Skin biopsy: a pillar in the identification of cutaneous Mycobacterium tuberculosis infection

J Infect Dev Ctries. 2012 Aug 21;6(8):626-31. doi: 10.3855/jidc.2729.

Abstract

Introduction: The present study aimed to establish the frequency and clinical characteristics of cutaneous tuberculosis among Mexican adult patients.

Methodology: Ninety-five patients with clinically compatible lesions to cutaneous tuberculosis participated in the study. All patients were HIV negative and none of them had previous anti-TB treatment. A skin biopsy was taken from every patient suspected of having tuberculosis, and a histopathologic examination was performed as follows: Ziehl-Neelsen staining; culturing of mycobacteria by Löwenstein-Jensen (L-J) medium; Mycobacteria Growth Indicator Tube detection via BACTEC (MGIT-360); and polymerase chain reaction (PCR) with the sequence of insertion IS6110 for Mycobacterium tuberculosis complex.

Results: Tuberculosis was confirmed in 65 out of 95 cases (68.4%). Identified lesions were scrofuloderma (42 cases, 64.6%); lupus vulgaris (12 cases, 18.4%); warty tuberculosis (six cases, 9.2%); and papulonecrotic tuberculoid (five cases; 7.7%). The Ziehl-Neelsen staining was positive for acid fast bacilli in nine cases (13.8%) and 48 patients were positive for the PCR amplification (73.8%). All skin biopsies resulted positive for tuberculosis. A positive clinical response to the specific treatment was considered a confirmation for tuberculosis. The noninfectious etiology corresponded to 30 cases (31.6%).

Conclusions: Tuberculosis in developing countries is still an important cause of skin lesions which must be studied via histopathological examination and culture due to their low bacillary load. A PCR test is necessary to obtain faster confirmation of the disease and to establish an early, specific and effective treatment.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antitubercular Agents / administration & dosage
  • Bacteriological Techniques
  • Biopsy / methods*
  • Culture Media / chemistry
  • DNA Transposable Elements
  • DNA, Bacterial / genetics
  • Female
  • Histocytochemistry
  • Humans
  • Male
  • Mexico
  • Microscopy
  • Middle Aged
  • Mycobacterium tuberculosis / isolation & purification*
  • Polymerase Chain Reaction / methods
  • Skin / microbiology*
  • Skin / pathology
  • Treatment Outcome
  • Tuberculosis, Cutaneous / diagnosis*
  • Tuberculosis, Cutaneous / microbiology
  • Tuberculosis, Cutaneous / pathology
  • Young Adult

Substances

  • Antitubercular Agents
  • Culture Media
  • DNA Transposable Elements
  • DNA, Bacterial