Tuberculous primary complex

Tuberculous chancre.

Mostly occurring in the intestine, lungs and rarely on the skin, primary complex on first contact with the pathogen.

It occurs mainly in children in endemic areas.

• When the immune system is usually intact, initial contact with the pathogen occurs. Spontaneous healing is extremely rare. Light skin defects can often be the cause.
• Incubation period
• 3-4 weeks.

• Localisations
  • Face, gluteal, extremities.
• At the site of entry, there may be the appearance of a small papule or nodule (ggl. > 5 cm in size) which ulcerates in the course. Even after weeks, no healing is in sight.
• Locoregional lymph node adenopathy and lymphangitis. Meltdown and perforation may occur.

• Feeding tuberculosis is called an infection caused by contaminated milk and subsequent tonsil infection. The tonsillar change (primary infection) is rather inconspicuous, while locoregional lymph node adenopathy is visible cervically.

• Circumcision tuberculosis: Tuberculosis infection, which occurs in the context of circumcision.

• Anamnesis (contact with contaminated milk, infected person, etc.).
• Clinical.
• Bact.
• Biopsy (both dermatopathological and microbiological examination).
• Tuberculin test (Mendel-Mantoux).
• Quantiferone test.
• If necessary, e.g. systemic involvement.
• Thoracic X-ray or CT thorax.
• Sonography of the abdomen and kidneys.
• Collect sputum in the morning on 3 consecutive days (fasting up to 4h).
• Pass urine in the morning on 3 consecutive days (fluid restriction the evening before!).
• Bronchoalveolar lavage (BAL).

Initially uncharacteristic. After about 1 month, tuberculous granulomas first appear.

• Healing after 1-3 months.
• Lupus vulgaris or erythema nodosum may develop.

Therapy regimen:

• The initial phase should last for 8 weeks/2 months. During this time, the majority of the bacteria are killed. In the subsequent phase of therapy (lasting for months), attempts are made to eliminate the remaining bacteria. Antituberculous therapy should be continued for at least 2 months after the skin is free of symptoms.

• Therapy should last individually between 12-24, but at least 6 months!

Induction phase (2 months):

• Rifampicin p.o. 10 mg/kg bw/d
• Isoniazide p.o. 5 mg/kg bw. (with Vit B 6)
• Pyrazinamide p.o. 35 mg/ bw/ d if necessary combination with allopurinol!
• Ethambutol p.o. 15 mg/kg bw/ d
• A clear improvement can be seen in the vast majority of cases after 1 ½ months.

Consolidation phase:

• Induction phase (2 months):
• Rifampicin p.o. 10 mg/kg bw/d
• Isoniazide p.o. 5 mg/kg bw. (with Vit B 6)
• Ethambutol p.o. 15 mg/kg bw/d (can also be omitted if isoniazid resistance has been ruled out)
• HIV patients: therapy must last ≥ 7 months. Ethambutol should be replaced by streptomycin p.o. 15-20 mg/kg bw/d (from > 60 y. max 750 mg) in case of additional therapy with NNRTIs.

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