primary cutaneous tuberculosis syndrome
Introduction
Introduction to primary skin tuberculosis syndrome Primary complex disease (cutaneous tuberculosis), also known as tuberculouschancre or tuberculous chancre, has never been infected with various types of tuberculosis, has no acquired immunity against tubercle bacilli and the first skin infection tuberculosis Skin tuberculosis caused by bacilli. More common in children, tubercle bacilli are mostly directly inoculated into the skin through minor trauma to the skin. basic knowledge The proportion of illness: 0.005% Susceptible people: more common in children Mode of infection: spread of germs Complications: tuberculosis, cervical lymph node tuberculosis, bone tuberculosis, kidney tuberculosis
Cause
Causes of primary skin tuberculosis syndrome
(1) Causes of the disease
Mycobacterium tuberculosis is a pathogenic bacteria causing skin tuberculosis. It is an acid-fast bacillus with acid-fast staining in red, human type, bovine type, bird type, mouse shape, cold-blooded animal and African type. Human, bovine and African types are pathogenic to humans, while skin tuberculosis is mainly caused by human form, followed by bovine type.
The route of infection of skin tuberculosis is divided into:
1. External infection: Due to skin or mucous membrane damage, Mycobacterium tuberculosis directly invades the skin or mucous membrane and causes disease.
2. Internal infection: There is a tuberculosis lesion in the patient. Mycobacterium tuberculosis causes disease by transferring blood or lymphatic system to the skin or mucous membrane. It can also be caused by local tuberculosis lesion directly to the adjacent skin or mucosa, or through the lumen. The bacillus is brought to the skin or mucous membrane near the mouth and causes disease.
(two) pathogenesis
When the Mycobacterium tuberculosis invades the body, it is first phagocytosed by neutrophils, and continues to multiply in it, and then taken to the deep part of the body by neutrophils. When the white blood cells are broken, the bacteria are released, and then the macrophages are By phagocytosis, bacteria continue to multiply in macrophages, causing cell infiltration and formation of chronic granulomas. At this time, bacterial antigens stimulate B lymphocytes and T lymphocytes, respectively, to produce antibodies and sensitized lymphocytes, because bacteria are more hidden in cells. Therefore, the antibody can not enter the cell to resist bacteria, so the antibody has no strong immunoprotective effect, but when the sensitized lymphocytes are contacted with Mycobacterium tuberculosis or phagocytic cells containing Mycobacterium tuberculosis, a series of immune effector factors are released, mainly Macrophage migration inhibitory factor (MIF), macrophage activating factor (MAF) and chemokines attract macrophage cells around Mycobacterium tuberculosis and sensitized lymphocytes, enhancing macrophage activity and intracellular Digestive enzymes such as lysozyme and hydrolase increase, becoming activated macrophages, which can kill and destroy tubercle bacilli hidden in cells.
Prevention
Primary skin tuberculosis syndrome prevention
Precautionary principle: It is mainly to mobilize the masses, vigorously publicize the prevention and treatment knowledge of tuberculosis, conduct regular health checkups, early diagnosis, early treatment, eliminate infection sources, eliminate infection routes, carry out BCG vaccination, and enhance the body's resistance.
Complication
Primary cutaneous tuberculosis syndrome complications Complications tuberculosis cervical lymph node tuberculosis tuberculosis kidney tuberculosis
Tuberculosis in other parts of the body, such as tuberculosis (often low fever, night sweats, weight loss history), peritoneal tuberculosis, lymph node tuberculosis, bone tuberculosis, kidney tuberculosis.
Symptom
Symptoms of primary skin tuberculosis syndrome Common symptoms Papular lymphadenopathy ulcer granuloma erythema (border clear...
According to the different clinical manifestations, they are classified as follows:
1. Limited type: including primary skin tuberculosis and re-infected skin tuberculosis, tubercle bacilli in the lesion is easy to detect, pathological changes are typical tuberculous granuloma changes, the course of disease is slow, and the atrophic scar remains after the fall. Types include primary skin tuberculosis syndrome, systemic miliary skin tuberculosis, vulgaris vulgaris, spastic skin tuberculosis, verrucous skin tuberculosis, ulcerative skin tuberculosis, etc.
2. Dissemination type (blood-derived): mainly through blood line dissemination, tuberculosis is not easy to detect in lesions, pathological changes in addition to tuberculous granuloma changes, often accompanied by changes in blood vessels, most cases can not find activity Tuberculosis, and no significant effect against tuberculosis treatment, there is a tendency to naturally regress, this type has papular gangrenous tuberculosis, facial disseminated miliary lupus, hard erythema, mossy skin tuberculosis, penile tuberculosis and so on.
The disease is rare, the initial development is brown red papules, and later develop into induration or plaque, ulceration after ulceration, granulation is formed on the edge of the ulcer, the nearby lymph nodes are swollen, can be broken, there is cheese formation, ulceration Tubercle bacilli are easily found in ulcers of skin and lymph nodes, often in children's face and limbs, and also in mucous membranes. Occasionally, adults develop, tuberculin test from negative to positive within weeks after ulceration.
Examine
Examination of primary skin tuberculosis syndrome
Histopathology: neutrophil infiltration at the beginning, with necrotic area, a large number of tuberculosis, monocyte and macrophage infiltration after 2 weeks, epithelial cells and giant cells appeared in the later stage, cheese-like necrosis gradually decreased , Mycobacterium tuberculosis is also significantly reduced.
Diagnosis
Diagnosis and diagnosis of primary skin tuberculosis syndrome
According to the rash, it is a brownish red papule, which gradually develops into an induration or plaque. After ulceration, it forms an ulcer. The edge of the ulcer has a granulation formation on the base. The lymph nodes in the vicinity are swollen. In the past, there was a history of tuberculosis, and the early tuberculin test was negative. And histological changes, etc., can be diagnosed.
1. Hard squat: There is a history of contact with sexually transmitted diseases, which occurs mostly in the genital area. The nearby lymph nodes can be swollen but not ruptured, and the syphilis is positive.
2. Sporotrichosis: Lymph nodes are often not swollen, and many lesions occur, and spores can be cultured.
