frequently encountered. LV planus mainly affected the face. Ulcerative and atrophic types of LV were infrequent. Extensive lesions in three children led to disfiguring scars and contractures. Scrofuloderma often involved the cervical group of lymph nodes followed by the inguinal, submandibular, and axillary groups. As compared to skin tuberculosis in adults, regional lymph node involvement in LV was more common, and a combination of both LV and SD was less frequent in children. No difference in clinical presentation could be detected between the BCG vaccinated and unvaccinated children. Tuberculous infection either in the lungs or the bones was present in eight children. An HIV test done in five patients with widespread lesions was negative. Irregular therapy or late diagnosis leading to serious complications, inadequate parental or community support, and lack of awareness among practitioners are the problems to be remedied.

89 citations


Cites background or result from "Skin tuberculosis as seen at Ga‐Ran..."

  • ...More than one form of skin tuberculosis can affect a patient (4,14,26)....

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  • ...The former may present as a chancre due to exogenous infection in children exposed to tubercle bacilli for the first time (26,31) or as noduloulcerative lesions secondary to BCG inoculation in infants (32,33)....

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  • ...A larger number of children were seen in the younger age groups, as in another hospital-based study (26)....

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Journal ArticleDOI
TL;DR: The high incidence of tuberculosis in Blackburn is mainly linked to its significant proportion of residents of ISC ethnic origin and there were no cases of HIV infection coexisting with either cutaneous or other forms of tuberculosis.
Abstract: Summary Data collected prospectively on all 1065 cases of tuberculosis occurring in the Blackburn district, U.K. (population 265.000), over a 15-year period have been analysed, and from these 47 cases of cutaneous tuberculosis have been identified. The most common form was scrofuloderma, skin involvement with adjacent structural disease, of which there were 2b cases (55. 3%). There was no ethnic bias in this group. The eight white patients with scrofuloderma were of average age 66 years, and are thought to represent reactivation disease.Six palients (12.8%) had lupus vulgaris, four (8.5%) had metastatic tuberculosis and 10 (21.3%) were diagnosed as having one of the tuberculides, of which Bazin's disease (erythema induratum) was the most common. In addition, one patient (2.2%) had orificial tuberculosis. In contrast to scrofuloderma. all other forms of cutaneous tuberculosis occurred almost exclusively in patients from the Indian Subcontinent (ISC).The high incidence of tuberculosis in Blackburn is mainly linked to its significant proportion of residents of ISC ethnic origin. There were no cases of HIV infection coexisting with either cutaneous or other forms of tuberculosis. Recommendations for the treatment of cutaneous tuberculosis are made.

79 citations

Journal ArticleDOI
TL;DR: The presence of primary vasculitis and granulomas suggests that types III and IV hypersensitivity reactions play a role in the pathogenesis or erythema induratum of Bazin.
Abstract: Erythema induratum of Bazin is a tuberculid that is strongly associated with tuberculosis. Clinically, erythema induratum of Bazin show recurrent tender subcutaneous nodules that occur mainly on the calves of women with tuberculin hypersensitivity. Previous studies have not documented the histopathologic spectrum of erythema induratum of Bazin in detail. We identified two major histopathologic groups in 19 of 20 skin biopsies obtained from 20 patients with well-documented erythema induratum of Bazin. Six cases (group I) showed focal septolobular panniculitis in close association with a single muscular artery or small vessel with primary neutrophilic vasculitis. Thirteen cases (group II) revealed diffuse septolobular panniculitis with primary neutrophilic vasculitis of either large or smaller vessels. Both groups showed varying combinations and degrees of acute and chronic inflammation, coagulative and caseation-like necrosis, and granulomatous inflammation. Poorly developed granulomas predominated, but mixed, palisading, and lipophagic granulomas also occurred. Inflammation and necrosis were more extensive in group II. Erythema induratum of Bazin may show predominantly acute suppurative or granulomatous panniculitis. Immunostaining showed S100+ antigen-presenting cells, macrophages, and T-lymphocytes. B-lymphocytes were rare. The presence of primary vasculitis and granulomas suggests that types III and IV hypersensitivity reactions play a role in the pathogenesis or erythema induratum of Bazin. The latter remains a clinicopathologic diagnosis, but awareness of the heterogeneous histopathologic spectrum of EIB will ensure a timely diagnosis and institution of antituberculous treatment.

63 citations

Journal ArticleDOI
TL;DR: The recognition of cutaneous TB is important, as the diagnosis is frequently overlooked resulting in delayed treatment.
Abstract: Cutaneous involvement is a rare manifestation of tuberculosis (TB). The correct diagnosis is often significantly delayed because cutaneous TB is not routinely considered in the differential diagnosis or because investigations fail to reveal the presence of Mycobacterium tuberculosis. The clinical features of cutaneous TB are diverse, and result from exogenous and endogenous spread of M. tuberculosis and from immune-mediated mechanisms. The recognition of cutaneous TB is important, as the diagnosis is frequently overlooked resulting in delayed treatment.

62 citations

References
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Journal ArticleDOI
TL;DR: Books and internet are the recommended media to help you improving your quality and performance.

1,014 citations

Journal ArticleDOI
01 Mar 1981-Medicine
TL;DR: A system of classification is proposed which uses simple terms, avoids confusing nomenclature, and incorporates pathophysiologic descriptions and prognostic information to help clinicians understand and diagnose the diverse forms of cutaneous mycobacterial infections.

191 citations

Journal ArticleDOI
TL;DR: It is suggested that these tuberculides begin as an Arthus reaction which is followed by a delayed hypersensitivity response, which will prevent local proliferation of Mycobacterium tuberculosis in most cases, but in rare cases local multiplication of the organisms may lead to the development of lupus vulgaris.
Abstract: SUMMARY Ninety-one cases of papulonecrotic tuberculide were seen by the Department of Dermatology during the past 17 years. A focus of tuberculosis was found in 38%. Associated clinical phenomena included tuberculous arteritis with gangrene and the development of lupus vulgaris from papulonecrotic tuberculides. It is suggested that these tuberculides begin as an Arthus reaction which is followed by a delayed hypersensitivity response. The latter will prevent local proliferation of Mycobacterium tuberculosis in most cases, but in rare cases local multiplication of the organisms may lead to the development of lupus vulgaris. All patients improved rapidly on antituberculous treatment.

84 citations

Journal ArticleDOI
TL;DR: Although it was not possible to fulfill the required criteria for diagnosing tuberculosis in these lesions, it is believed there is sufficient circumstantial evidence to support the hypothesis that erythema induratum is a true tuberculid.
Abstract: The clinical and histologic features of 26 cases of erythema induratum are reviewed. The characteristic cutaneous lesions on the legs of middle-aged women were violaceous, indurated nodules, 1 to 2 cm in diameter, which were painful, occasionally ulcerated, and could heal with scarring. The diagnosis was confirmed in all patients by a strongly positive Mantoux test result (1:10,000 dilution) and by clearing of lesions after antituberculosis therapy. The histologic features were varied but were predominantly those of a vasculitis with a paraseptal and lobular panniculitis. Although it was not possible to fulfill the required criteria for diagnosing tuberculosis in these lesions, we believe there is sufficient circumstantial evidence to support the hypothesis that erythema induratum is a true tuberculid.

64 citations

Journal ArticleDOI
TL;DR: The genus Mycobacterium, by causing tuberculosis and leprosy, probably causes more suffering for humans than all other bacterial genera combined, and its members are found in soil, marshes, ponds, rivers, swimming pools, and estuaries; Sphagnum bogs are particularly rich in mycobacteria.
Abstract: The genus Mycobacterium, by causing tuberculosis and leprosy, probably causes more suffering for humans than all other bacterial genera combined. It is hardly surprising, therefore, that most attention has been given to Mycobacterium tuberculosis, while other culturable strains have been grouped together under such derogatory terms as \"atypical,\" \"unclassified,\" \"anonymous,\" \"pseudotubercle,\" and \"tuberculoid.\" From the biologic point of view, however, M. tuberculosis is not the most central nor most typical member of the genus. It may indeed be said that M. tuberculosis and Mycobacterium leprae, by devolving to a state of obligate pathogenicity, are the atypical mycobacterial species. The mycobacteria are the ducks of the microbial world. They have thick, water-repellant coats and are found at water/air interfaces. Indeed, the name Mycobacterium was given to this genus because the strains grow as mould-like pellicles on the surface of liquid media. The saprophytic strains therefore are found in soil, marshes, ponds, rivers, swimming pools, and estuaries. Sphagnum bogs are particularly rich in mycobacteria. They have also been isolated on several occasions from domestic and industrial water supplies, water storage tanks, and taps.' There are therefore many opportunities for contact between mycobacteria and animals or humans, and such contact, particularly through dermal abrasions, probably has played an im-

54 citations