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.

1. Alavi Darazam I, Shamaei M, Mobarhan M, Ghasemi S, Tabarsi P, Motavasseli M et al. Nocardiosis: risk factors, clinical characteristics and outcome. Iran Red Crescent Med J 2013;15:436-9.
2. Barbagallo J, Tager P, Ingleton R, Hirsch RJ , Weinberg JM. Cutaneous Tuberculosis. American Journal of Clinical Dermatology 2002;3:319-28.
3. Gattuso G, Tomasoni D, Scalzini A , Costa P. [Disseminated nocardiosis in a patient with haemophilia: a problem of differential diagnosis]. Infez Med 2012;20:200-4.
4. Grange JM. Complications of bacille Calmette-Guerin (BCG) vaccination and immunotherapy and their management. Commun Dis Public Health 1998;1:84-8.
5. Macgregor R. Cutaneous tuberculosis. Clinics in Dermatology 1995;13:245-55.
6. MacGregor RR. Cutaneous tuberculosis. Clin Dermatol 1995;13:245-55.
7. Sehgal VN, Bhattacharya SN, Jain S , Logani K. CUTANEOUS TUBERCULOSIS: THE EVOLVING SCENARIO. International Journal of Dermatology 1994;33:97-105.
8. Sehgal VN, Gupta RP, Karmakar S, Logani KB , Jain S. In situ characterization of lymphocytic immunophenotypes and interleukin-2 receptors in cutaneous tuberculosis and leprosy-a comparative evaluation. Clin Exp Dermatol 1994;19:312-6.
9. Yates VM , Ormerod LP. Cutaneous tuberculosis in Blackburn district (U.K.): a 15-year prospective series, 1981-95. Br J Dermatol 1997;136:483-9.
10. Yu CT, Tsai YH, Leu HS , Shieh WB. [Pulmonary nocardiosis with skin and subcutaneous dissemination. An imitator mimicking tuberculosis]. Changgeng Yi Xue Za Zhi 1992;15:54-8.
11. MacGregor RR. Cutaneous tuberculosis. Clin Dermatol 1995;13:245-55.
12. Handog, E. (2016). Cutaneous manifestations of tuberculosis. Uptodate.com. Retrieved 24 May 2016, from http://www.uptodate.com/contents/cutaneous-manifestations-of-tuberculosis?source=search_result&search=tuberkulosis+skin&selectedTitle=1~16
13. Haas, W. (2016). RKI - RKI-Ratgeber für Ärzte - Tuberkulose. Rki.de. Retrieved 24 May 2016, from https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Tuberkulose.html#doc2374486bodyText3