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Tuberculosis

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Dermatology in Public Health Environments

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Abstract

The number of cases of cutaneous tuberculosis (CTB) is increasing concomitantly with the increase of pulmonary tuberculosis. Migration, increasing immunosuppression factors, and treatment resistance are mainly responsible for this growth. The varied clinical presentation and low sensitivity of conventional tests make CTB a disease difficult to confirm in many cases. Most histopathologic examination has classic findings; however, bacilli frequency is low and atypical granulomas may occur. New tests with lower error rate and higher accuracy are available and should become known. The list of diseases that are differential diagnosis is extensive and beyond the shape of the skin lesion, depending on the location and age. The initial treatment is equal to the pulmonary tuberculosis, but has some particularities, as difficulty in confirming possible drugs’ resistance. This knowledge is essential for coping with the disease in the current scenario.

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Abbreviations

AFB:

Acid-fast bacillus

AIDS:

Acquired immunodeficiency syndrome

AMTDT:

Amplified Mycobacterium tuberculosis Direct Test

BCG:

Bacillus Calmette-Guérin

COVID-19:

Coronavirus disease 2019

CTB:

Cutaneous tuberculosis

EIB:

Erythema Induratum of Bazin

EN:

Erythema nodosum

HIV:

Human immunodeficiency virus

IGRA:

Interferon-γ release assay

IL:

Interleukin

INF:

Interferon

LV:

Lupus vulgaris

MAC:

M. avium-intracellulare complex

MDA:

Multiple displacement amplification

MTB:

Mycobacterium tuberculosis

MTC:

Mycobacterium tuberculosis complex

NSAIDs:

Nonsteroidal anti-inflammatory drugs

NTM:

Nontuberculous mycobacteria

PCR:

Polymerase chain reaction

PPD:

Purified protein derivative

RHZ:

Rifampicin, isoniazid, and pyrazinamide

SARS-CoV-19:

Severe acute respiratory syndrome coronavirus 2

TB:

Tuberculosis

TGF:

Transforming growth factor

Th:

T-helper

TST:

Tuberculin skin test

TVC:

Tuberculosis verrucosa cutis

WHO:

World Health Organization

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    Josemir Belo dos Santos, Iana Costa Freitas de Oliveira, Maria de Fátima Medeiros Brito, Matilde Campos Carrera, Virgínia Paiva Parisio & Vanessa Lucília Silveira de Medeiros

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Glossary

Acid-fast bacilli (AFB)

Testing may be used to detect several different types of acid-fast bacilli, but it is most commonly used to identify an active tuberculosis infection caused by the most medically important AFB, Mycobacterium tuberculosis. Are called acid-fast bacilli because they are rod-shaped bacteria (bacilli) that can be seen under the microscope following a staining procedure whereby the bacteria retain the color of the stain after an acid wash (acid-fast).

Bacille Calmette-Guérin (BCG)

Vaccine (strain 1331) is a live mycobacteria vaccine derived from attenuated strains of Mycobacterium bovis to prevent tuberculosis and other mycobacterial infections. BCG has been recommended only for immunocompetent children and adults who have high risk of ongoing exposure that cannot be avoided. In addition, it is used as an immunostimulant in the treatment of several diseases.

Erythema induratum of Bazin (EIB)

Is a granulomatous lobular panniculitis associated with tuberculosis, which affects the lower limbs of young and middle-aged women.

Erythema nodosum

Is characterized by the presence of nodular swelling, hardened, nonulcerative nodules which are seen predominantly in the lower limbs of women.

Interferon-γ release assay (IGRA)

Are tests used to identify indirectly a cellular immune response specific to peptides present in the MTB. Currently, there are two commercially available tests approved by the FDA, which use different techniques, the T-SPOT®.TB test and the QuantiFERON® TB Gold Plus (QFT-plus) test.

Lupus vulgaris

Is a chronic, progressive, and potentially disfiguring form of cutaneous tuberculosis, which occurs in patients with a high degree of immunity against Mycobacterium tuberculosis.

Scrofuloderma

Also known as tuberculosis colliquativa cutis, is the most common form of CTB in developing countries such as Brazil and India and can occur at any age, although children, adolescents, and the elderly are the most affected.

Tuberculids

Are considered hypersensitivity reactions to M. tuberculosis antigens present in extracutaneous focus or, rarely, after BCG vaccination.

Tuberculin skin test

(Mantoux technique, PPD, TST) technique consists in one injection of Purified Protein Derivative (PPD) of Mycobacterium tuberculosis in the superficial dermis, in the middle third of the left forearm. The TST is a delayed hypersensitivity type IV reaction induced by T lymphocytes.

Tuberculous gumma

Also called metastatic tuberculous abscess, is a multibacillary cutaneous tuberculosis. It results from the hematogenous dissemination of the bacillus by an active tuberculosis primary focus, especially in periods of decreased cellular immunity.

Tuberculosis verrucosa cutis

Is the most common form of exogenous cutaneous tuberculosis. The lesion develops from direct inoculation in the skin of previously sensitized individuals with moderate to high immunity against Mycobacterium tuberculosis.

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dos Santos, J.B., de Oliveira, I.C.F., de Fátima Medeiros Brito, M., Carrera, M.C., Parisio, V.P., de Medeiros, V.L.S. (2023). Tuberculosis. In: Rangel Bonamigo, R. (eds) Dermatology in Public Health Environments. Springer, Cham. https://doi.org/10.1007/978-3-031-13505-7_6

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  • DOI: https://doi.org/10.1007/978-3-031-13505-7_6

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-031-13505-7

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