MMed (Dermatology), Faculty of Health Sciences, University of the Witwatersrand / Introduction: Cutaneous tuberculosis (TB) accounts for about 2 - 3% of all cases
of tuberculosis. It is as a result of direct infection of the skin or immune
responses to antigenic components of Mycobacterium tuberculosis, known as
tuberculids. In sub-Saharan Africa around 70% of patients with tuberculosis are
co - infected with the human immunodeficiency virus (HIV). The prevalence of
HIV in South Africa is approximately 11.4%. There are no studies in South Africa
on the manifestations of cutaneous tuberculosis in the setting of HIV infection.
Aims: The objectives of this study were to determine the clinical and
histopathological spectrum of cutaneous tuberculosis in the Johannesburg area
and to assess the correlation of HIV infection and CD4 count, on the clinical and
pathological presentation.
Patients and Methods: This was a prospective, hospital-based study conducted
over a period of 3 ½ years from Oct 2004 - March 2008. A total of 74 patients
diagnosed with cutaneous tuberculosis who were seen during the above
mentioned period were enrolled for the study. Patients were enrolled from the
three academic hospitals, Johannesburg, Chris Hani Baragwanath and Helen
Joseph. Inclusion criteria included patients aged 10 years and older diagnosed
with cutaneous tuberculosis. Patients from whom consent could not be obtained
and those with lesions caused by non-tuberculous mycobacteria were excluded
from the study.
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The diagnosis was based on clinical and histopathological features as well as
supportive diagnostic tests. Data was captured onto Epi-Info spreadsheet and
then analyzed using STATA data software.
Results: The entire clinical spectrum of lesions of cutaneous TB was seen with
the exception of the nodular and phlebetic tuberculids. Erythema induratum, a
tuberculid was the most common form of cutaneous TB accounting for more than
a third (36.5%) of all cases. Scrofuloderma was the most common true infection
accounting for about 29.7% of all cases. HIV-TB co-infection rate was 61.4%.
The histology ranged from a granulomatous inflammation with absence of bacilli
to a diffuse inflammation with abundance of bacilli.
Conclusions: Despite the high prevalence of TB and high TB-HIV co-infection
rate, cutaneous tuberculosis infection is still relatively uncommon. There is a
however a relative increase in the frequency of true infections particularly
scrofuloderma in comparison with the studies done previously here in South
Africa. The association between HIV positive status and true infections was
statistically significant with p = 0.024 and was not found to be statistically
significant between HIV positive status and tuberculids with p = 0.71.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/8791 |
| Date | 23 September 2010 |
| Creators | Moche, Mohlabe John |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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