Tuberculosis and Leprosy

Scollard, David M.; Dacso, Mara M.; Abad-Venida, Ma. Luisa

doi:10.1016/j.det.2015.03.016

Cited by 30 publications

(43 citation statements)

References 84 publications

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“…The precise mode of transmission of leprosy remains uncertain but probably involves human-to-human contact through respiratory droplets (29,30,(45)(46)(47) or through blood transfusion (48). Ecological data suggest that environmental factors, such as trauma or skin breaks during soil and water exposures, insect vectors, free-living amoebas, and animal reservoirs (e.g., armadillos, squirrels, felines, or other animals), influence leprosy transmission (39,47,(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63). Zoonotic transmission from armadillos acting as reservoirs of infection has been confirmed for autochthonous southeast United States cases (51,52).…”

Section: Mycobacterial Species As Human Pathogensmentioning

confidence: 99%

“…Cutaneous forms of tuberculosis are a rare clinical manifestation of M. tuberculosis or M. bovis infection, comprising approximately only 1 to 2% of all TB cases (47,(64)(65)(66)(67). In settings where immunization programs administer the bacillus Calmette-Guérin (BCG) vaccine, an attenuated form of M. bovis, cutaneous complications, including local reactions, abscess formation, ulcerations, scrofuloderma, and, rarely, disseminated infections, may occur (64,65).…”

Section: Cutaneous Tuberculosismentioning

confidence: 99%

“…Visceral tuberculosis (pulmonary or extrapulmonary) is rarely associated with concomitant cutaneous involvement (68). However, when it occurs, it is usually in the form of scrofuloderma or lupus vulgaris (47,(67)(68)(69)(70). The ability to culture M. tuberculosis facilitates the diagnosis of the cutaneous disease, in contrast to M. leprae (47).…”

Section: Cutaneous Tuberculosismentioning

confidence: 99%

“…However, when it occurs, it is usually in the form of scrofuloderma or lupus vulgaris (47,(67)(68)(69)(70). The ability to culture M. tuberculosis facilitates the diagnosis of the cutaneous disease, in contrast to M. leprae (47). Therefore, the gold standard for diagnosing cutaneous tuberculosis is mycobacterial culture of skin biopsy specimens or via molecular detection (47,71).…”

Section: Cutaneous Tuberculosismentioning

confidence: 99%

“…The ability to culture M. tuberculosis facilitates the diagnosis of the cutaneous disease, in contrast to M. leprae (47). Therefore, the gold standard for diagnosing cutaneous tuberculosis is mycobacterial culture of skin biopsy specimens or via molecular detection (47,71). Depending on the BCG vaccination status, tuberculin skin testing using purified protein derivative has a specificity of 63% and a sensitivity between 33 and 96% for cutaneous tuberculosis (47,72).…”

Section: Cutaneous Tuberculosismentioning

confidence: 99%

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Cutaneous Mycobacterial Infections

et al. 2018

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SUMMARY Humans encounter mycobacterial species due to their ubiquity in different environmental niches. In many individuals, pathogenic mycobacterial species may breach our first-line barrier defenses of the innate immune system and modulate the activation of phagocytes to cause disease of the respiratory tract or the skin and soft tissues, sometimes resulting in disseminated infection. Cutaneous mycobacterial infections may cause a wide range of clinical manifestations, which are divided into four main disease categories: (i) cutaneous manifestations of Mycobacterium tuberculosis infection, (ii) Buruli ulcer caused by Mycobacterium ulcerans and other related slowly growing mycobacteria, (iii) leprosy caused by Mycobacterium leprae and Mycobacterium lepromatosis, and (iv) cutaneous infections caused by rapidly growing mycobacteria. Clinically, cutaneous mycobacterial infections present with widely different clinical presentations, including cellulitis, nonhealing ulcers, subacute or chronic nodular lesions, abscesses, superficial lymphadenitis, verrucous lesions, and other types of findings. Mycobacterial infections of the skin and subcutaneous tissue are associated with important stigma, deformity, and disability. Geography-based environmental exposures influence the epidemiology of cutaneous mycobacterial infections. Cutaneous tuberculosis exhibits different clinical phenotypes acquired through different routes, including via extrinsic inoculation of the tuberculous bacilli and dissemination to the skin from other sites, or represents hypersensitivity reactions to M. tuberculosis infection. In many settings, leprosy remains an important cause of neurological impairment, deformity, limb loss, and stigma. Mycobacterium lepromatosis, a mycobacterial species related to M. leprae, is linked to diffuse lepromatous leprosy of Lucio and Latapí. Mycobacterium ulcerans produces a mycolactone toxin that leads to subcutaneous tissue destruction and immunosuppression, resulting in deep ulcerations that often produce substantial disfigurement and disability. Mycobacterium marinum, a close relative of M. ulcerans, is an important cause of cutaneous sporotrichoid nodular lymphangitic lesions. Among patients with advanced immunosuppression, Mycobacterium kansasii, the Mycobacterium avium-intracellulare complex, and Mycobacterium haemophilum may cause cutaneous or disseminated disease. Rapidly growing mycobacteria, including the Mycobacterium abscessus group, Mycobacterium chelonei, and Mycobacterium fortuitum, are increasingly recognized pathogens in cutaneous infections associated particularly with plastic surgery and cosmetic procedures. Skin biopsies of cutaneous lesions to identify acid-fast staining bacilli and cultures represent the cornerstone of diagnosis. Additionally, histopathological evaluation of skin biopsy specimens may be useful in identifying leprosy, Buruli ulcer, and cutaneous tuberculosis. Molecular assays are useful in some cases. The treatment for cutaneous mycobacterial infections depends on the specific pathogen and therefore requires a careful consideration of antimicrobial choices based on official treatment guidelines.

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