Cutaneous tuberculosis (overview) A18.4

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Chef M.; Koch's disease

History
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Koch, 1882

Definition
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A classical infectious disease occurring worldwide, which must be reported by name and most frequently affects the lungs, intrathoracic lymph nodes, bronchi and pleura. Tuberculosis of the urogenital tract, peripheral lymph nodes, bones, joints and skin is not uncommon.

Pathogen
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Pathogen: Mycobacterium tuberculosis complex.

The following species belong to this group:

  • (M.) tuberculosis (99%; man as reservoir)
  • M. bovis (bovine tuberculosis)
  • M. africanum (humans as reservoir, see mycobacteria).

Classification
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The disease can start highly acute, acute, subacute, chronic and also symptom-free. If left untreated, the course is intermittent.

A distinction is made between:

  • primary cutaneous tuberculosis
  • post-primary tuberculosis.

Primary cutaneous tuberculosis: the tuberculous primary complex of the skin as an exogenous primary infection by direct contact of an injured skin area with tuberculous material and the formation of a nodular infiltrate with caesarean and ulcer formation and regional lymphadenitis is rare.

Post-primary tuberculosis: post-primarily, cutaneous tuberculosis can be caused by inoculation or by endogenous spread.

Depending on the immunity situation, the following clinical pictures develop (see Table 1):

The tuberculous primary complex of the skin as an exogenous primary infection by direct contact of an injured skin area with tuberculous material and the formation of a nodular infiltrate with caesarean and ulcer formation and regional lymphadenitis is rare.

Occurrence/Epidemiology
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It is estimated that 1/3 of humanity is infected with tuberculosis. Approximately 15% of the infected persons are affected by active tuberculosis. About 95% of the cases of disease and death affect developing countries. This is due to the general nutritional status and the high HIV infection.

The average incidence in Germany is 5.4/100,000 inhabitants/year. It is with versch. It is significantly higher among various risk groups (HIV-infected persons, immunosuppressions, drug addicts, malnourished persons, migrants from high-risk countries). TB is the most frequent cause of death in AIDS patients. Multidrug-resistant tuberculosis (MDR = multidrug-resistant tuberculosis = resistance to at least INH+RMP) tuberculosis is becoming an increasing problem (the number of infected people worldwide is estimated at 50 million). Countries with a high burden of MDR tuberculosis are (according to WHO, as of 2013: Ethiopia, Armenia, Azerbaijan, Bangladesh, Bulgaria, Belarus, China, Congo, Estonia, Georgia, India, Indonesia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Myanmar, Nigeria, Pakistan, Philippines, Russia, South Africa, Tajikistan, Ukraine, Uzbekistan, Vietnam)

Cutaneous tuberculosis affects about 1.0-1.5% of all extra-pulmonary tuberculosis infections.

Etiopathogenesis
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Transmission most often by droplet infection, rarely by skin contact with infected material or through food.

Diagnosis
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Microscopic(Ziehl-Neelsen staining) or cultural pathogen detection (only culture and animal experiments are reliable - see below mycobacteria).

The Quantiferon-TB-Gold-Test has established itself as the serological detection method. This is a highly sensitive immunological test for tuberculosis screening, in which the tuberculosis-specific antigens ESAT-6 (early secretory antigen target-6), CFP-10 (culture filtrate protein 10) and TB 7.7(p4) are used. These only occur in M. tuberculosis and M. bovis.

Therapy
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Therapy of the dermatologically relevant forms see under tuberculosis cutis luposa.

Tables
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Skin tuberculosis

Reaction of the organism

Tuberculin reaction

Pathogen quantity

Cutaneous forms

Subcutaneous forms

Anergy positive

0

+++

Tuberculous primary complex

anergy negative

0

+++

Tuberculosis miliaris ulcerosa cutis et mucosae

Tuberculosis cutis miliaris disseminata

Tuberculosis fungosa serpiginosa

Allergy (postprimary skin tuberculosis)

+

+

Tuberculosis cutis luposa

tuberculosis cutis colliquativa

Tuberculosis cutis verrucosa

Hyperergy

("Id" reactions)

++

+/0

lichen scrophulosorum

Erythema induratum

Papulonecrotic tuberculide

(Bazin's disease)

Note(s)
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Indications of an association of tuberculosis with multicentre reticulohistiocytosis are given in the literature.

Literature
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  1. Koch R (1882) The etiology of tuberculosis. Berlin clinical weekly 19: 221-230
  2. Koch R (1884) The etiology of tuberculosis. Announcements from the Imperial Health Office 2: 1-88
  3. Peters F et al (2016) Germ or no germ: Challenges in the diagnosis of mycobacterial skin infections. J Dtsch Dermatol Ges 14:1227-1236
  4. Schmekal B et al (2002) Skin tuberculosis with atypical mycobacteria 8 years after combined pancreas-kidney transplantation. At J Nephrol 22: 566-568
  5. Senol M et al (2003) A case of lupus vulgaris with unusual location. J Dermatol 30: 566-569
  6. Utikal J et al (2003) Cutaneous non-Langerhans' cell histiocytoses. J Dtsch Dermatol Ges 1: 471-491
  7. van Zyl L et al (2015) Cutaneous tuberculosis overview andcurrent
    treatment regimens. Tuberculosis (Edinb) 95:629-638

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020