CUTANEOUS TUBERCULOSIS AND ITS CO-EXISTENCE WITH HIV INFECTION

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CUTANEOUS TUBERCULOSIS AND ITS CO-EXISTENCE WITH HIV INFECTION

Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 49

Abstract

BACKGROUND Cutaneous tuberculosis is one of the major chronic infective disorders of skin but now a days the disease has re-emerged in areas with a high prevalence of HIV infection. This study was conducted to evaluate the incidence of cutaneous tuberculosis and its co-existence with HIV infection which helps in defining its status. MATERIALS AND METHODS 20 patients clinically suspected as cutaneous tuberculosis were selected for the study over a period of one year. Detailed history, clinical examination, routine haematological test, skin biopsy, x-ray chest, Mantoux test and test for detection of HIV 1 & 2 antibodies were carried out in all patients. Z-N staining and culture were done wherever we could obtain sample from the lesion. RESULTS In our longitudinal study, incidence of cutaneous tuberculosis was found to be 0.17% among patients attending OPD in tertiary care centre. The disease occurred mainly in third and fourth decade of life that is 55% of total patients. Commonly seen in Male (55%) then female (45%) and among these 65% were engaged in outdoor activities, while remaining 35% were housewives. Cutaneous tuberculosis was more common in low and middle socioeconomic class (80%), remaining 20% were of higher class. The commonest clinical forms of cutaneous tuberculosis were lupus vulgaris (55%) followed by scrofuloderma (25%), tuberculosis verrucosa cutis (10%), tuberculid (5%) and acute miliary TB (5%). In lupus vulgaris, majority of the lesions (54.55%) over face followed by (36.36%) over extremities and one rare case on genital region. In scrofuloderma majority of the lesions (60%) were over cervical region. In TBVC, all the lesions were on extremities. Mantoux test was positive in (72.72%) cases of lupus vulgaris (8 out of 11 cases), all cases of TBVC (100%) and 20% cases of scrofuloderma (1 out of 5 cases). Ziehl Neelsen staining showed acidfast bacilli in 5 cases out of 9 patients. Among these, 2 cases belonged to scrofuloderma and lupus vulgaris while 1 case was of TBVC. Culture on Lowenstein Jensen Medium was done for 6 weeks in 9 cases. Out of these, 3 cases were positive, 2 of lupus vulgaris and 1 of TBVC. X-ray chest findings suggestive of Active pulmonary Koch’s in 40% of all the cases and evidence of healed lesions in 10% of cases, no abnormality was detected in remaining 50% of cases. The histopathological finding were suggestive of granuloma composed of epithelioid cells and Lymphocytes in 91% (10 out of 11) cases of lupus vulgaris. Granuloma formation in 66.66% (3 out of 5) cases of scrofuloderma and 100% in all cases of TBVC (2 out of 2). Out of remaining 2 patients, acute miliary tuberculosis and papulonecrotic tuberculid showed non-specific histopathological findings. ELISA for HIV was positive in 20% (4 out of 20) cases. Limitations- 1. Small sample size. 2. The study is only of clinical experience of one particular area. CONCLUSION The diagnosis of cutaneous tuberculosis should therefore be based on history and evolution of the disease, cardinal clinical features and histopathological characteristics. An increased awareness of the re-emergence of cutaneous tuberculosis will allow for the proper diagnosis and management of this increasingly common skin disorder

Authors and Affiliations

Sunil Lad, Lokesh Siddanan Jappa

Keywords

Cutaneous Tuberculosis HIV Culture Z-N Staining.

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EP ID EP549231
DOI 10.14260/jemds/2018/1172
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