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.

  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