Clinico-epidemiological study of cutaneous tuberculosis in a tertiary care hospital of Rajasthan
Abstract
India constitutes about one fourth of the Global TB burden. Cutaneous TB is less common clinical form of tuberculosis accounting for 1-2 % of the total extra-pulmonary cases. Objective of this study was to describe the clinical and epidemiological pattern of Cutaneous TB presenting in the Skin Outpatient Department (OPD). Patients presenting with clinically suspected skin lesions of Cutaneous TB from January 2015 to August 2016 were included in the study. Dermatological and systemic examination was carried out and histopathogical examination of skin punch biopsy was done. It was observed that out of a total of sixty patients, 45 (75%) patients were found to have features of Cutaneous TB on histopathology. Lupus vulgaris (42.2%) was the most common form of Cutaneous TB. Most patients were in age group of 11-30 years. Male to female ratio was 1.6:1. Most common sites of involvement were lower limbs and neck. Mantoux test was positive(≥15 mm induration) in 66.7% cases. Typical tuberculoid histology was found in 91.1% cases. No cases of tuberculids were seen and nonspecific chronic inflammation was seen in six cases. It was concluded that Cutaneous TB may present with different morphological patterns resembling other inflammatory, infective and neoplastic conditions. Proper and thorough investigations are necessary for detection of Cutaneous TB as the annual incidence of total TB cases in India is high.
Keywords
Download Options
Introduction
Mycobacterium tuberculosis was discovered more than 130 years ago and anti-tubercular therapy (ATT) had been used for more than 50 years, still TB continues to kill more than 1.7 million people globally each year. It is one of the leading causes of death from an infectious disease and is an enormous global health problem1 .In last few decades, resurgence of tuberculosis has been documented in both developed and developing nations and this increase in TB burden coincided with human immunodeficiency virus (HIV) epidemics. Since then the disease pattern has changed with a higher incidence of extra-pulmonary tuberculosis (EPTB) as well as disseminated TB. Incidence of Cutaneous TB has increased in areas with a high HIV incidence and multi-drug resistant pulmonary tuberculosis. 2,3
Cutaneous TB is one of the less common clinical forms of TB accounting for approximately 1 - 2% of total extra-pulmonary cases but contributes to significant morbidity. Its global resurgence parallels the increasing incidence of pulmonary TB and emergence of multidrug resistance. The diverse clinical presentation of cutaneous TB includes warty plaques, infiltrated plaques with scarring, inflammatory papules, suppurative nodules, chronic ulcers, necrotic lesions and non-inflamed clusters of papules amongst others. Mycobacterium tuberculosis, Mycobacterium bovisare common pathogens. BCG vaccine can also cause Cutaneous TB.
Conclusion
This present study concludes that Lupus vulgaris was the most common form of Cutaneous TB observed in this study. Extremities were the most common site of presentation. Cutaneous TB may present with different morphological patterns resembling various inflammatory, infective and neoplastic conditions. Proper history, thorough clinical examination & investigations should be undertaken to detect the cases so that they are not missed as, specially in countries like India where the annual incidence of TB is high.