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]

  • Skin tuberculosis on hand

    Skin tuberculosis on hand

  • Skin tuberculosis on face

    Skin tuberculosis on face

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
Further information: History of Tuberculosis

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

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