Subcutaneous tuberculosis and fistulose

Last Updated: 2019-08-27

Author(s): -

Special form of tuberculosis cutis colliquativa.

Multiple fistulas with purulent secretion.

  • Clinic
  • Biopsy (both dermatopathological and microbiological examination).
  • Tuberculin test (Mendel-Mantoux). 
  • Quantiferon test. 
  • Possible participation in the system:
  • Thorax X-ray or CT thorax.
  • Sonography of the abdomen and kidneys.
  • In the morning on 3 consecutive days collect sputum (sober up to 4h).
  • In the morning, give urine on 3 consecutive days (fluid restriction the evening before!).
  • Bronchoalveolar lavage (BAL).

Especially localized in the anogenital region.

Abscesses, tuberculoid structures.

Therapy schedule:

  • The initial phase should last 8 weeks/2 months. During this time, the majority of bacteria are killed. In the following therapy phase (which lasts for months), an attempt is made to eliminate the remaining bacteria. The antituberculous therapy should be continued for at least 2 months after the absence of skin symptoms. 
  • The therapy should last individually between 12-24, but at least 6 months!

Induction phase (2 months):

  • Rifampicin p.o. 10 mg/kg bw/ d
  • Isoniazid p.o. 5 mg/kg bw. (with Vit B 6)
  • Pyrazinamid 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 month at ½ .

 

·         Consolidation phase:

  • Induction phase (2 months): 
  • Rifampicin p.o. 10 mg/kg bw/ d 
  • Isoniazid p.o. 5 mg/kg bw. (with Vit B 6) 
  • Ethambutol p.o. 15 mg/kg bw/d (may be omitted if isoniazid resistance has been excluded) 
  • HIV patients.: Therapy must be done at ≥ for 7 months. Ethambutol should be replaced by streptomycin p.o. 15-20 mg/kg bw/d (from > 60 years max 750 mg) in case of additional therapy with NNRTI. 
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