Cutaneous Tuberculosis: Incidence and Clinic histopathological correlation

Athilakshmi, S (2011) Cutaneous Tuberculosis: Incidence and Clinic histopathological correlation. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION : Tuberculosis, one of the oldest diseases known to mankind, continues to be a major public health problem in the world today , especially in developing countries like India. According to WHO, over one third population are at risk in developing tuberculosis today. Extrapulmonary TB constitutes only 10% of all cases of tuberculosis and cutaneous TB accounts to about 1.5% of all such cases. Improved living standards, effective screening and treatment have greatly reduced the prevalence of TB in industrialised countries but resurgence is being witnessed in developing countries. The factors responsible for resurgence are : • overcrowding due to migration of infected people from areas of high prevalence to low endemic areas. • worsening urban economic and social environment. • emergence of MDR M.tuberculosis. • increasing incidence of AIDS. Though cutaneous TB constitutes only a minor proportion , bearing in mind the prevalence of TB, these numbers become significant. Cutaneous TB can mimic the clinicopathological features of many other skin diseases, and underlying systemic or organ TB can be difficult to detect, resulting in diagnostic challenges and pitfalls and potential delays in diagnosis and institution of treatment. The varied clinicopathological features of cutaneous TB are attributed to • pathogenecity of organism. • resistance of the organism. • portal of infection. • immune status of the host. Cutaneous manifestations of TB include a wide and often overlapping spectrum of papules, pustules, papulonecrotic , nodular, verrucous lesions, panniculitis, plaques, ulcers, sinuses, scars. This study was undertaken to unravel the variations in morphology and clinicohistopathological correlation of various types of cutaneous TB. AIM OF THE STUDY : To find out the incidence of various morphological types and clinicohistopathological correlation of cutaneous TB presenting to our department and to compare that in the literature. MATERIALS AND METHODS : Resurgence of tuberculosis in the era of HIV has rejuvenated the interest in this global problem. Moreover there is increased incidence of tuberculosis, due to multidrug resistant strains of M.tuberculosis. Transmission of cutaneous tuberculosis is facilitated by overcrowding, malnutrition and low socio economic status. Though the incidence of Cutaneous tuberculosis is low worldwide it is increasing in developing countries like India. This study is undertaken to unravel the variations in morphology and histopathology of Cutaneous tuberculosis and create awareness about Cutaneous tuberculosis. Study Design : Prospective Study. Study Procedure : Patients attending Dermatology OPD,Govt Stanley hospitals with clinical suspicion of cutaneous tuberculosis, who are histopathologically proven , will be included in this study. Study Duration : One Year-May 2009 to April 2010. RESULTS : Out of 30 cases studied, males were found to be more commonly affected than females.There were 16 males, 12 females and 2 male children. Depending upon morphological features and histopathological features, 30 cases were typified and of this 14 cases had warty tuberculosis, 9 cases had lupus vulgaris, 2 cases had scrofuloderma 2 cases had papulonecrotic tuberculid 2 cases had erythema nodosum and 1 was a case of lichen scrofulosorum. Histopathological correlation was present in all cases except a case of scrofuloderma, which showed only ulceration of the epidermis and few lymphocytic infiltrate in the dermis. Patients with warty TB showed characteristic tuberculoid granulomas(11 cases) in the mid dermis and epidermal changes were present in 10 cases. Out of 9 cases of lupus vulgaris epidermal changes were present in 4 cases, characteristic tuberculoid granulomas was present in 3 cases, Langhans giant cells were present in 4 cases. Ziehl-Neelson stain was performed on all cases but could demonstrate AFB only in one case of scrofuloderma. AFB culture was done in 2 cases of scrofuloderma and the result was negative in both cases. Chest x-ray finding consistent with tuberculosis was present in 10 cases. Of this hilar adenitis was present in 3 cases, apical opacity was present in 2 cases. Mantoux was present in all cases except one case of scrofuloderma, which may be due to anergy. The highest age incidence was found to be between 20 – 30 years and most of the patients with cutaneous TB, who were included in the study were males. Of the 30 cases studied, lymphadenopathy was present in 3 cases- tender matted lymphadenitis was present in 1 case of scrofuloderma and a case of warty TB over right knee joint and non tender ipsilateral cervical lymphadenopathy was present in 1 case of lupus vulgaris involving right forearm. CONCLUSION : Following were the conclusions derived from this study, which included 30 cases • Warty tuberculosis was the commonest type followed by lupus vulgaris. • There was an increased incidence of warty tuberculosis among males and lupus vulgaris among females. • Majority of the patients belonged to 20-30 years age group. • Clinicopathological correlation was present in all cases except one case of scrofuloderma. • Most of the patients belonged to low socioeconomic status, the risk probably due to over crowding, poor hygiene and malnutrition.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Cutaneous Tuberculosis ; Incidence ; Clinic histopathological correlation.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 02 Mar 2018 02:48
Last Modified: 03 Mar 2018 01:35

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