Tuberculous primary complex
Last Updated: 2019-08-27
ICD11: -
Last Updated: 2019-08-27
Author(s): Anzengruber F., Navarini A.
ICD11: -
Tuberculous chancre.
Usually in the intestine, lungs and rarely on the skin occurring primary complex at first contact with the pathogen.
Mostly found in children in endemic areas.
A small, ulcerating papule or lump (possibly > 5 cm in size) may occur at the site of entry. Even after weeks, no healing is in sight.
Locoregional lymph node adenopathy and lymphangitis. Melting and perforation may occur.
Feeding tuberculosis is called infection by contaminated milk and subsequent tonsil infection. The tonsil change (primary infection) is rather inconspicuous, while cervically a locoregional lymph node adenopathy is visible.
Circumcision tuberculosis: Tuberculosis infection that occurs during circumcision.
Clinic.
Collect sputum in the morning for 3 consecutive days (up to 4 hours sober).
In the morning deliver urine on 3 consecutive days (fluid restriction the evening before!).
Bronchoalveolar lavage (BAL).
Initially uncharacteristic. After about 1 month tuberculous granulomas appear.
Lupus vulgaris or erythema nodosum may develop.
Therapy regimen:
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) the remaining bacteria are eliminated. The anti-tubercular therapy should be continued for at least 2 months after the skin is free of symptoms.
The therapy should last individually between 12-24, but at least 6 months!
Induction phase (2 months):
Pyrazinamide p.o. 35 mg/ bw/ d possibly in 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:
Isoniazid p.o. 5 mg/kg bw. (with Vit B 6)
Ethambutol p.o. 15 mg/kg bw/ d (may also be omitted if isoniazide resistance is excluded)
HIV patient: Therapy must take place at ≥ for 7 months. Ethambutol should be replaced by streptomycin p.o. 15-20 mg/kg bw/ d (from > 60 J. max 750 mg) for additional therapy with NNRTI.
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