Información del artículo
Abstract
Pulmonary and cutaneous tuberculosis are caused by Mycobacterium tuberculosis. According to data from the World Health Organization, there are around 8 million new cases per year. The incidence of cutaneous tuberculosis has risen in parallel with that of pulmonary tuberculosis, and coinfection by M tuberculosis and human immunodeficiency virus is considered to be one of the main causes. Current diagnostic methods for pulmonary and extrapulmonary tuberculosis are far from perfect, leading to a delay in starting appropriate therapy. We present a review of these diagnostic methods and of their use in the cutaneous forms. In conclusion, histopathologic findings and isolation of M tuberculosis in cultures of biopsy material or by polymerase chain reaction are the most useful diagnostic tools in cutaneous tuberculosis.
Key words:
cutaneous tuberculosis
diagnosis
mycobacteriosis
Resumen
La tuberculosis pulmonar y cutánea está causada por Mycobacterium tuberculosis. Según datos de la Organización Mundial de la Salud (OMS) se presentan alrededor de 8 millones de casos nuevos al año. La incidencia de la tuberculosis cutánea se ha incrementado paralelamente con la de la tuberculosis pulmonar. La coinfección de M. tuberculosis y el virus de la inmunodeficiencia humana (VIH) se considera una de las principales causas. Los métodos diagnósticos utilizados en la actualidad para la identificación de tuberculosis tanto pulmonar como extrapulmonar dejan un amplio margen de error, retrasando el inicio de un tratamiento oportuno. Presentamos una revisión de dichos métodos y de su aplicación en las formas cutáneas. En conclusión, los hallazgos histopatológicos y el aislamiento de M. tuberculosis en cultivos de biopsias o por reacción en cadena de la polimerasa (PCR) son las herramientas diagnósticas más útiles para la tuberculosis cutánea.
Palabras clave:
tuberculosis cutánea
diagnóstico
micobacteriosis
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References
[1.]
Alianza Alto a la Tuberculosis y Organización Mundial de la Salud.
Plan Mundial para Detener la Tuberculosis 2006-2015.
Organización Mundial de la Salud, (2006),
[2.]
M.C. Fariña, M.I. Gegundez, E. Piqué, J. Esteban, L. Martín, L. Requena, et al.
Cutaneous tuberculosis: a clinical, histopathologic, and bacteriologic study.
J Am Acad Dermatol, 33 (1995), pp. 433-440
[3.]
M. Sàbat, M. Ribera, J.M. Casanova, I. Bielsa, M.J. Fuente, C. Ferrándiz.
Carcinoma epidermoide sobre lupus vulgar.
Actas Dermosifiliogr, 94 (2003), pp. 616-619
[4.]
I. Kivanc-Altunay, Z. Baysal, T.R. Ekmekci, A. Koslu.
Incidence of cutaneous tuberculosis in patients with organ tuberculosis.
Int J Dermatol, 42 (2003), pp. 197-200
[5.]
E. Roche, M.L. García Melgares, J.J. Vilata, J.M. Fortea.
Escrofuloderma de larga evolución.
Actas Dermosifiliogr, 96 (2005), pp. 522-524
[6.]
J.A. Caminero, M. Casal, V. Auxina, J.M. Pina, J. Sauret.
Recomendaciones SEPAR. Diagnóstico de la tuberculosis.
Arch Bronconeumol, 32 (1996), pp. 85-99
[7.]
Diagnostic Standards and Classification of Tuberculosis in Adults and Children.
This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July 1999. This statement was endorsed by the Council of the Infectious Disease Society of America.
Am J Respir Crit Care Med, 161 (2000), pp. 1376-1395
[8.]
M. Pai, A. Ramsay, R. O’Brien.
Evidence-based tuberculosis diagnosis.
PLoS Med, 5 (2008), pp. e156
[9.]
G. Tappeiner, K. Wolff.
Tuberculosis and other mycobacterial infections.
Fitzpatrick's Dermatology in General Medicine, 6th ed., pp. 1933-1949
[10.]
M. Ramos-e-Silva, M.C. Ribeiro de Castro.
Mycobacterial infections.
Dermatology, pp. 1145-1164
[11.]
O.W. Tincopa Wong, L. Sánchez Saldana.
Tuberculosis cutánea.
Dermatol Peru, 13 (2003), pp. 195-214
[12.]
C. Varas, P. Eguino, J. Gardeazabal, J.L. Diaz-Pérez.
Tuberculosis cutánea en cicatriz quirúrgica.
Actas Dermosifiliogr, 94 (2003), pp. 412-413
[13.]
C. Serra Guillén, C. Requena, A. Alfaro, L. Hueso, E. Nagore, R. Botella Estrada, et al.
Lupus vulgar de 50 años de evolución.
Actas Dermosifiliogr, 96 (2005), pp. 376-378
[14.]
P.F. Hsiao, C.Y. Tzen, H.C. Chen, H.Y. Su.
Polymerase chain reaction based detection of Mycobacterium tuberculosis in tissues showing granulomatous inflammation without demonstrable acid-fast bacilli.
Int J Dermatol, 42 (2003), pp. 281-286
[15.]
N. Senturk, S. Sahin, T. Kocagoz.
Polymerase chain reaction in cutaneous tuberculosis: is it a reliable diagnostic method in paraffin-embedded tissues?.
Int J Dermatol, 41 (2002), pp. 863-866
[16.]
R. Zenteno Cuevas.
Pasado, presente y futuro de las técnicas diagnósticas de tuberculosis.
Rev Inst Nal Enf Resp Mex, 16 (2003), pp. 181-186
[17.]
M.C. Cruciani, M. Scarparo, O. Malena, G. Bosco, C. Serpelloni, C. Mengoli.
Meta-analysis of BACTEC MGIT 960 and BACTEC 460 TB, with or without solid media, for detection of mycobacteria.
J Clin Microbiol, 42 (2004), pp. 2321-2325
[18.]
K.C. Umapathy, R. Begum, G. Ravichandran, F. Rahman, C.N. Paramasivan, V.D. Ramanathan.
Comprehensive findings on clinical, bacteriological, histopathological and therapeutic aspects of cutaneous tuberculosis.
Trop Med Int Health, 11 (2006), pp. 1521-1528
[19.]
S.H. Tan, B.H. Tan, C.L. Goh, K.C. Tan, M.F. Tan, W.C. Ng, et al.
Detection of Mycobacterium tuberculosis DNA using polymerase chain reaction in cutaneous tuberculosis and tuberculids.
Int J Dermatol, 38 (1999), pp. 122-127
[20.]
V. Loera-Castañeda, J. Sánchez-Corona, M.C. Morán-Moguel.
El papel de las técnicas de biología molecular en el diagnóstico y control de tuberculosis.
Gac Med Mex, 3 (2003), pp. 288-290
[21.]
O. Welsh, L. Vera-Cabrera, M. Fernández-Reyes, M. Gómez, J. Ocampo-Candiani.
Cutaneous tuberculosis confirmed by PCR in three patients with biopsy and culture negative for Mycobacterium tuberculosis.
Int J Dermatol, 46 (2007), pp. 734-735
[22.]
M. Ramam, M. Rashimi, V. Ramesh.
How soon does cutaneous tuberculosis respond to treatment? Implications for a therapeutic test of diagnosis.
Int J Dermatol, 44 (2005), pp. 121-124
[23.]
P. Ena, L.A. Sechi, S. Saccabusi, P. Molicotti, M.P. Lorrai, M. Siddi, et al.
Rapid identification of cutaneous infections by nontubercular mycobacteria by polymerase chain reaction-restriction analysis length polymorphism of the hsp65 gene.
Int J Dermatol, 40 (2001), pp. 495-499
[24.]
N. Salian, J. Rish, M. Husain, K. Eisenach, D. Cave, A. Rendón, et al.
Detection of Mycobacterium tuberculosis in formalin-fixed, paraffin-embedded tissue using a polymerase chain reaction.
Am J Respir Crit Care Med, 153 (1996), pp. 1419-1423
[25.]
R.L. Houghton, M.J. Lodes, D.C. Dillon, L.D. Reynolds, C.H. Day, P.D. McNeill, et al.
Use of multiepitope polyproteins in serodiagnosis of active tuberculosis.
Clin Diagn Lab Immunol, 9 (2002), pp. 883-891
[26.]
Y.B. Amor, E. Shashkina, S. Johnson, P.J. Bifani, N. Kurepina, B. Kreiswirth, et al.
Immunological characterization of novel secreted antigens of Mycobacterium tuberculosis.
Scand J Immunol, 61 (2005), pp. 139-146
[27.]
S.S. Negi, R. Anand, S.F. Basir, S.T. Pasha, S. Gupta, S. Khare, et al.
Protein antigen b (Pab) based PCR test in diagnosis of pulmonary and extra-pulmonary tuberculosis.
Indian J Med Res, 124 (2006), pp. 81-88
[28.]
A.M. Desai, S. Hsu.
Medical pearl: interpretation of tuberculin skin test in patients who have received the BCG vaccine.
J Am Acad Dermatol, 53 (2005), pp. 868-869
[29.]
G.H. Mazurek, J. Jereb, P. Lobue, M.F. Iademarco, B. Metchock, A. Vernon.
Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States.
MMWR Recomm Rep, 54 (2005), pp. 49-55
[30.]
T. Meier, H.P. Eulenbruch, P. Wrighton-Smith, G. Enders, T. Regnath.
Sensitivity of a new commercial enzyme-linked immunospot assay (T SPOT-TB) for diagnosis of tuberculosis in clinical practice.
Eur J Clin Microbiol Infect Dis, 24 (2005), pp. 529-536
[31.]
R.L.V. Skjøt, T. Oettinger, I. Rosenkrands, P. Ravn, I. Brock, S. Jacobsen, et al.
Comparative evaluation of low molecular mass proteins from Mycobacterium tuberculosis identifies members of the ESAT-6 family as immunodominant T cell antigens.
Infect Immun, 68 (2000), pp. 214-220
[32.]
A.A. Pathan, K.A. Wilkinson, P. Klenerman, H. McShane, R.N. Davidson, G. Pasvol, et al.
Direct ex vivo analysis of antigen-specific IFN-g-secreting CD4 T cells in Mycobacterium tuberculosis-infected individuals: associations with clinical disease state and effect of treatment.
J Immunol, 167 (2001), pp. 5217-5225
[33.]
J. Pollock, P. Andersen.
The potential of the ESAT-6 antigen secreted by virulent mycobacteria for specific diagnosis of tuberculosis.
J Infect Dis, 175 (1997), pp. 1251-1254
[34.]
P. Ravn, M.E. Munk, A.B. Andersen, B. Lundgren, J.D. Lundgren, L.N. Nielsen, et al.
Prospective evaluation of a wholeblood test using Mycobacterium tuberculosis-specific antigens ESAT-6 and CFP-10 for diagnosis of active tuberculosis.
Clin Diagn Lab Immunol, 12 (2005), pp. 491-496
[35.]
T. Mori, M. Sakatani, F. Yamagishi, T. Takashima, Y. Kawabe, K. Nagao, et al.
Specific detection of tuberculosis infection: an interferon-gamma-based assay using new antigens.
Am J Respir Crit Care Med, 170 (2004), pp. 59-64
[36.]
A.S. Mustafam, F. Oftung, H.A. Amoudy, N.M. Madi, A.T. Abal, F. Shaban, et al.
Multiple epitopes from the Mycobacterium tuberculosis ESAT-6 are recognized by antigen-specific human T cell lines.
Clin Infect Dis, 30 (2000), pp. S201-S205
[37.]
L. Pinxteren, P. Ravn, E. Agger, J. Pollock, P. Andersen.
Diagnosis of tuberculosis based on two specific antigens ESAT-6 and CFP-10.
Clin Diagn Lab Immunol, 7 (2000), pp. 155-160
[38.]
M. Pai, L.W. Riley, J.M. Colford Jr..
Interferon-gamma assays in the immunodiagnosis of tuberculosis: a systematic review.
Lancet Infect Dis, 4 (2004), pp. 761-776
[39.]
P.C. Hill, R.H. Brookes, A. Fox, D. Jackson-Sillah, D.J. Jeffries, M.D. Lugos, et al.
Longitudinal assessment of an ELISPOT test for Mycobacterium tuberculosis infection.
PLoS Med, 4 (2007), pp. e192
[40.]
R. Diel, R. Loddenkemper, K. Meywald-Walter, S. Niemann, A. Nienhaus.
Predictive value of a whole-blood IFN-g assay for the development of active TB disease.
Am J Respir Crit Care Med, 177 (2008), pp. 1164-1170
[41.]
D.P. Dosanjh, T.S. Hinks, J.A. Innes, J.J. Deeks, G. Pasvol, S. Hackforth, et al.
Improved diagnostic evaluation of suspected tuberculosis.
Ann Intern Med, 148 (2008), pp. 325-336
[42.]
G. Ferrara, M. Losi, R. D’Amico, P. Roversi, R. Piro, M. Meacci, et al.
Use in routine clinical practice of two commercial blood tests for diagnosis of infection with Mycobacterium tuberculosis.
Lancet, 367 (2006), pp. 1328-1334
[43.]
D.S.M. Van-Lume, J.R. de Souza, W.G. Melo, V.L. Melo, M.M.L. Cabral, J.C. Rego, et al.
Preliminary results in the immunodiagnosis of tuberculosis in children based on T cell responses to ESAT-6 and PPD antigens.
Mem Inst Oswaldo Cruz [online], 103 (2008), pp. 401-404
[44.]
E. Julián, L. Matas, A. Pérez, J. Alcaide, M.A. Lanéelle, M. Luquin.
Serodiagnosis of tuberculosis: comparison of Immunoglobulin A (IgA) response to sulfolipid I with IgG and IgM responses to 2,3-diacyltrehalose, 2,3,6-triacyltrehalose, and cord factor antigens.
J Clin Microbiol, 40 (2002), pp. 3782
[45.]
C. Coitinho, R. San Martín, C. Mier, R. Rodríguez, S. Zuzino Torres, C. Rivas.
Utilidad de la dosificación de adenosin deaminasa en el diagnóstico de la tuberculosis pleural. Primera experiencia nacional.
Rev Med Urug, 23 (2007), pp. 19-24
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