A Multicenter Clinical Retrospective Research Of Cutaneous Tuberculosis And Clinical Study Of Tuberculosis Correlated Panniculitis

Cutaneous tuberculosis(CTB) is a relatively rare form of extrapulmonary tuberculosisthat is caused by Mycobacterium tuberculosis(MTB). It may occur as a result of exogenousinoculation of tuberculosis or endogenous spread of the organisms. Most people infectedwith M. tuberculosis contain the initial infection and develop latent tuberculosis infection(LTBI). This state is characterised by the evidence of immune response against thebacterium (a positive tuberculin skin test or T-SPOT.TB) but no signs of active infection.However, reactivation of latent infection occurs several factors, related to both host andbacterium, leading to active and contagious tuberculosis. Cutaneous tuberculosis isfequently elusive as it mimics a wide differential diagnosis and is classified into true CTBor tuberculids.China is one of the high-prevalence of tuberculosis countries. According to previousepidemiology and clinical studies, pulmonary and extrapulmonary tuberculosis’s patterns ofprevalence and clinical manifestation are clearly understood now. Thus the measures oftuberculosis prevention were operated well. Although CTB is a rare form ofextrapulmonary tuberculosis that accounts for approximately1%of TB cases, it should notbe neglected due to China’s high incidence of active TB and LTBI. Up to now, there are alot researches of tuberculosis at other sites both in China and abroad,but also lack of largesample analysis of CTB in domestic. In order to investigate the clinical and epidemiologicalfeatures of CTB, data for CTB were obtained from4clinical centers from different regionsof China in the present study.Tuberculids are generalized exanthems in patients with a moderate or high degree ofimmunity to TB due to previous infection. Nodular vasculitis (NV) and erythema nodosum(EN) are MTB-associated panniculitis that presents with multiple, painful, recurringnodules that affect the lower limbs of women. NV and EN have diverse etiologies with varying pathogeneses leading to similar histological changes and LTBI has been cited asone of the etiologic factors. In order to appraise the correlation between LTBI and NV, weconduct a clinical study of TB-related panniculitis.The paper consists of two chapters:1) Data from four third class A hospitals in Chinawere obtained to determine the patterns of prevalence of CTB.2) To appraise thecorrelation between LTBI and panniculits, we conduct a clinical study of TB relatedpanniculitis.Chapter I A Multicenter Clinical Retrospective Research of CutaneousTuberculosisSubjects Subjects obtained from four third class A hospitals(SouthWest Hospital ofThird Military Medical University, Fourth Military Medical University Affiliated Hospitalof Xijing, Wuhan First Hospital, Hangzhou Third People’s Hospital) were diagnosed withCTB for a total of1194cases.Methods A multicenter retrospective study was done on CTB patients of fourhospitals in China. The data on clinical presentations including general information, clinicalmanifestation, histological findings, past medical history were collected in form.Descriptive method was used for data analysis by SPSS19.0.Results Totally1194CTB cases enrolled in the study, including666of true CTB and528of tuberculids. Among them LV, TVC and EI are the most common types. All the casesare aged from3to86years old and the median age was34.73years old. There were61.87%cases aged10to39years old. CTB is common in youth and middle-aged people.Besides, the rate of males and females is1:1.4. The incidence of CTB were different inyears. In SouthWest Hospital of Third Military Medical University, true tuberculosisdecreased by the year of1960and tuberculids increased from2005and then higher thantrue tuberculosis. But in other3centers, true tuberculosis is higher than tuberculids.Different type of CTB has different lesions and sites. Plaque (38.42%) is common in LV,and hyperplasia is in most manifestation of TVC cases. Other than that, ulcer and erosionare both common in SFD and TCU cases, and nodules are common in EI.Conclusions CTB causes a long course and the median duration is5.5years. LV andTVC are common in true tuberculosis and EI is the most in tuberculids. In different centers the onset age of CTB are almost in the same age group that youth and middle-aged peopletake a major part. The incidence of CTB is different in different years and the maincomposition of CTB is becoming atypical and hard to diagnose.Chapter II Clinical Study of Tuberculosis Correlated PanniculitisSubjects A number of282patients were diagnosed with panniculitis in SouthwestHospital of Third Military Medical University in Chongqing from January2011to August2013.Methods We retrospectively reviewed the clinical and histopathological features of282cases of panniculitis. Based on the TST and T-SPOT.TB, cases were divided intosevaral groups. Among them, cases whose TST results were PPD2+or3+with positiveT-SPOT.TB were treated with triple anti-tuberculosis medicine for9months. These caseswere been followed up in9months for the lesions and recurrence. SPSS19.0was utilizedfor statistical analysis, including Chi-square test, Pearson relative test and so on.Results There were282patients enrolled in the study, including30males and252females. The age ranged from13to75(37.23±13.06) years old. As the results of TST,35(12.42%)patients were negative and247(87.58%) were positive. Among them,106hadT-SPOT.TB test with24negative (22.64%) and82positive (77.36%). The following ofhistopathological changes such as epidermis, different invasive cells,and degree ofgranulomatous infiltrates were associated with PPD results. No significant difference couldbe detected with the T-SPOT.TB results of histopathology. There were82TB-relatedpatients take the triple standard anti-tuberculosis therapy for9months and75patientsfinished the follow-up in which67patients were cured and7patients recurred during thefollow-up period. And all the7patients were recovered finally by regulates theanti-tuberculosis medicine.Conclusions Infection of TB is an important cause of panniculitis. The test oftuberculosis such as TST, T-SPOT.TB and the difference in histopathological manifestationare the clues of TB-related panniculits. We find that treatment by standard anti-tuberculosisregimen is effective in TB-related panniculits.