Tshisevhe Vhudzani, Mbelle Nontombi, Peters Remco P H
Lancet Laboratories, Rustenburg, South Africa.
Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
South Afr J HIV Med. 2019 Mar 12;20(1):895. doi: 10.4102/sajhivmed.v20i1.895. eCollection 2019.
Extrapulmonary tuberculosis (TB) causes a significant burden of disease worldwide, especially among HIV-infected individuals and those with other immunosuppressive conditions. Cutaneous TB is an important manifestation of extrapulmonary TB but is uncommonly reported in South Africa despite the high burden of HIV and TB co-infection. There is a paucity of published data on clinical presentation and outcome of cutaneous TB in this context. Raising awareness of this condition among clinicians is imperative to improve early diagnosis and optimise treatment outcomes.
In this series, we present three cases of cutaneous TB, two adults and one child, referred to a tertiary hospital from two primary healthcare centres and from a general practitioner. We demonstrate that the clinical presentation is diverse, ranging from papular lesions to abscesses, and that concordant pulmonary TB may be present.
In particular, we show the importance of performing diagnostic procedures (e.g. aspiration) in individuals presenting with an abscess that does not respond to broad spectrum antimicrobial treatment, particularly in those with advanced immunosuppression.
The outcome of our three patients was poor, highlighting the need for earlier diagnosis in this WHO Stage 4 condition and intensive management of clinical cases.
肺外结核病在全球造成了重大疾病负担，尤其是在艾滋病毒感染者和其他免疫抑制状况患者中。皮肤结核是肺外结核的一种重要表现，但尽管南非艾滋病毒和结核病合并感染负担很高，皮肤结核的报告却很少见。在这种情况下，关于皮肤结核临床表现和转归的已发表数据很少。提高临床医生对这种疾病的认识对于改善早期诊断和优化治疗结果至关重要。
在本系列中，我们介绍了三例皮肤结核病例，两名成人和一名儿童，分别来自两个基层医疗中心和一名全科医生转诊至一家三级医院。我们证明其临床表现多样，从丘疹性病变到脓肿不等，并且可能存在并发的肺结核。
特别是，我们展示了对于出现对广谱抗菌治疗无反应的脓肿的个体，尤其是那些有晚期免疫抑制的个体，进行诊断性操作（如抽吸）的重要性。
我们三名患者的预后较差，突出了在这种世界卫生组织4期疾病中进行早期诊断以及对临床病例进行强化管理的必要性。
