derma- mycobacterial infection Flashcards
Endogenous cutaneous tb
LV lupus vulgaris SD scrofula derma MTA metastatic tb abscess AMT acute miliary TB OT orificial tb
exogenous cutaneous tb
PIT primary inoculation tb
TVC tb verrucosa cutis
Cutaneous TB common in infant
PIT
Cutaneous TB via opercutaneous inoculatin, occurs at inoculated site of nonimmune host
PIT
Cutaneous TB common in male
TVC
Cutaneous TB common in female
LV
Cutaneous TB via Percutaneous inoculation, occurs in inoculated site in individual with prior tb infection
TVC
Cutaneous TB common in 3rd world country and tropics
TVC
Cutaneous TB common in all ages
LV
Cutaneous TB common in adolescent and elderly
SD
Cutaneous TB common in infant and adult who are immunocompromised
AMTRAK
cutaneous TB is also Common in farmer and butchers from what species of mycobacterium
M. Bovis
Papule and painless ulcer (tuberculous chancre) in 2-4wks
PIT
Regional LA in 3-8wks
PIT
SOP of PIT
Exposed skin of minor injuries
Papule with violaceous halo (hyperkeratosis, warty, firm plaque, irregular borders)
No LA
TVC
SOP of TVC
Dorsolat hands and fingers
Children- Lowe ext and knees
Soft flat papule, ill defined with smooth surface and slightly scaly
LV
Apple jelly color on diascopy
LV
SOP of LV
Head and neck
Hyperkeratotic form of LV = soft tumorous nodule
Ulcerative form of LV = punched out, serpinginous
Firm, subQ nodule, irrev deep seated which liquifies and perforates
SD
SOP of SD
Parotid, submandibular, supraclavicular
Lat neck
Contiguous spread from affected LN
SD
Most common opportunistic infection in hiv pts in developing countries
TB
Route of cutaneous TB
Exogenous
Endogenous
By autoinoculation
Oral lesions in tb Develops when..
Ingestion of bovine bacilli in nonpasteurized milk
Tuberculous gumma
MTA
SubQ abscess, no tender, cold fluctuant to fistula and ulcer.
MTA
SOP of MTA
Sites of previous trauma
Small yellowih nodule with painful irreg ulcer with undermined borders
OT
Results form autoinoculation from progressive TB of internal organs
OT
SOP of OT
Oral, pharyngeal - pulmonary tb
Vulva - GU TB
Anal - intestinal TB
Convert form neg to Pos skin test on wks of infection
PIT
Neg skin test
AMT
May be neg or pos skin test
SD
MTA
OT
Pos skin test
LV
TVC
Pit, without treatment, usually resovles within __mos with some residual scarring
12 mos
LV develops at site of
PIT
Cutaneous TB which are limited to skin and can be excised
PIT
TVC
Management of cutaneous TB
Prolonged Treatment with at least 2 drugs
Isoniazid and rifampin (9mos)
Age of fish tank granuloma
20-40yrs old
Fish tank granuloma is caused by
M. Marinum
Fish tank granuloma is common in m/f
Male
Incubation period of Fish tank granuloma
1wk -2mos
Fish tank granuloma is benign and self limited. May remain active but a singe papulonodular lesion resolves in
3mos to 3yrs
Prophylaxis for Fish tank granuloma
Wear waterproof gloves
Drug of choice for Fish tank granuloma
Clarithromycin
Also ethambutol and rifampin
Age of buruli /bairnsdale ulcer
Children and young adult
Etiology of buruli /bairnsdale ulcer
M. Ulcerans
Sex of buruli/bairnsdale ulcer
Male
Got from pricks or cuts from plants (wet, marshy, swampy sites)
Buruli / bairnsdale ulcer
Buruli secretes what toxin
Polyketide toxin (mycolactone)
Incubation period in buruli/bairnsdale
3mos
Painful/painless ulcer in buruli/bairnsdale
Painless subQ ulceration
Why should apply heat to buruli ulcer
Because ulcerana prefer cold temp
T or F: antimycobacteril is effective to buruli ulcer
False. Ineffective
Hansen’s disease
Leprosy
Chronic granulomatous disease
Leprosy
Mycobacterium leprae prefers hot/cold temp
Prefers cold temp
T or F: Mycobacterium are obligate afb
True
Localized skin involvement and peripheral n involvement
Few org in skin biopsies
Tuberculoid TLC
Generalized involvement
Skin, upper respi mm, RES, adrenal, tested
Many bacilli
Lepromatous LL
Combi of tuberculoid and lepromatous
Many bacilli
Borderline dimorphic BL
Classif of leprosy:
Very early lesion
Host response is indeterminate rather than diagnosis
Indeterminate and transitional form
Leprosy common in M/F
Male
T or F: leprosy has direct relations between skin color and severity of disease
False, inverse relation
Main reservoir in leprosy
Humans
Other than human, what is the reservoirs of leprosy
Armadillo
Mangabey monkey
Chimpanzees
Mode of trnasmiission of leprosy
Uncertain
Droplet infection
Contact with infected soil
Insect vector
Clinical expression of body to leprosy infection
Development of granuloma
Downgrading and reversal reaction
Lepra type 1 reaction
Disease in lepra type 1
Borderline disease BT BL
Why does downgrading occurs
Before therapy
When does reversal occurs
In response to therapy
Lepra type: acutely inflamed, with edema (face, hands, feet) and pain
Type 1
Erythema nodosum leprosum
Lepra 2
Patients in lepra type 2
LL
When does lepra type 2 occurs
After initiation of therapy (within first 2yrs)
Lepra type: painful red skin nodules superficially and deeply. Form abscess and ulcer on face and ext
Lepra type2
Lepra type: irreg erythema plaque. Many resolve spont or necrosis with ulceration
Lucio’s reaction
Lepra type: shallow large polygonal sloughing ulceration
Lucio’s reaction
Lepra type: variant of ENL or sec to arteriolar occlusion
Lucio’s reaction
Leprosy type: Hypo pigmented hypesthetic macule with raised edges (becomes atopic or depressed)
TT, BT
Leprosy type: its advanced lesion results to anesthetic and devoid of skin appendages
TT, BT
TT/BT: may resolve spont, not associated with Lepra reaction
TT
TT/BT: do not heal spont, type 1 lepra reaction
BT
Nerve involved in TT or BT
Ulnar nerve (pinprick test, temp, vibration)
Incubation period of tuberculoid leprosy
2-40yrs (5-7yrs)
Leprosy type: insidious onset and painless. PNS with persistent or recurrent painful numbness. no trauma
TT! BT
Leprosy type: punched out patches
Borderline leprosy
Leprosy type: diffuse derma infiltration and thickened Dermis
Diffuse lepromatosis
T or F: nerve involvement in LL is more extensive than TT
True
Leprosy type: histoid nodule
LL
PE of leprosy extremities
Sensory neuropathy
Plantar ulcers
Ulnar and peroneal palsy
Charcot jts
PE of leprosy nose
Chronic nasal congestion
Epistaxis
Saddle nose deformity
PE of leprosy eyes
Cranial nerve palsies
Lagophthalmus
LL: anterior chamber
Corneal damage
PE of leprosy testes
Hypogonadism
Pauli-bacillary
1-5 lesions
- afb
TT and BT
Multibacillary
> 5 lesions
+ afb
BB, LL, BL
Treatment for paucibacillary
Dapsone plus rifampin for 6mos
Treatment for multi bacillary
Dapsone
Clofazimine
Rifampin
Monthly for 1yrn
Slit skin smear
Leprosy
M. Leprae has not been cultured in vitro. It grows when inoculated into the
Mouse foot pad
Cardinal findings in leprosy
Pt from endemic area
Skin lesion with diminished or loss of sensation
Enlarged peripheral nerves
M. Leprae in skin
T or F: amyloidisis can complicate long standing leprosy
True
Course and prognosis of BT
2-4mos
Course and prognosis of BL
9mos
Course and prognosis of lepra type 2
Within 2 yrs
