of Cutaneous T B

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Cutaneous TUBERCLOSIS : 

1 M.Yousry TB&leprosy Cutaneous TUBERCLOSIS BY M.Yousry M.Abdel-Mawla. Zagazig faculty OF MEDICINE

Cutaneous T B : 

M.Yousry TB&leprosy 2 Cutaneous T B Mycobacterium tuberculosis is the causative agent of tuberculosis (TB). Aerobic, nonsporeforming, nonmotile, facultative, intracellular, curved rods measuring 0.2-0.5 by 2.0-4.0 mm. Stained with acid-fast stain.

The variants of cutaneous TB : 

M.Yousry TB&leprosy 3 The variants of cutaneous TB Primary-inoculation TB (tuberculous chancre) TB verrucosa cutis Scrofuloderma Lupus vulgaris TB cutis orificialis Miliary TB of the skin Tuberculids

Tuberculous Chancre : 

M.Yousry TB&leprosy 4 Tuberculous Chancre Results from direct introduction of mycobacteria into the skin or mucosa of an individual who was not previously infected with TB. . An inflammatory papule develops in 2-4 weeks at the inoculation site that breaks down into a firm, nonhealing, shallow, nontender, undermined ulcer with a granulomatous base. Painless regional lymphadenopathy is evident at 3-8 weeks.

TB verrucosa cutis : 

M.Yousry TB&leprosy 5 TB verrucosa cutis Occurs after direct inoculation of TB into the skin in someone who has been previously infected with mycobacteria Presents as a purplish or brownish-red warty growth Lesions most often occur on the knees, elbows, hands, feet and buttocks Lesions may persist for years but can clear up even without treatment

Lupus vulgaris : 

M.Yousry TB&leprosy 6 Lupus vulgaris Persistent and progressive form of cutaneous TB Small sharply defined reddish-brown lesions with a gelatinous consistency (called apple-jelly nodules) Lesions persist for years, leading to disfigurement and sometimes skin cancer

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Scrofuloderma : 

M.Yousry TB&leprosy 10 Scrofuloderma Results from direct extension of underlying TB infection of lymph nodes, bone or joints Often associated with TB of the lungs Firm, painless lesions that eventually ulcerate with a granular base May heal even without treatment but this takes years and leaves unsightly scars

Miliary TB : 

M.Yousry TB&leprosy 11 Miliary TB Chronic TB infection that has spread from the primary infection (usually in the lungs) to other organs and tissues via the bloodstream Skin lesions are small (millet-sized) red spots that develop into ulcers and abscesses In immunocompromised patients, e.g. HIV, AIDS, cancer The patient is generally sick Prognosis is poor (many patients die even if diagnosed and treated)

TB cutis orificialis : 

M.Yousry TB&leprosy 12 TB cutis orificialis Results from autoinoculation of mycobacteria into the periorificial skin and mucous membranes in patients with advanced TB Tuberculin sensitivity is strong. The site of the periorificial lesion often is determined by trauma. Red papules that evolve into painful, soft, punched-out, shallow ulcers.

Tuberculid : 

M.Yousry TB&leprosy 13 Tuberculid Generalised exanthem in patients with moderate or high degree of immunity to TB Usually in good health Erythema induratum (Bazin disease) :recurring lumps on the back of the legs (mostly women) that may ulcerate and scar. Papulonecrotic tuberculid :crops of recurrent crusted skin papules on knees, elbows, buttocks or lower trunk that heal with scarring after about 6 weeks. Lichen scrofulosorum : an extending eruption of small follicular papules

T B Patient Work Up : 

M.Yousry TB&leprosy 14 T B Patient Work Up Medical history Perform a physical examination. Tuberculin skin test Posteroanterior chest radiograph Specimens for bacteriologic examination: 3 sputum specimens on each of 3 consecutive days. Skin biopsies


M.Yousry TB&leprosy 15 THERAPY of T B Isoniazid: 5 mg/kg/d in adults; 10-20 mg/kg/d in children, not to exceed 300 mg qd Rifampin: 10 mg/kg/d in adults; 10-20 mg/kg/d in children, not to exceed 600 mg qd Pyrazinamide: 15-30 mg/kg/d in adults and children, not to exceed 2000 mg qd Ethambutol: 15-25 mg/kg/d in adults and children or streptomycin: 15 mg/kg/d in adults; 20-40 mg/kg/d in children, not to exceed 1000 mg qd

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