Cutaneous tuberculosis

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Cutaneous tuberculosis
Other names: Skin tuberculosis[1]
  • Top:Cutaneous tuberculosis
  • Bottom:Classification system of CTB[2]
SpecialtyDermatology, Infectious disease
SymptomsInflammatory papules, ulcers, nodules, pustules, verrucous plaques[3]
Diagnostic methodMantoux test, Serum QuantiFERON-TB Gold (QFT-G) levels, PCR, and skin biopsy[3]
Differential diagnosisChronic vegetative pyoderma,Blastomycosis,Chromoblastomycosis, drug reactions and Syphilitic gumma[3]
TreatmentIsoniazid, rifampicin, pyrazinamide, and ethambutol or streptomycin[3]
PrognosisGood(in individuals who are not immunocompromised)[3]
FrequencyUncommon(1% to 2% )[3]

Cutaneous tuberculosis is an infection due to M. Tuberculosis complex, and bacillus Calmette-Guérin. Clinical presentation depends on immunity and also environmental aspects; as well as those individuals using immunobiological drugs who may be susceptible.[4][5] In terms of the treatment for cutaneous tuberculosis we find that isoniazid, rifampicin, and ethambutol are used.[3]

Types

The types of cutaneous tuberculosis is consistent with the following:[6][7]

  • TB verrucosa cutis caused via exogenous reinfection and presents as warty lesions on the hands, and knees.
  • Miliary TB presents as multiple small skin lesions
  • Lupus vulgaris happens due to lymphatic spread from the internal location of tuberculosis and is usually reddish-brown plaques.
  • Scrofuloderma happens when tuberculosis spreads from a infected bone to the skin and subcutaneous nodules form .
  • Tuberculosis cutis orificialis presents usually around the nose or mouth.

Signs and symptoms

In an affected individual the presentation of skin tuberculosis would be the following:[6][7][8]

Complications

Among the possible complications of skin tuberculosis we find:[7]

Cause

M. tuberculosis colonies

Mycobacterium tuberculosis, is a species of pathogenic bacteria in the family Mycobacteriaceae and the causative agent of tuberculosis.[9][10]

M. tuberculosis has an unusual, waxy coating on its cell surface primarily due to the presence of mycolic acid. This coating makes the cells impervious to Gram staining, and as a result, M. tuberculosis can appear weakly Gram-positive.[11]

Mechanism

As to the mechanism via which cutaneous tuberculosis can occur, we find that there are two:[3]

  • Endogenous invasion is the result of spread of pulmonary tuberculosis by lymphatic dissemination.
  • Exogenous invasion is via direct inoculation of the bacteria.

Diagnosis

Mantoux tuberculin skin test

In terms of the diagnosis of cutaneous tuberculosis we find that the following is done:[3] [12]

Differential diagnosis

The DDx is based, but not limited, to the following:[3]

Treatment

Surgical excision of cutaneous TB a) before surgery b) healing at 30 days

In terms of treatment we find there are two phases:[3]

  • Intensive phase which rapidly decreases the burden of M. tuberculosis(8 weeks)
  • Continuation phase(9-12 months)

The multidrug treatment involves isoniazid, rifampicin, pyrazinamide, and ethambutol or streptomycin.

Surgical excision of cutaneous TB such as lupus vulgaris or scrofuloderma may be needed.[7]

Epidemiology

As to the epidemiology of cutaneous tuberculosis we find that of the individuals that have extra-pulmonary manifestations of TB, about one to two percent develop cutaneous tuberculosis. It is common in areas of the globe where HIV is also common.[3]

Some types of cutaneous tuberculosis affect young or middle-aged females; though males may be affected as well. Cases in South Africa and Pakistan have been reported, as to rare type(s) of cutaneous tuberculosis.[13] Per WHO the countries with the most cases of cutaneous tuberculosis as a consequence of having a high TB incidence (as well as immunocompromised individuals) are:[14][6]

History

Dr. Rene Laennec

In terms of the history of cutaneous tuberculosis we find that it was first described by Laennec in 1826.[15]

However, the wider discovery of Mycobacterium tuberculosis,which is responsible for tuberculosis, was made by Dr. Robert Koch in 1882.[16]

See also

References

  1. "Cutaneous tuberculosis (Concept Id: C0041309) - MedGen - NCBI". www.ncbi.nlm.nih.gov. Archived from the original on 2024-08-18. Retrieved 2024-08-15.
  2. van Staden, Daniélle; Haynes, Richard K.; Viljoen, Joe M. (15 June 2022). "Adapting Clofazimine for Treatment of Cutaneous Tuberculosis by Using Self-Double-Emulsifying Drug Delivery Systems". Antibiotics (Basel, Switzerland). 11 (6): 806. doi:10.3390/antibiotics11060806. ISSN 2079-6382. Archived from the original on 14 July 2022. Retrieved 11 August 2024.
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 Charifa, Ahmad; Mangat, Rupinder; Oakley, Amanda M. (2024). "Cutaneous Tuberculosis". StatPearls. StatPearls Publishing. Archived from the original on 2021-08-28. Retrieved 2021-06-17.
  4. Dias, Maria Fernanda Reis Gavazzoni; Bernardes Filho, Fred; Quaresma, Maria Victória; Nascimento, Leninha Valério do; Nery, José Augusto da Costa; Azulay, David Rubem (December 2014). "Update on cutaneous tuberculosis". Anais Brasileiros de Dermatologia. 89 (6): 925–938. doi:10.1590/abd1806-4841.20142998. Archived from the original on 28 August 2021. Retrieved 17 June 2021.
  5. Hill, Michael K.; Sanders, Charles V. (January 2017). "Cutaneous Tuberculosis". Microbiology Spectrum. 5 (1). doi:10.1128/microbiolspec.TNMI7-0010-2016. ISSN 2165-0497. Archived from the original on 28 August 2021. Retrieved 17 June 2021.
  6. 6.0 6.1 6.2 Tirado-Sánchez, Andrés; Bonifaz, Alexandro (1 June 2018). "Cutaneous Tuberculosis: a Review of the Current Literature". Current Tropical Medicine Reports. 5 (2): 67–76. doi:10.1007/s40475-018-0140-z. ISSN 2196-3045. Archived from the original on 14 August 2024. Retrieved 20 August 2024.
  7. 7.0 7.1 7.2 7.3 "Cutaneous tuberculosis (TB)". DermNet®. 26 October 2023. Archived from the original on 21 May 2024. Retrieved 12 August 2024.
  8. Maloney, McKenzie E.; Cohen, Bernard (17 May 2023). "Cutaneous tuberculosis in the pediatric population: A review". JAAD International. 12: 105–111. doi:10.1016/j.jdin.2023.05.001. ISSN 2666-3287. Archived from the original on 20 August 2024. Retrieved 20 August 2024.
  9. Gordon SV, Parish T (April 2018). "Microbe Profile: Mycobacterium tuberculosis: Humanity's deadly microbial foe". Microbiology. 164 (4): 437–439. doi:10.1099/mic.0.000601. PMID 29465344.
  10. Ryan KJ, Ray CG (2004). "Mycobacteria". Sherris Medical Microbiology : an Introduction to Infectious Diseases (4th ed.). New York: McGraw-Hill. p. 439. ISBN 978-0-83-858529-0.
  11. Fu LM, Fu-Liu CS (2002-01-01). "Is Mycobacterium tuberculosis a closer relative to Gram-positive or Gram-negative bacterial pathogens?". Tuberculosis. 82 (2–3): 85–90. doi:10.1054/tube.2002.0328. PMID 12356459.
  12. Kaul, Subuhi; Jakhar, Deepak; Mehta, Shilpa; Singal, Archana (December 2023). "Cutaneous tuberculosis. Part II: Complications, diagnostic workup, histopathologic features, and treatment". Journal of the American Academy of Dermatology. 89 (6): 1107–1119. doi:10.1016/j.jaad.2021.12.064. Archived from the original on 2024-08-18. Retrieved 2024-08-15.
  13. dos Santos, Josemir Belo; Figueiredo, Ana Roberta; Ferraz, Cláudia Elise; de Oliveira, Márcia Helena; da Silva, Perla Gomes; de Medeiros, Vanessa Lucília Silveira (2014). "Cutaneous tuberculosis: epidemiologic, etiopathogenic and clinicalaspects - Part I". Anais Brasileiros de Dermatologia. 89 (2): 219–229. doi:10.1590/abd1806-4841.20142334. ISSN 0365-0596. Archived from the original on 3 December 2023. Retrieved 20 August 2024.
  14. "Tuberculosis 2021" (PDF). WHO. Archived (PDF) from the original on 14 October 2021. Retrieved 20 August 2024.
  15. Sharma, Neeraj; Kumar, Kunal; Chaudhary, Robin; Yadav, Aseem; Singh, Nalin; Vasan, Amit Singh (14 November 2023). "Papulonecrotic Tuberculid—a Rare Cutaneous Expression of a Common Disease: a Case Report". SN Comprehensive Clinical Medicine. 5 (1): 268. doi:10.1007/s42399-023-01612-y. ISSN 2523-8973. Archived from the original on 18 August 2024. Retrieved 17 August 2024.
  16. "World TB Day History". Centers for Disease Control and Prevention. 18 October 2023. Archived from the original on 7 December 2018. Retrieved 17 August 2024.

Further reading