「Dermatological mycobacterium infecions」の版間の差分

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==skin mycobacterial diseases==
 
==skin mycobacterial diseases==
 
*leprosy
 
*leprosy

2021年5月30日 (日) 17:02時点における最新版

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skin mycobacterial diseases

  • leprosy
    • only in human
  • cutaneous TB
    • only in human
  • non-TB mycobacterium (NTM)
    • water-borne

when to suspect

  • skin symptoms WITHOUT inflammatory sings (pain, swelling, redness)
  • slow progression
  • specific patient background
    • occupation, living place, triggering event

cutaneous TB

  • estimated 1-2% of all TB patients
  • diverse range of symptoms

route of transmission

  • exogenous inoculation
    • ulcer,
    • tuberculosis verrucosa cutis, warty tuberculosis
    • orificial tuberculosis - direct contact of M.t. contained in sputum from pulmonary TB
  • endogenous spread from internal TB
    • abscess,
    • scrofuloderma - emerged from lymphadenitis
  • hematogenous
    • nodule, abscess, patch
    • as part of miliary tuberculosis
    • immunocompromised host, children
  • tuberculid - allergic reaction against M. tuberculosis
    • erythema, papule
    • in immunocompetent patient
    • skin biopsy of the eruption shows no bacteria
    • strong positivity of Mantoux test
    • Bazin erythema
      • usually localized to lower legs

treatment

  • same as of systemic tuberculosis

skin NTM

all manifest in similar skin lesions, eruptions

  • M. ulcerans = Buruli ulcer
  • M. chelonae
  • M. marinum - highest incidence
    • contact with tropical fish
  • M. avium
    • long-maintained hot bath
    • hot spring
  • M. peregrinum
  • M. massiliense (M. abscessus subsp. massiliense)

treatment

  • use more than two antibiotics to prevent from resistance
  • clarithromycin, rifampicin, quinolone, minocycline..
  • NO standarized regimen nor treatment duration

Buruli ulcer

diagnosis

  • mandatory
    • skin manifestation
    • histopathology
    • PCR