「Dermatological mycobacterium infecions」の版間の差分
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18行目: | 18行目: | ||
==leprosy== | ==leprosy== | ||
+ | *manifests in skin and peripheral nerves | ||
+ | *papule, macule, plaque, hypopigmentation, nodule | ||
+ | *loss of sensation, paralysis, amyotrophy | ||
+ | *incubation months to >30 years | ||
+ | |||
+ | ===Ridley-Jopling classification=== | ||
+ | *TT - tuberculoid | ||
+ | *BT - borderline tuberculoid | ||
+ | *BB - borderline borderline | ||
+ | *BL - borderline lepromatous | ||
+ | *LL - lepromatous | ||
+ | |||
+ | *TT direction - abnormal or significant immune response (granulomatous) against few ''M. leprae'' bacilli | ||
+ | **PB in WHO classification | ||
+ | **infiltrated plaque | ||
+ | **well-defined, sharp border | ||
+ | **single skin lesion | ||
+ | **localized, asymmetrical | ||
+ | **loss of sensation at skin lesion | ||
+ | ***in histopathology nerves are surrounded by granuloma | ||
+ | *LL direction - least cellular immunity or allergic reaction against much amount of ''M. leprae'' bacilli | ||
+ | **MB in WHO classification | ||
+ | **macule, papule, nodule | ||
+ | ** | ||
==cutaneous TB== | ==cutaneous TB== |
2021年4月22日 (木) 09:35時点における版
目次
skin mycobacterial diseases
- leprosy
- only in human
- cutaneous TB
- only in human
- non-TB mycobacterium (NTM)
- water-borne
- M. ulcerans = Buruli ulcer
- M. chelonae
- M. marinum - highest incidence
- M. avium - long-maintained hot bath
when to suspect
- skin symptoms without inflammatory sings (pain, swelling, redness)
- slow progression
- specific patient background
- occupation, living place, triggering event
leprosy
- manifests in skin and peripheral nerves
- papule, macule, plaque, hypopigmentation, nodule
- loss of sensation, paralysis, amyotrophy
- incubation months to >30 years
Ridley-Jopling classification
- TT - tuberculoid
- BT - borderline tuberculoid
- BB - borderline borderline
- BL - borderline lepromatous
- LL - lepromatous
- TT direction - abnormal or significant immune response (granulomatous) against few M. leprae bacilli
- PB in WHO classification
- infiltrated plaque
- well-defined, sharp border
- single skin lesion
- localized, asymmetrical
- loss of sensation at skin lesion
- in histopathology nerves are surrounded by granuloma
- LL direction - least cellular immunity or allergic reaction against much amount of M. leprae bacilli
- MB in WHO classification
- macule, papule, nodule
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