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Incidence of various clinico-morphological variants of cutaneous tuberculosis and HIV concurrence: a study from the Indian subcontinent.

Varshney A, Goyal T - Ann Saudi Med (2011 Mar-Apr)

Bottom Line: We also looked for differences and HIV concurrence between immunocompetent and immunocomprised patients.HIV co-infection rates were similar to those in other studies.Many atypical morphological forms and presentations were observed in HIV co-infected patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Muzaffarnagar Medical College, Muzaffarnagar, India. tarang_derma@yahoo.co.in

ABSTRACT

Background and objectives: There are few reports of cutaneous tuberculosis with immunosuppressed states such as HIV, use of immunosuppressants or malignancy. Diagnosis is thus difficult and despite scientific advances such as polymerase chain reaction, it is frequently missed. Although rare, given its worldwide prevalence and the rising incidence of HIV, it is important for clinicians to recognize the variants and promptly treat the patient.

Design and setting: Retrospective study of all cases of cutaneous tuberculosis diagnosed from October 2007 to November 2009 at an outpatient clinic of a tertiary-care hospital in northern India.

Methods: We collected information on the clinical form of disease, histopathology and HIV concurrence rates and looked for differences in presentation between mmunocompetent and immunocompromised states. We also looked for differences and HIV concurrence between immunocompetent and immunocomprised patients. Diagnosis was based on clinical, histopathological and microbiological tests for tuberculosis and a test for HIV.

Results: The overall incidence of cutaneous tuberculosis was 0.7% (131 of 18720 outpatients). HIV concurrence was 9.1% (12 cases) of all cutaneous tuberculosis cases. Most common variants seen were scrofuloderma (36.5%), lupus vulgaris (31%), tuberculosis verruca cutis (12.9%), lichen scrofulosorum (11.4%), papulonecrotic tuberculids (3.8%), erythema nodosum (2.2%) and erythema induratum of Bazin (1.5%).

Conclusions: Cutaneous tuberculosis rates were slightly higher in our study than in other studies from India. HIV co-infection rates were similar to those in other studies. Many atypical morphological forms and presentations were observed in HIV co-infected patients. Due to the varied clinical presentations, physician awareness and a high index of suspicion are necessary to diagnose cutaneous forms of tuberculosis.

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Scrofuloderma in an HIV-positive child showing multiple undermined ulcers, pus and discharging sinuses in the neck, axillary, pre-sternal and chest regions with puckered scar marks in the axillary region.
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Figure 1: Scrofuloderma in an HIV-positive child showing multiple undermined ulcers, pus and discharging sinuses in the neck, axillary, pre-sternal and chest regions with puckered scar marks in the axillary region.

Mentions: The most commonly seen variant was scrofuloderma (48 cases). Most cases had a single site involved, but 6 cases (12.5% of all scrofuloderma cases) had multiple sites involved. Most patients were of low socioeconomic status. The most common underlying structure involved was lymph nodes in 39 cases (81.2% of all scrofuloderma cases), followed by bony structures in 8 cases (16.6% of all scrofuloderma cases). One case of direct extension from epididymis was found (2% of all cases). Scrofuloderma was predominantly seen in younger subjects (mean age, 23.4 years) as compared to other variants. Pulmonary TB was present in 40% of cases (19 patients). Five cases (10.4% of all scrofuloderma cases) were HIV positive. Some common observations with HIV co-infection were extensive contiguous lymph node sites (Figure 1), simultaneous involvement of more than one underlying structure, such as lymph nodes and bones (Figure 2), and involvement of pulmonary TB was more common.


Incidence of various clinico-morphological variants of cutaneous tuberculosis and HIV concurrence: a study from the Indian subcontinent.

Varshney A, Goyal T - Ann Saudi Med (2011 Mar-Apr)

Scrofuloderma in an HIV-positive child showing multiple undermined ulcers, pus and discharging sinuses in the neck, axillary, pre-sternal and chest regions with puckered scar marks in the axillary region.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3102471&req=5

Figure 1: Scrofuloderma in an HIV-positive child showing multiple undermined ulcers, pus and discharging sinuses in the neck, axillary, pre-sternal and chest regions with puckered scar marks in the axillary region.
Mentions: The most commonly seen variant was scrofuloderma (48 cases). Most cases had a single site involved, but 6 cases (12.5% of all scrofuloderma cases) had multiple sites involved. Most patients were of low socioeconomic status. The most common underlying structure involved was lymph nodes in 39 cases (81.2% of all scrofuloderma cases), followed by bony structures in 8 cases (16.6% of all scrofuloderma cases). One case of direct extension from epididymis was found (2% of all cases). Scrofuloderma was predominantly seen in younger subjects (mean age, 23.4 years) as compared to other variants. Pulmonary TB was present in 40% of cases (19 patients). Five cases (10.4% of all scrofuloderma cases) were HIV positive. Some common observations with HIV co-infection were extensive contiguous lymph node sites (Figure 1), simultaneous involvement of more than one underlying structure, such as lymph nodes and bones (Figure 2), and involvement of pulmonary TB was more common.

Bottom Line: We also looked for differences and HIV concurrence between immunocompetent and immunocomprised patients.HIV co-infection rates were similar to those in other studies.Many atypical morphological forms and presentations were observed in HIV co-infected patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Muzaffarnagar Medical College, Muzaffarnagar, India. tarang_derma@yahoo.co.in

ABSTRACT

Background and objectives: There are few reports of cutaneous tuberculosis with immunosuppressed states such as HIV, use of immunosuppressants or malignancy. Diagnosis is thus difficult and despite scientific advances such as polymerase chain reaction, it is frequently missed. Although rare, given its worldwide prevalence and the rising incidence of HIV, it is important for clinicians to recognize the variants and promptly treat the patient.

Design and setting: Retrospective study of all cases of cutaneous tuberculosis diagnosed from October 2007 to November 2009 at an outpatient clinic of a tertiary-care hospital in northern India.

Methods: We collected information on the clinical form of disease, histopathology and HIV concurrence rates and looked for differences in presentation between mmunocompetent and immunocompromised states. We also looked for differences and HIV concurrence between immunocompetent and immunocomprised patients. Diagnosis was based on clinical, histopathological and microbiological tests for tuberculosis and a test for HIV.

Results: The overall incidence of cutaneous tuberculosis was 0.7% (131 of 18720 outpatients). HIV concurrence was 9.1% (12 cases) of all cutaneous tuberculosis cases. Most common variants seen were scrofuloderma (36.5%), lupus vulgaris (31%), tuberculosis verruca cutis (12.9%), lichen scrofulosorum (11.4%), papulonecrotic tuberculids (3.8%), erythema nodosum (2.2%) and erythema induratum of Bazin (1.5%).

Conclusions: Cutaneous tuberculosis rates were slightly higher in our study than in other studies from India. HIV co-infection rates were similar to those in other studies. Many atypical morphological forms and presentations were observed in HIV co-infected patients. Due to the varied clinical presentations, physician awareness and a high index of suspicion are necessary to diagnose cutaneous forms of tuberculosis.

Show MeSH
Related in: MedlinePlus