Cutaneous tuberculosis: diagnosis, histopathology and
               treatment - Part II

Santos, Josemir Belo dos; Figueiredo, Ana Roberta; Ferraz, Cláudia Elise; Oliveira, Márcia Helena de; Silva, Perla Gomes da; Medeiros, Vanessa Lucília Sileira de

doi:10.1590/abd1806-4841.20142747

Acessibilidade / Reportar erro

Brasil

Anais Brasileiros de Dermatologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Continuing Medical Education • An. bras. dermatol. 89 (4) • Jul-Aug 2014 • https://doi.org/10.1590/abd1806-4841.20142747 copy

Cutaneous tuberculosis: diagnosis, histopathology and treatment - Part II^* * Work performed at the Clínica Dermatológica do Hospital das Clínicas da Universidade Federal de Pernambuco (HC/UFPE) - Recife (PE), Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

The evolution in the knowledge of tuberculosis' physiopathology allowed not only a better understanding of the immunological factors involved in the disease process, but also the development of new laboratory tests, as well as the establishment of a histological classification that reflects the host's ability to contain the infectious agent. At the same time, the increasing bacilli resistance led to alterations in the basic tuberculosis treatment scheme in 2009. This article critically examines laboratory and histological investigations, treatment regimens for tuberculosis and possible adverse reactions to the most frequently used drugs.

Erythema induratum; Latent tuberculosis; Mycobacterium tuberculosis; Tuberculosis; Tuberculosis, cutaneous; Tuberculosis, lymph node

Author /year	Type of study	Conclusions
Nimala et al India, 1977	20 cases of CTB versus	In CTB > frequency of epidermic hyperplasia, small areas of ulceration, significant fibrosis and occasional caseous necrosis
Nimala et al India, 1977	20 cases of tuberculoid leprosy
Paksoy and Hekim Turkey, 1993	16 cases of lupusvulgaris versus 12 cases of cutaneous leishmaniasis	Tuberculoid granulomas and giant cells are more frequent in CTB
Min et al South Korea, 2012	15 cases of CTB versus	Giant cells, tuberculoid granulomas, and caseous necrosis were significantly associated to CTB (p< 0.05).
Min et al South Korea, 2012	10 cases of atypical mycobacteriosis

Regimen	Drugs	Weight Range	Unit/dose	Months
Intensive phase	RHZE	20 to 35 Kg	2 tablets	2 Months
	150/75/400/275mg	36 to 50 Kg	3 tablets
	Tablet with combined fixed-dose	>50 Kg	4 tablets
Maintenance Phase	RH	20 to 35 Kg	1 capsule or tablet 300/200mg	4 Months
	300/200mg or 150/100mg capsule or tablet	36 to 50 Kg	1 capsule or tablet 300/200mg + 1 capsule or tablet 150/100mg
		>50 Kg	2 capsules or tablets 300/200mg

Regimen	Drugs	Patient's weight
		Up to 20kg > mg/Kg/day	>20 to 35kg mg/Kg/ day	>35 to 45kg mg/Kg/ day	>45kg mg/Kg/ day
2RHZ	R	10	300	450	600
Attack Phase	H	10	200	300	400
	Z	35	1000	1500	2000
4RH	R	10	300	450	600
Maintenance Phase	H	10	200	300	400

Adverse events	Probable causal drug(s)	Conduct
Nausea, vomit, abdominal pain	Rifampicin	Reschedule time of drug administration (2h after breakfast or with breakfast); consider using symptomatic medication; assess liver function
	Isoniazid
	Pyrazinamide
	Ethambutol
Sweating/red urine	Rifampicin	Advise the patient
Pruritus or light exanthema	Isoniazid	Prescribe antihistaminic drugs
Pruritus or light exanthema	Rifampicin
Articular pain	Pyrazinamide	Prescribe analgesics and Non-steroidal anti-inflammatory drugs (NSAID)
Articular pain	Isoniazid
Peripheral neuropathy	Isoniazid (common)	Prescribe pyridoxine (Vitamin B6) 50 mg/day
Peripheral neuropathy	Ethambutol (uncommon)	Prescribe pyridoxine (Vitamin B6) 50 mg/day
Asymptomatic hyperuricemia	Pyrazinamide	Prescribe diet low in purine
Hyperuricemia with arthralgia	Pyrazinamide	Prescribe diet low in purine and medicate with allopurinol and colchicine, if necessary
Hyperuricemia with arthralgia	Ethambutol
Headache, Anxiety, euphoria, insomnia	Isoniazid	Advise the patient
Fever	Rifampicin	Advise the patient
	Isoniazid

Adverse events	Probable causal drug(s)	Conduct
Exanthema or moderate to sever hypersensibility	Rifampicin	Suspend treatment; reintroduce each drug separately after resolution; in severe cases or relapses replace scheme by others without the causal drug
	Isoniazid
	Pyrazinamide
	Ethambutol
	Streptomycin
Psychosis, seizures, toxic encephalopathy or coma	Isoniazid	Suspend Isoniazid and restart special scheme without it
Optical neuritis	Ethambutol	Suspend drug and restart special scheme without it. This reaction is dose-dependent, and when detected early it is reversible. It is rare to develop ocular toxicity in the first two months with the recommended doses.
Optical neuritis	Isoniazid
Hepatotoxicity	Pyrazinamide	Suspend treatment; wait for symptom resolution and liver enzyme levels to decrease; reintroduce drugs separately after assessing hepatic function.
	Isoniazid
	Rifampicin
Hypoacusis Vertigo, nystagmus	Streptomycin	Suspend Streptomycin and restart special scheme without it
Thrombocytopenia, leukopenia, eosinophilia, hemolytic anemia, agranulocytosis, vasculitis	Rifampicin	Suspend treatment and restart special scheme without the causal medication
	Isoniazid
Interstitial nephritis	Rifampicin	Suspend treatment and restart special scheme without the causal medication
Interstitial nephritis	Pyrazinamide
Rhabdomyolysis with myoglobinuria and kidney failure	Pyrazinamide	Suspend Pyrazinamide and restart special scheme without it

Sociedade Brasileira de Dermatologia Av. Rio Branco, 39 18. and., 20090-003 Rio de Janeiro RJ, Tel./Fax: +55 21 2253-6747 - Rio de Janeiro - RJ - Brazil
E-mail: revista@sbd.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] MAILING ADDRESS: Josemir Belo dos Santos, Clínica Dermatológica do Hospital das Clínicas da Universidade Federal de Pernambuco, Avenida Prof. Moraes Rego, 123 - Cidade Universitária, 50670-901 - Recife - PE, Brazil. E-mail: josemirbelo@uol.com.br

1) B	6) B	11) B	16) C
2) D	7) C	12) A	17) D
3) A	8) D	13) D	18) D
4) C	9) B	14) A	19) D
5) D	10) D	15) C	20) B

Brasil

Brasil

Cutaneous tuberculosis: diagnosis, histopathology and treatment - Part II* * Work performed at the Clínica Dermatológica do Hospital das Clínicas da Universidade Federal de Pernambuco (HC/UFPE) - Recife (PE), Brazil.

Cutaneous tuberculosis: diagnosis, histopathology and treatment - Part II^* * Work performed at the Clínica Dermatológica do Hospital das Clínicas da Universidade Federal de Pernambuco (HC/UFPE) - Recife (PE), Brazil.