Tuberculous primary complex

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.

  • If the immune system is mostly intact, initial contact with the pathogen occurs. Spontaneous healing is extremely rare. Slight skin defects can often be the cause.
  • Latent period
  • 3–4 weeks.

  • Localizations 
    • Face, gluteal, extremities.
  • 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.

  • Medical History (contact with contaminated milk, infected person, etc.).
  • Clinic.

  • Bacterial swab- if possible.
  • Biopsy (both dermatopathological and microbiological examination).
  • Tuberculin test (Mendel-Mantoux).
  • Quantiferon test.
  • If necessary, e.g. a system participation.
  • Thorax x-ray or CT thorax.
  • Sonography of the abdomen and kidneys.
  • 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.

  • Healing after 1-3 months.
  • 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):

  • Rifampicin p.o. 10 mg/kg KG/ d
  • Isoniazid p.o. 5 mg/kg bw (with Vit B 6)
  • 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:

  • 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 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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