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Of  Cutaneous  T  B
Of  Cutaneous  T  B
Of  Cutaneous  T  B
Of  Cutaneous  T  B
Of  Cutaneous  T  B
Of  Cutaneous  T  B
Of  Cutaneous  T  B
Of  Cutaneous  T  B
Of  Cutaneous  T  B
Of  Cutaneous  T  B
Of  Cutaneous  T  B
Of  Cutaneous  T  B
Of  Cutaneous  T  B
Of  Cutaneous  T  B
Of  Cutaneous  T  B
Of  Cutaneous  T  B
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Of Cutaneous T B


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  • 1. Cutaneous TUBERCLOSIS BY M.Yousry M.Abdel-Mawla. Zagazig faculty OF MEDICINE
  • 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.
  • 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
  • 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.
  • 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
  • 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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  • 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
  • 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)
  • 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.
  • 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
  • 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
  • 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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