DOCSLIB.ORG

Lupus Vulgaris

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Lupus Vulgaris PRACTICE IN BRIEF Cutaneous tuberculosis is on the rise in immigrant population. Difficulty in diagnosis is due to rarity of condition in developed nations. Provides differential diagnosis of mid facial cutaneous lesions. Provides a diagnostic approach for a dental practitioner in the case of lupus vulgaris. Lupus vulgaris — Report of a case with facial involvement S. Thomas,1 S. Suhas,2 K. M. Pai3 and A. R. Raghu4 Cutaneous tuberculosis of the orofacial region is a rare condition and when it occurs, can cause confusion regarding the true nature of the lesion. This is compounded by the fact that neither mantoux test nor histopathology is confirmatory. In this report we discuss a case of lupus vulgaris with emphasis on the diagnostic approach to be followed by dental practitioners who come across a similar case. Tuberculosis of the skin is a rare disease size and number despite treatment with top- Examination of the patient (Fig. 1) accounting for approximately 1% of all ical and systemic antibiotics. These nodules revealed erythrematous scaly plaque with reported cases of tuberculosis.1,2 Cutaneous later coalesced to form a plaque on the nose. crusting around the nose extending on to tuberculosis has various clinical manifesta- The lesion was localised on the nose for two the cheeks, inferiorly to the lower lip, angle tions such as plaque, ulcers or mutilating years and in the last six months it had of the mouth and superiorly to the right lesions. One progressive form of cutaneous extended to involve the right lower eyelid lower eye lid. There was destruction of ala tuberculosis that occurs as a post-primary and upper lip, and had lead to the destruc- nasi, nasal septum and columella. The right infection in a person with moderate or high tion of the nasal tip. lower eyelid showed loss of eyelashes with degree of immunity is known as lupus vul- garis.3 Lupus vulgaris (LV) is characterised by plaque with apple-jelly nodule that extends irregularly with scar formation and tissue destruction.3 The lesion typically appears on the head and neck, particularly around the nose.4 Lupus vorax is a variant of LV that affects the nasal cartilage causing ulceration and mutilation.3 We report a case of lupus vulgaris affecting the nose with emphasis on the diagnostic difficulties and treatment protocol. CASE REPORT A nine-year-old boy presented with a three- year history of multiple nodules appearing on and around the nose. These increased in 1*Department of Oral Medicine and Radiology, College of Dental Surgery, Manipal-576104, Karnataka, India; 2-4Department of Oral Medicine and Radiology, College of Dental Surgery, Manipal-576104, Karnataka, India. *Correspondence to Dr Shibu Thomas E mail: [email protected] Refereed Paper Received 14.10.03; Accepted 06.02.04 Fig. 1 Extra oral photograph showing midfacial destructive lesion showing erythrematous scaly plaque DOI: 10.1038/sj.bdj.4812038 © British Dental Journal 2005; 198: 135–137 with crusting around the nose. BRITISH DENTAL JOURNAL VOLUME 198 NO. 3 FEBRUARY 12 2005 135 PRACTICE A review after three months revealed healed lesions on the face (Fig. 3) and improved eye symptoms. ATT was contin- ued for another three months then stopped. The patient is being reviewed every month for assessment of a possible relapse. Recon- structive surgery is planned for a later date. DISCUSSION LV usually results from an infection of the skin in a person who has been infected else- where with mycobacterium tuberculosis.5 Usually the pathogenic mechanism is con- tiguous, lymphatic or haematogenous, spread from a tuberculous lesion. In rare sit- uations it can appear at the site of primary inoculation or at the site of a BCG vaccina- tion.6 The disease may have different forms of presentation including plaque, ulcer, muti- lating lesions, vegetative, tumour like lesion, and papulonodular lesion. The ulcerative and the mutilating form have Fig. 2 Photomicrograph of section stained with hematoxylin and eosin at 10X magnification showing multiple subepithelial granulomas without central casseation necrosis. the highest tendency for scarring together with deep tissue involvement.3 LV is commonly seen on the face, ears ectropion of the eyelid. There was conjuncti- defined epitheloid cells interspersed with and neck and may heal with scarring. val congestion and epiphora. Swelling and mononuclear leukocytes. These features Facial involvement may typically involve crusting of upper lip and fissuring of the were suggestive of a chronic granulomatous the nose and may result in destruction of angle of mouth was evident. Mouth opening inflammatory reaction. No typical tubercu- the nasal and septal cartilage. This muti- was limited as upper and lower lip appeared lous follicles or acid-fast bacilli could be lating variant of lupus vulgaris is also fibrosed and could not be everted. identified. Culture was negative for fungi, known as lupus vorax.7,8 Multiple bilateral submandibular lymph bacteria and acid-fast bacilli. Mycobacteri- The nasal lesion of LV may spread nodes were palpable, mobile and non tender. um tuberculosis DNA was identified from either directly or through lymphatic ves- Routine haematological and biochemical the tissue sample of the lesion subjected to sels to the buccal mucosa, palate, gingiva, investigations revealed no abnormalities. polymerase chain reaction (PCR). conjunctiva or oropharynx, giving rise to Serological test results for Leishmania, The patient was put on four drug anti ulcers or vegetation in these areas.7,9 Fur- syphilis, and human immunodeficiency tubercular therapy (ATT) consisting of ther complications include secondary virus were negative. Para nasal sinus view Rifampicin 450 mg one-and-a-half tablets infection of the ulcerative lesion and and chest radiograph findings were normal. once daily, Isoniazid 300mg one-and-a- scarring deformities such as ectropion Fine needle aspiration cytology of lungs half tablets once daily, Pyrazinamide 750 and microstomia requiring plastic sur- revealed no evidence of tuberculosis. A mg half a tablet once daily and Ethambutol gery.8,9 purified protein derivative test (Mantoux 200 mg 1 tablet once daily for a period of In our patient the typical nasal lesion was test) was strongly positive, 14 mm diameter two months, following which Isoniazid and evident, along with scarring and involve- after 48 hours. A biopsy of the nasal lesion Rifampacin were continued for the next ment of upper lip and lower eyelid resulting (Fig. 2) revealed a delicate stroma, markedly four months. For the right eye, moistening in ectropion of the eyelid. The differential amorphous, exhibiting areas of necrosis sur- eye drops (0.7% hydroxypropyl methyl cel- diagnosis (Fig. 4) should include lupus ery- rounded by many multinucleated giant cells lulose) and antibiotic eye ointment (0.3% thematosus, lymphocytoma, Spitz naevus, of langhans type containing many small W/W ciprofloxacin) were used for a period syphilis, psoriasis and Bowen’s disease for nuclei disposed to the periphery and a few ill of two weeks. an early nodule or early plaque type. For the Type of Lupus Vulgaris Differential diagnosis Early plaque or early nodule type • Lupus erythematosus • Lymphocytoma • Spitz naevus • Syphilis • Psoriasis • Bowen’s disease Multinodular or vegetative type • Leishmaniasis • Leprosy • Sarcoidosis • Acne rosacea • Wegener’s granulomatosus Fig. 3 Post treatment photograph of face showing healed lesion and residual defect. Fig. 4 Differential diagnosis for lupus vulgaris. 136 BRITISH DENTAL JOURNAL VOLUME 198. NO. 3 FEBRUARY 12 2005 PRACTICE more mutinodular or vegetative type the Investigations for Lupus Vulgaris 1. Chen C H, Shih J F, Wang L S, Perng R P. Tuberculous differential diagnosis will include leishma- subcutaneous abscess: analysis of seven cases. • Chest radiograph Tuber Lung Dis 1996; 77: 184-187. niasis, leprosy, sarcoidosis, acne rosacea and 2. Grosset J H. Present status of chemotherapy for 3,8 • Mantoux test Wegener’s granulomatosus. tuberculosis. Rev Infect Dis 1989; II: 347-352. • Incisional biopsy Diagnosis of cutaneous tuberculosis is 3. Gawkrodger D J. Mycobacterial infections. In: Rook at times difficult because the clinical • Acid fast bacilli culture A, Wilkinson DS, Ebling FJG (Eds). Textbook of th appearance of the lesion may not always • Polymerase chain reaction Dermatology, 6 ed. Oxford; Boston: Blackwell Scientific, 1998; V.2, Chap. 28, p1194. be characteristic and will require multiple 4. El-Gatit A L, EL-Deriny, Mahmoud A A and Ashi A S. investigations (Fig. 5). At times culture for Presumed periorbital lupus vulgaris with ocular Fig. 5 Investigations for lupus vulgaris. the bacilli may not yield positive results extension. Ophthalmology 1999; 106: 1990-1993. and demonstration of acid-fast bacilli may 5. Sehgal V N, Jain M K and Srivastava G. Changing pattern of cutaneous tuberculosis — A prospective be difficult especially in patients with strong but cannot be confirmed with biopsy study. Int J Dermatol 1989; 28: 231-236. chronic lesions and with a high degree of or the Mantoux test. Then diagnosis can be 6. Marcoval J, Servitje O, Moreno A, et al. Lupus immunity against the infection.6,7,10,11 In done based on the therapeutic response of vulgaris. Clinical, histopathologic, and bacteriologic the present case acid fast bacilli could not the lesion to anti tubercular drugs.14 study of 10 cases. J Am Acad Dermatol 1992; 26: be demonstrated in the biopsy specimen The absolute criteria for diagnosis of 404-407. 7. Farina M C, Gegundez M I, Pique E, et al. Cutaneous and culture for acid fast bacilli yielded cutaneous tuberculosis are a positive culture tuberculosis. Clinical, histopathologic, and negative results. of M.tuberculosis from the lesion or success- bacteriologic study of 10 cases. J Am Acad Dermatol Tuberculosis infection is a granuloma- ful guinea-pig inoculation, or DNA identifi- 1995; 33: 433-440. tous inflammatory reaction in which the cation by PCR. In PCR, specific fragments of 8. Freitag D S, Chin R.
Load more

Recommended publications
  • Chapter 3 Bacterial and Viral Infections
    GBB03 10/4/06 12:20 PM Page 19 Chapter 3 Bacterial and viral infections A mighty creature is the germ gain entry into the skin via minor abrasions, or fis- Though smaller than the pachyderm sures between the toes associated with tinea pedis, His customary dwelling place and leg ulcers provide a portal of entry in many Is deep within the human race cases. A frequent predisposing factor is oedema of His childish pride he often pleases the legs, and cellulitis is a common condition in By giving people strange diseases elderly people, who often suffer from leg oedema Do you, my poppet, feel infirm? of cardiac, venous or lymphatic origin. You probably contain a germ The affected area becomes red, hot and swollen (Ogden Nash, The Germ) (Fig. 3.1), and blister formation and areas of skin necrosis may occur. The patient is pyrexial and feels unwell. Rigors may occur and, in elderly Bacterial infections people, a toxic confusional state. In presumed streptococcal cellulitis, penicillin is Streptococcal infection the treatment of choice, initially given as ben- zylpenicillin intravenously. If the leg is affected, Cellulitis bed rest is an important aspect of treatment. Where Cellulitis is a bacterial infection of subcutaneous there is extensive tissue necrosis, surgical debride- tissues that, in immunologically normal individu- ment may be necessary. als, is usually caused by Streptococcus pyogenes. A particularly severe, deep form of cellulitis, in- ‘Erysipelas’ is a term applied to superficial volving fascia and muscles, is known as ‘necrotiz- streptococcal cellulitis that has a well-demarcated ing fasciitis’. This disorder achieved notoriety a few edge.
    [Show full text]
  • Pattern of Cutaneous Tuberculosis Among Children and Adolescent
    Bangladesh Med Res Counc Bull 2012; 38: 94-97 Pattern of cutaneous tuberculosis among children and adolescent Sultana A1, Bhuiyan MSI1, Haque A2, Bashar A3, Islam MT4, Rahman MM5 1Dept. of Dermatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, 2Dept. of Public health and informatics, BSMMU, Dhaka, 3SK Hospital, Mymensingh Medical College, Mymensingh, 4Dept. of Physical Medicine and Rehabilitation, BSMMU, Dhaka, 5Dept. of Dermatology, National Medical College, Dhaka. Email: [email protected] Abstract Cutaneous tuberculosis is one of the most subtle and difficult diagnoses for dermatologists practicing in developing countries. It has widely varied manifestations and it is important to know the spectrum of manifestations in children and adolescent. Sixty cases (age<19 years) of cutaneous tuberculosis were included in this one period study. The diagnosis was based on clinical examination, tuberculin reaction, histopathology, and response to antitubercular therapy. Histopahology revealed 38.3% had skin tuberculosis and 61.7% had diseases other than tuberculosis. Among 23 histopathologically proved cutaneous tuberculosis, 47.8% had scrofuloderma, 34.8% had lupus vulgaris and 17.4% had tuberculosis verrucosa cutis (TVC). Most common site for scrofuloderma lesions was neck and that for lupus vulgaris and TVC was lower limb. Cutaneous tuberculosis in children continues to be an important cause of morbidity, there is a high likelihood of internal involvement, especially in patients with scrofuloderma. A search is required for more sensitive, economic diagnostic tools. Introduction of Child Health (BICH) and Institute of Diseases of Tuberculosis (TB), an ancient disease has affected Chest and Hospital (IDCH) from January to humankind for more than 4,000 years1 and its December 2010.
    [Show full text]
  • Disseminated Mycobacterium Tuberculosis with Ulceronecrotic Cutaneous Disease Presenting As Cellulitis Kelly L
    Lehigh Valley Health Network LVHN Scholarly Works Department of Medicine Disseminated Mycobacterium Tuberculosis with Ulceronecrotic Cutaneous Disease Presenting as Cellulitis Kelly L. Reed DO Lehigh Valley Health Network, [email protected] Nektarios I. Lountzis MD Lehigh Valley Health Network, [email protected] Follow this and additional works at: http://scholarlyworks.lvhn.org/medicine Part of the Dermatology Commons, and the Medical Sciences Commons Published In/Presented At Reed, K., Lountzis, N. (2015, April 24). Disseminated Mycobacterium Tuberculosis with Ulceronecrotic Cutaneous Disease Presenting as Cellulitis. Poster presented at: Atlantic Dermatological Conference, Philadelphia, PA. This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact [email protected]. Disseminated Mycobacterium Tuberculosis with Ulceronecrotic Cutaneous Disease Presenting as Cellulitis Kelly L. Reed, DO and Nektarios Lountzis, MD Lehigh Valley Health Network, Allentown, Pennsylvania Case Presentation: Discussion: Patient: 83 year-old Hispanic female Cutaneous tuberculosis (CTB) was first described in the literature in 1826 by Laennec and has since been History of Present Illness: The patient presented to the hospital for chest pain and shortness of breath and was treated for an NSTEMI. She was noted reported to manifest in a variety of clinical presentations. The most common cause is infection with the to have redness and swelling involving the right lower extremity she admitted to having for 5 months, which had not responded to multiple courses of antibiotics. She acid-fast bacillus Mycobacterium tuberculosis via either primary exogenous inoculation (direct implantation resided in Puerto Rico but recently moved to the area to be closer to her children.
    [Show full text]
  • Tuberculosis: an Overview
    Tuberculosis: An Overview By: Raymond Lengel, FNP, MSN, RN Purpose: To provide an overview of tuberculosis including its transmission, risk factors, signs and symptoms, diagnosis and treatment options. Objectives · List five risk factors for tuberculosis · Discuss the use of the Mantoux test, QuantiFERON and chest x-ray in the diagnosis of tuberculosis · List five signs and symptoms of tuberculosis · Differentiate between latent and active tuberculosis · Discuss treatment options for tuberculosis Tuberculosis (TB) is caused by the bacteria Mycobacterium tuberculosis. The disease can affect any part of the body – such as the spine, brain and kidney - but it most commonly affects the lungs. Public health efforts have significantly reduced the spread of the disease. TB is an airborne disease and is spread from person to person when respiratory droplets are breathed into the respiratory tract. Latent vs. Active Tuberculosis Latent TB is disease where one is infected with the bacteria but is not ill. Active TB is when disease is present, bacteria are growing and the patient has signs and symptoms of TB. Latent TB occurs when the bacterium enters the body, but the immune response prevents the bacteria from proliferating. These individuals have a positive tuberculin skin test or a positive QuantiFERON blood test. Those with latent TB can progress to active TB. When the disease is in latency the individual cannot pass the disease on to others. Active TB involves the proliferation of bacteria and symptoms suggestive of TB. Those with active TB can pass the disease to others. Those who have latent TB are at risk to develop active disease.
    [Show full text]
  • Using of T-Spot.Tb and Mantoux Tests in Diagnosis of M
    PROCEEDINGS OF THE LATVIAN ACADEMY OF SCIENCES. Section B, Vol. 63 (2009), No. 6 (665), pp. 257–263. DOI: 10.2478/v10046-010-0001-1 USING OF T-SPOT.TB AND MANTOUX TESTS IN DIAGNOSIS OF M. tuberculosis INFECTION IN BCG VACCINATED CHILDREN AGED FIVE AND YOUNGER Iveta Ozere, Ìirts Skenders, Iveta Lîduma, Olga Bobrikova, Zita Lauska, Anita Skangale, Anita Jagmane, Vita Kalniòa, and Vaira Leimane State Agency of Tuberculosis and Lung Diseases of Latvia, p.o. Cekule, Rîgas raj., LV- 2118, LATVIA; e-mail: [email protected] Communicated by Ludmila Vîksna Infection with M. tuberculosis (MT) is difficult to diagnose in young BCG (Bacillus Calmette-Guérin) vaccinated children using Mantoux test alone, as a positive test result may be due to infection with MT and previous BCG vaccination. We aimed to test the T-SPOT.TB test for BCG-vaccinated children aged five and younger in two groups — with or without contact with an active tuberculosis (ATB) patient. Prospectively a study group of 121 children (having contact with ATB patient) and a control group of 64 children (without known contact with ATB patient) were ex- amined using Mantoux and T-SPOT.TB tests. The T-SPOT.TB test was positive in 66 (54.5%) study group children and in 2 (3.1%) control group children (P < 0.01). Induration in the Mantoux test ³ 10 mm was observed in 62 (91.0%) of 68 T-SPOT.TB positive children, and 34 (29.1%) of 117 T-SPOT.TB negative children (P < 0.01). In the group with a negative T-SPOT.TB result boosting of the Mantoux test was observed in 21 (66%) of 32 children who had received repeated Mantoux testing before being included in the study.
    [Show full text]
  • A Case of Lupus Vulgaris Carmen D
    Symmetrically Distributed Orange Eruption on the Ears: A Case of Lupus Vulgaris Carmen D. Campanelli, BS, Wilmington, Delaware Anthony F. Santoro, MD, Philadelphia, Pennsylvania Cynthia G. Webster, MD, Hockessin, Delaware Jason B. Lee, MD, New York, New York Although the incidence and morbidity of tuberculo- sis (TB) have declined in the latter half of the last decade in the United States, the number of cases of TB (especially cutaneous TB) among those born outside of the United States has increased. This discrepancy can be explained, in part, by the fact that cutaneous TB can have a long latency period in those individuals with a high degree of immunity against the organism. In this report, we describe an individual from a region where there is a rela- tively high prevalence of tuberculosis who devel- oped lupus vulgaris of the ears many years after arrival to the United States. utaneous tuberculosis (TB) is a rare manifes- tation of Mycobacterium tuberculosis infection. C Scrofuloderma, TB verrucosa cutis, and lupus vulgaris (LV) comprise most of the cases of cutaneous TB. All 3 are rarely encountered in the United States. During the last several years, the incidence of TB has declined in the United States, but the incidence of these 3 types of cutaneous TB has increased in foreign-born individuals. This discrepancy can be ex- plained, in part, by the fact that TB can have a long latency period, especially in those individuals with a Figure 1. Orange plaques and nodules on the right ear. high degree of immunity against the organism. Indi- viduals from regions where there is a high prevalence Case Report of TB may develop cutaneous TB many years after ar- A 71-year-old man from the Philippines presented rival to the United States, despite screening protocol with an eruption on both ears that had existed for when they enter the United States.
    [Show full text]
  • Nontuberculous Mycobacterial Skin Infection: Cases Report And
    วารสารวิชาการสาธารณสุข Journal of Health Science ปี ท ี � �� ฉบับที� � พฤศจิกายน - ธันวาคม ���� Vol. 23 No. 6, November - December 2014 รายงานผู้ป่วย Case Report Nontuberculous Mycobacterial Skin Infection: Cases Report and Problems in Diagnosis and Treatment Jirot Sindhvananda, M.D., Preya Kullavanijaya, M.D., Ph.D., FRCP (London) Institute of Dermatology, Department of Medical Services, Ministry of Public Health, Thailand Abstract Nontuberculous mycobacteria (NTM) are infrequently harmful to humans but their incidence increases in immunocompromised host. There are 4 subtypes of NTM; among them M. marinum is the most common pathogen to human. Clinical manifestation of NTM infection can mimic tuberculosis of skin. Therefore, supportive evidences such as positive acid-fast bacilli smear, characteristic histopathological finding and isolation of organism from special method of culture can help to make the definite diagnosis. Cases of NTM skin infection were reported with varying skin manifestations. Even patients responsed well with many antimicrobial agents and antituberculous drug, some difficult and recalcitrant cases have partial response especially in M. chelonae infected-cases. Kay words: nontuberculous mycobacteria, M. chelonae, skin infection, treatment Introduction were once termed as anonymous, atypical, tubercu- Nontuberculous mycobacteria (NTM) are infre- loid, or opportunistic mycobacteria that are infre- quently harmful to humans but their incidence in- quently harmful to humans(1-4). Until recently, there creases in immunocompromised host. There are 4 were increasing coincidences of NTM infections with subtypes of NTM; and the subtype M. marinum is the a number of immunocompromised and AIDS cases. most common pathogen to human(1). Clinical mani- The diagnosis of NTM infection requires a high festation of NTM infection can mimic tuberculosis of index of suspicion.
    [Show full text]
  • Lupus Vulgaris with Unusual Involvement
    LUPUS VULGARIS WITH UNUSUAL INVOLVEMENT Cihangir Aliağaoğlu1, Mustafa Atasoy2, Ümran Yıldırım3, R. İsmail Engin2, Handan Timur2 Düzce University, Faculty of Medicine, Departments of Dermatology and Pathology3, Düzce, Atatürk University, Faculty of Medicine, Department of Dermatology2, Erzurum, Turkey Lupus vulgaris is the most encountered form of cutaneous tuberculosis, and the most common site of involvement is the head and neck. In our lupus vulgaris cases, the lesions were located in throcal area in one case and gluteal area in the other. Ziehl-Neelsen and periodic acid-Schiff stains did not demonstrate any acid-fast bacilli. Culture did not grow mycobacterium tuberculosis except in case 1. PPD was strongly positive in all of the cases. Lesions of lupus vulgaris improved after anti-tuberculotic threrapy. Key words: Lupus vulgaris, unusual involvement Eur J Gen Med 2007; 4(3):135-137 INTRODUCTION gave an apple-jelly appearance. The systemic Lupus vulgaris (LV) is usually the result examination was normal. Lymph nodes were of dissemination from an endogenous focus not palpable. No BCG scar was visible. The during a period of lowered resistance and entire dermis was composed of non-caseous mycobacterium tuberculous bacillemia in a granulomatous inflammation which contains previously sensitized host with a strongly epitheloid histiocytes, lymphocytes, and positive delayed hypersensitivity to tuberculin large numbers of Langhans type giant cells (1). LV is often located on the face. Other sites (Figure 1B). A Mantoux test was positive of predilection are the nose, ears, chin, neck, with erythema and induration of 18 mm after and, rarely, extremities, buttock and trunk. 48 hours. Mycobacterium tuberculosis was It is more common in females than in males, cultured from the biopsy specimen.
    [Show full text]
  • PRODUCT MONOGRAPH TUBERSOL Tuberculin Purified
    sanofi pasteur Section 1.3.1 Product Monograph 299 – TUBERSOL® PRODUCT MONOGRAPH TUBERSOL® Tuberculin Purified Protein Derivative (Mantoux) Solution for injection Diagnostic Antigen to aid in the detection of infection with Mycobacterium tuberculosis ATC Code: V04CF01 Manufactured by: Sanofi Pasteur Limited Toronto, Ontario, Canada Control # 157184 Date of Approval: 02 October 2012 Product Monograph Template – Schedule D Page 1 of 18 sanofi pasteur Section 1.3.1 Product Monograph 299 – TUBERSOL® Table of Contents PART I: HEALTH PROFESSIONAL INFORMATION ........................................................... 4 SUMMARY PRODUCT INFORMATION .................................................................................. 4 Route of Administration .................................................................................................................... 4 Dosage Form / Strength ..................................................................................................................... 4 Active Ingredients ............................................................................................................................. 4 Clinically relevant Non-medicinal Ingredients ................................................................................. 4 DESCRIPTION ............................................................................................................................... 4 INDICATIONS AND CLINICAL USE ........................................................................................ 4 CONTRAINDICATIONS
    [Show full text]
  • Testing for Diagnosis of Active Or Latent Tuberculosis
    Corporate Medical Policy Testing for Diagnosis of Active or Latent Tuberculosis AHS – G2063 File Name: testing_for_diagnosis_of_active_or_latent_tuberculosis Origination: 4/1/2019 Last CAP Review: 2/2021 Next CAP Review: 2/2022 Last Review: 2/2021 Description of Procedure or Service Description Infection by Mycobacterium tuberculosis (Mtb) results in a wide range of clinical presentations dependent upon the site of infection from classic signs and symptoms of pulmonary disease (cough >2 to 3 weeks' duration, lymphadenopathy, fevers, night sweats, weight loss) to silent infection with a complete absence of signs or symptoms(Lewinsohn et al., 2017). Culture of Mtb is the gold standard for diagnosis as it is the most sensitive and provides an isolate for drug susceptibility testing and species identification (Bernardo, 2019). Nucleic acid amplification tests (NAAT) use polymerase chain reactions (PCR) to enable sensitive detection and identification of low density infections ( Pai, Flores, Hubbard, Riley, & Colford, 2004). Interferon-gamma release assays (IGRAs) are blood tests of cell-mediated immune response which measure T cell release of interferon (IFN)-gamma following stimulation by specific antigens such as Mycobacterium tuberculosis antigens (Lewinsohn et al., 2017; Dick Menzies, 2019) used to detect a cellular immune response to M. tuberculosis which would indicate latent tuberculosis infection (LTBI) (Pai et al., 2014). Scientific Background Tuberculosis (TB) continues to be a major public health threat globally, causing an estimated 10.0 million new cases and 1.5 million deaths from TB in 2018 (WHO, 2016, 2019), with the emergence of multidrug resistant strains only adding to the threat (Dheda et al., 2014). The lungs are the primary site of infection by Mtb and subsequent TB disease.
    [Show full text]
  • Delayed Granulomatous Lesion at the Bacillus Calmette-Gue´Rin Vaccination Site
    302 Letters to the Editor baseline warts (imiquimod 11% vs. vehicle 6%; p = 0.488), 2. Buetner KR, Spruance SL, Hougham AJ, Fox TL, Owens ML, more imiquimod-treated patients experienced a 50% reduc- Douglas JM Jr. Treatment of genital warts with an immune- tion in baseline wart area (38% vs. 14%; p = 0.013). Use of response modi er (imiquimod). J Am Acad Dermatol 1998; 32: imiquimod was not associated with any changes in laboratory 230–239. values, including CD4 count. It was not associated with any 3. Beutner KR, Tyring SK, Trofatter KF, Douglas JM, Spruance S, adverse drug-related events, and no exacerbation of HIV/AIDS Owens ML, et al. Imiquimod, a patient-applied immune-response was attributed to the use of imiquimod. However, it appeared modi er for treatment of external genital warts. Antimicrob Agents Chemother 1998; 42: 789–794. that topical imiquimod was still less eVective at achieving total 4. Tyring SK, Arany I, Stanley MA, Tomai MA, Miller RL, clearance than in the studies with HIV-negative patients, which Smith MH, et al. A randomized, controlled, molecular study of is most likely a re ection of the impaired cell-mediated condylomata acuminata clearance during treatment with imiqui- immunity seen in the HIV-positive population (8). mod. J Infect Dis 1998; 178: 551–555. There has also been a report of improved success when topical 5. Arany I, Tyring SK, Stanley MA, Tomai MA, Miller RL, imiquimod was combined with more traditional destructive Smith MH, et al. Enhancement of the innate and cellular immune therapy for HPV infection in HIV-positive patients, particularly response in patients with genital warts treated with topical imiqui- in the setting of the use of highly-active antiretroviral therapy mod cream 5%.
    [Show full text]
  • Lupus Vulgaris of the External Nose in a Paediatric Patient: a Case Report from Muhimbili National Hospital, Tanzania
    Global Journal of Otolaryngology ISSN 2474-7556 Case Report Glob J Otolaryngol Volume 19 Issue 4 - March 2019 Copyright © All rights are reserved by Zephania Saitabau Abraham DOI: 10.19080/GJO.2019.19.556019 Lupus Vulgaris of the External Nose in a Paediatric Patient: A Case Report from Muhimbili National Hospital, Tanzania Zephania Saitabau Abraham1*, Daudi Ntunaguzi2 Enica Richard Massawe2 and Aveline Aloyce Kahinga2 1Department of Surgery, University of Dodoma-College of Health Sciences, Tanzania 2Department of Otorhinolaryngology-Muhimbili University of Health and Allied Sciences, Tanzania Submission: March 07, 2019; Published: March 13, 2019 *Corresponding author: Zephania Saitabau Abraham, Department of Surgery, University of Dodoma-College of Health Sciences, Tanzania Abstract histopathologically.Lupus vulgaris isOn the local most examination, common form the ofpatient cutaneous had irregularly tuberculosis bordered, which usually well demarcated, occurs in patients whitish who to reddish have been lesion previously on her external sensitized nose. to Mycobacterium tuberculosis. We present a case of a 4-year-old girl who was diagnosed to have lupus vulgaris clinically and was then confirmed histopathologicalThe histopathological basis examination so as to avoid showed its destructive many dermal consequences stromal granulomaswhich are mainly of epithelioid erosion of cells, the externalmany multinucleated nose, nasal cavity giant and cells the of face Langhans and in raretype. occasions, This case reportpossible is thereforedevelopment
    [Show full text]