Skin biopsy: a pillar in the identification of cutaneous Mycobacterium tuberculosis infection

  • Alejandro Hernández Solis Hospital General de México y Facultad de Medicina, UNAM, Mexico
  • Norma Estela Herrera González Sección de Posgrado, Escuela Superior de Médicina, IPN, Mexico
  • Fernando Cazarez Instituto de Diagnóstico y Referencia Epidemiológica, Secretaria de Salud, Mexico
  • Patricia Mercadillo Pérez Hospital General de México y Facultad de Medicina, UNAM, Mexico
  • Hiram Olivera Diaz Instituto de Diagnóstico y Referencia Epidemiológica, Secretaria de Salud, Mexico
  • Alejandro Escobar-Gutierrez Instituto de Diagnóstico y Referencia Epidemiológica, Secretaria de Salud, Mexico
  • Ileana Cortés Ortíz Instituto de Diagnóstico y Referencia Epidemiológica, Secretaria de Salud, Mexico
  • Heleodora González González Hospital General de México y Facultad de Medicina, UNAM, Mexico
  • Arturo Reding-Bernal Hospital General de México y Facultad de Medicina, UNAM, Mexico
  • Raúl Cícero Sabido Hospital General de México y Facultad de Medicina, UNAM, Mexico
Keywords: cutaneous tuberculosis, polymerase chain reaction (PCR), Mycobacterium tuberculosis

Abstract

Introduction: The present study aimed to establish the frequency and clinical characteristics of cutaneous tuberculosis among Mexican adult patients.

Methodology: Ninety-five patients with clinically compatible lesions to cutaneous tuberculosis participated in the study. All patients were HIV negative and none of them had previous anti-TB treatment. A skin biopsy was taken from every patient suspected of having tuberculosis, and a histopathologic examination was performed as follows: Ziehl-Neelsen staining; culturing of mycobacteria by Löwenstein-Jensen (L-J) medium; Mycobacteria Growth Indicator Tube detection via BACTEC (MGIT-360); and polymerase chain reaction (PCR) with the sequence of insertion IS6110 for Mycobacterium tuberculosis complex.

Results: Tuberculosis was confirmed in 65 out of 95cases (68.4%). Identified lesions were scrofuloderma (42 cases, 64.6%); lupus vulgaris (12 cases, 18.4%); warty tuberculosis (six cases, 9.2%); and papulonecrotic tuberculoid (five cases; 7.7%). The Ziehl-Neelsen staining was positive for acid fast bacilli in nine cases (13.8%) and 48 patients were positive for the PCR amplification (73.8%). All skin biopsies resulted positive for tuberculosis. A positive clinical response to the specific treatment was considered a confirmation for tuberculosis. The noninfectious etiology corresponded to 30 cases (31.6%).

Conclusions: Tuberculosis in developing countries is still an important cause of skin lesions which must be studied via histopathological examination and culture due to their low bacillary load. A PCR test is necessary to obtain faster confirmation of the disease and to establish an early, specific and effective treatment.  

Author Biographies

Alejandro Hernández Solis, Hospital General de México y Facultad de Medicina, UNAM, Mexico

Hospital General de México

Investigador en Ciencias Medicas B. UNIDAD DE NEUMOLOGIA

Norma Estela Herrera González, Sección de Posgrado, Escuela Superior de Médicina, IPN, Mexico

Hospital General de México

Investigador en Ciencias Medicas B. UNIDAD DE NEUMOLOGIA

Fernando Cazarez, Instituto de Diagnóstico y Referencia Epidemiológica, Secretaria de Salud, Mexico

Hospital General de México

Investigador en Ciencias Medicas B. UNIDAD DE NEUMOLOGIA

Patricia Mercadillo Pérez, Hospital General de México y Facultad de Medicina, UNAM, Mexico

Hospital General de México

Investigador en Ciencias Medicas B. UNIDAD DE NEUMOLOGIA

Hiram Olivera Diaz, Instituto de Diagnóstico y Referencia Epidemiológica, Secretaria de Salud, Mexico

Hospital General de México

Investigador en Ciencias Medicas B. UNIDAD DE NEUMOLOGIA

Alejandro Escobar-Gutierrez, Instituto de Diagnóstico y Referencia Epidemiológica, Secretaria de Salud, Mexico

Hospital General de México

Investigador en Ciencias Medicas B. UNIDAD DE NEUMOLOGIA

Ileana Cortés Ortíz, Instituto de Diagnóstico y Referencia Epidemiológica, Secretaria de Salud, Mexico

Hospital General de México

Investigador en Ciencias Medicas B. UNIDAD DE NEUMOLOGIA

Heleodora González González, Hospital General de México y Facultad de Medicina, UNAM, Mexico

Hospital General de México

Investigador en Ciencias Medicas B. UNIDAD DE NEUMOLOGIA

Arturo Reding-Bernal, Hospital General de México y Facultad de Medicina, UNAM, Mexico

Hospital General de México

Investigador en Ciencias Medicas B. UNIDAD DE NEUMOLOGIA

Raúl Cícero Sabido, Hospital General de México y Facultad de Medicina, UNAM, Mexico

Hospital General de México

Investigador en Ciencias Medicas B. UNIDAD DE NEUMOLOGIA

Published
2012-08-21
How to Cite
1.
Solis AH, González NEH, Cazarez F, Pérez PM, Diaz HO, Escobar-Gutierrez A, Ortíz IC, González HG, Reding-Bernal A, Sabido RC (2012) Skin biopsy: a pillar in the identification of cutaneous Mycobacterium tuberculosis infection. J Infect Dev Ctries 6:626-631. doi: 10.3855/jidc.2729
Section
Original Articles