细菌性皮肤病

20 0 330 85　疣状皮肤结核患者皮损中结核杆菌DN A的检测 /李保强 (河北承德医学院附院皮肤科 )…∥皮肤病与性病 .- 2 0 0 3,2 5 (2 ) .- 4～ 5采用 PCR技术对 1 0例病史 2年以上的患者皮损进行了结核杆菌 DN A检测。结果 1例呈阳性 ,而作为阳性对照的 4例淋巴结结核组织 3例阳性 ,2例正常组织均为阴性。说明疣状皮肤结核组织后期病菌极少或没有 ,PCR技术不失为一个快速检测结核杆菌的方法。参 6　 (张孝友 )2 0 0 330 86　烧伤创面耐甲氧西林金黄色葡萄球菌的监测 /杨丽英 (上海二医大瑞金医院烧伤科 )…∥上海第二医科大学学报 .- …     

足部疣状皮肤结核1例

疣状皮肤结核（tuberculosis verrucosa cutis）是一种典型的外源性皮肤结核。笔者近期诊治1例非典型的足部疣状皮肤结核患者，现报告如下。     

PCR技术在皮肤结核诊断中的作用

采用ＰＣＲ技术对６８例皮肤结核及相关疾病进行结核杆菌基因扩增，结果寻常狼疮１９／２１例为阳性，疣状皮肤结核５／５例阳性，颜面粟粒性狼疮１／２３例阳性，而硬红斑均为阴性，结显示ＰＣＲ是皮肤结核一种快速、简便及敏感性高的诊断方法。     

抗菌肽LL-37、HBD-2和HBD-3在皮肤结核皮损中的表达

目的 研究抗菌肽LL-37、人β防御素-2（HBD-2）、HBD-3在寻常狼疮和疣状皮肤结核皮损中的表达,探讨皮肤结核的发病机制。方法　免疫组化方法检测LL-37、HBD-2、HBD-3在18例寻常狼疮和疣状皮肤结核患者皮损、15例银屑病患者皮损以及10例健康人皮肤石蜡切片中的表达。SPSS13.0统计软件进行数据分析,组间行t检验。结果　LL-37、HBD-2在皮肤结核皮损中主要表达于表皮中上层、附属器及血管壁,与正常皮肤比较为高表达（t = 2.632,2.399,P值均 ＜ 0.05）,且与银屑病的表达模式类似。HBD-3在皮肤结核皮损中未见表达,而在银屑病皮损及正常皮肤中均可见表达。结论　抗菌肽LL-37和HBD-2可能参与皮肤结核的免疫反应过程,而HBD-3在皮肤结核的表达缺失可能与其发病密切相关。     

非典型疣状皮肤结核1例

皮肤结核是由结核杆菌直接侵犯皮肤,或其他脏器结核病灶内的结核杆菌经血行或淋巴系统传播到皮肤组织引起的皮肤损害。笔者诊治1例被误诊为着色芽生菌病的疣状皮肤结核患者,现报告如下。     

疣状皮肤结核一例

本文报道一例疣状皮肤结核患者，曾按银屑病治疗无效。该患者结核分枝杆菌DNA(+),T-SPOT试验(+),PPD(+++),给予异烟肼、利福平、乙胺丁醇和吡嗪酰胺四联口服治疗2个月后，皮损明显消退。     

手部疣状皮肤结核1例

患者男,54岁。左手掌及腕部出现疣状结节及斑块10年余。皮损组织病理示表皮角化过度伴角化不全,假上皮瘤样增生,真皮浅层见结核样浸润,无明显干酪样坏死。结核菌素试验弱阳性,抗酸染色(-),皮损组织真菌培养(-)。诊断:疣状皮肤结核。     

阴茎疣状癌伴隐性梅毒1例

目的患者男,44岁。包皮赘生物逐渐增大10年,无痛痒。皮肤科检查：腹侧包皮可见2cm×3cm大小红色疣状赘生物,边界清,质硬,无浸润。皮肤组织病理示：疣状癌。HPV16阳性;RPR1：8阳性,TPHA阳性。     

裴氏瓶霉致皮肤着色芽生菌病误诊为疣状皮肤结核1例

报告裴氏瓶霉致皮肤着色真菌病误诊为疣状皮肤结核1例。患者男，52岁。右上肢红斑、结节、疣状增生5年，无明显自觉症状。组织病理及真菌学检查结果符合裴氏瓶霉，结合临床表现及外伤史确诊为裴氏瓶霉致皮肤着色真菌病。     

应用聚合酶链反应诊断疣皮肤结核1例报告

报告１例４５岁女性疣状皮肤结核患者，病期１３年，于右臂部至右大腿后上方、右耳廓及右胸部呈现肉芽肿性皮损，组织病理疑为结核，抗酸染色（一）。遂将石蜡切块作聚合酶链反应检查，扩增出结核杆菌特异ＤＮＡ片段。经抗痨治疗皮损治愈。     

Toll样受体2、4 和9在皮肤结核皮损中的表达

目的 研究Toll样受体2、4和9 （TLR-2、TLR-4、TLR-9）在寻常狼疮和疣状皮肤结核皮损中的表达,探讨其在皮肤结核发病中的作用。方法 经临床与病理确诊的皮肤结核（包括寻常狼疮和疣状皮肤结核）患者皮损标本18份,斑块状银屑病皮损15份为阳性对照,色素痣边缘正常皮肤10份为阴性对照。用免疫组化法观察TLR-2、TLR-4、TLR-9的表达情况。采用SPSS 13.0统计软件进行统计学分析,组间比较行t检验。结果 TLR-2在正常皮肤表达于除基底层外的表皮全层,而在皮肤结核和银屑病皮损表达于表皮的中上层,3组的表达强度均为高表达（A值分别为0.28 ± 0.03、0.25 ± 0.04和0.25 ± 0.05）,3组差异无统计学意义（P > 0.05）。TLR-4在正常皮肤和银屑病呈低或无表达（A值分别为0.07 ± 0.09和0.02 ± 0.05）,而皮肤结核（0.16 ± 0.07）呈低表达,其表达强度高于正常皮肤（t = 2.58,P ＜ 0.05）和银屑病皮损（t = 6.24,P ＜ 0.01）。TLR-9在正常皮肤和皮肤结核表达于表皮全层、附属器及血管壁,而皮肤结核的表达强度（A值为0.25 ± 0.05）高于正常皮肤（0.19 ± 0.05）,两组比较,t = 2.88,P ＜ 0.05。结论 TLR-2、TLR-4和TLR-9在皮肤结核皮损中均存在表达,其中TLR-4和TLR-9的表达高于正常皮肤,提示其在皮肤结核的免疫应答中可能起一定的作用。     

Therapierefraktäre „Psoriasis vulgaris“

A 61-year-old patient had a 25-year history of erythematous scaling lesions, diagnosed and treated as psoriasis vulgaris. He presented with a growing nodule within the erythematous plaque. Biopsy shows epithelioid cell granulomas with prominent Langhans giant cells. There was no sign of a squamous cell carcinoma. The tuberculin test was strongly positive and M. tuberculosis complex was detected in the biopsy material by PCR. He was diagnosed with lupus vulgaris, the most frequent form of cutaneous tuberculosis. Other types include tuberculosis verrucosa cutis, tuberculosis cutis orificialis and disseminated military tuberculosis. The patient was treated with rifampicin, isoniazid, pyrazinamide and ethambutol for two months, following a four month treatment with rifampicin and isoniazid. The skin lesions rapidly resolved under antituberculotic treatment.     

应用聚合酶链反应诊断疣状皮肤结核1例报告

报告１例４５岁女性疣状皮肤结核患者，病期１３年。于右臀部至右大腿后上方、右耳廓及右胸部呈现肉芽肿性皮损。组织病理疑为结核，抗酸染色（一）。遂将石蜡切块作聚合酶链反应（ＰＣＲ）检查，扩增出结核杆菌特异ＤＮＡ片段。经抗痨治疗皮损治愈。     

Tuberculosis verrucosa cutis on the sole of the foot

We report an unusual case of tuberculosis verrucosa cutis on the plantar aspect of the foot that had been present for more than 40 years in a 62-year-old Indian man. He had a grade IV positive Heaf test and a normal chest radiograph. Mycobacterium tuberculosis was successfully cultured from the third biopsy taken from the lesion. This case demonstrates the indolent nature of the lesion and stresses the importance of taking adequate biopsies for microbiological culture when there is a high index of suspicion for M. tuberculosis. The diagnosis of tuberculosis verrucosa cutis should be based on history and evolution of the disease, cardinal morphological features and histopathological characteristics. Response to anti-tuberculosis drugs may be of assistance.     

CUTANEOUS TUBERCULOSIS IN HONG KONG: A 10-YEAR RETROSPECTIVE STUDY

Background. Cutaneous tuberculosis was once a relatively common skin disease in Hong Kong. Tuberculosis verrucosa cutis was the commonest type. Because the last survey was carried out 25 years ago, it was thought necessary to find out the new incidence and pattern of this important disease in this locality. Methods. A 10-year (1983-1992) retrospective survey on the epidemiologic and clinicobacteriologic aspects of cutaneous tuberculosis had been done in the public sector of Hong Kong. The records of the confirmed cases were retrieved for statistical analysis. Results. A total of 176 cases are included in the final analysis. This represents 0.066% of all new skin cases seen during the 10-year period. Among these, 79.5% are erythema induratum, 6.3% lupus vulgaris, and 4.5% tuberculosis verrucosa cutis. They are further divided into true cutaneous tuberculosis (14.8%, n=26) and the tuberculide (85.2%, n=150). Among the patients with true tuberculosis, 42.3% had lupus vulgaris, 30.8% had tuberculosis verrucosa cutis, and 26.9% had scrofuloderma. Among the tuberculides, erythema induratum accounted for 93.3%. Conclusions. Cutaneous tuberculosis is now uncommon in Hong Kong. Tuberculosis verrucosa cutis is no longer the commonest type in Hong Kong as described in some textbooks. Erythema induratum is now the most common among the total cases and lupus vulgaris is the most common among the true cutaneous forms of tuberculosis.     

Comparative efficacy of drug regimens in skin tuberculosis

Three antituberculous drug regimens have been employed to study the therapeutic response in 90 patients with any one of the commonly encountered paucibacillary forms of skin tuberculosis, namely lupus vulgaris, tuberculosis verrucosa cutis and scrofuloderma. The first two regimens contained rifampicin, isoniazid and either pyrazinamide or thiacetazone, and the third regimen had rifampicin and isoniazid only. The disease was clinically defined as localized when confined to one area and widespread when the lesions were disseminated. The observations revealed that the response of lupus vulgaris and tuberculosis verrucosa cutis was alike in all the three regimens, with the localized lesions subsiding completely after 4 months of therapy and the more extensive forms taking 5 months. Patients with scrofuloderma responded similarly to both the triple drug regimens. The discharge, sinuses and ulcers cleared in 6 months but the lymph nodes took longer to regress, up to 7 months in localized and 9 months in more widespread scrofuloderma. To obtain the same results with rifampicin and isoniazid, all patients with widespread scrofuloderma and one-third of those with localized forms had to be treated for 10 and 9 months, respectively. No serious drug side-effects, apart from giddiness with rifampicin and acneiform eruptions with thiacetazone, were encountered. No instances of relapse were noted in the 50% of patients who were followed-up for 3 1/2 years after therapy. Single-drug therapy with isoniazid for lupus vulgaris, as given in the past, is to be discouraged as it may promote the emergence of drug-resistant bacilli in those with an undetected focus of infection.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of tuberculosis cutis luposa and cutaneous leishmaniasis

We present a comparative study concerning two cases of tuberculosis cutis luposa and cutaneous leishmaniasis, respectively. These two Turkish female patients had suffered from changes of the facial skin since 20 years (tuberculosis cutis luposa) and for 5 months (cutaneous leishmaniasis). The tuberculosis cutis luposa had been misdiagnosed as cutaneous leishmaniasis and surgically treated. Both cases showed an apple jelly-like color at the edges of the lesions with soft tissue. With tuberculosis cutis luposa, the lesions had a larger extension and a more hyperkeratotic picture. We discuss the different histopathologic changes of both cases. As bacteriologic culture revealed mycobacterium tuberculosis, on one hand, and histopathology leishmania species intrahistiocytically, on the other, we could finally make the corresponding diagnoses.     

Development of a polymerase chain reaction dot-blotting system for detecting cutaneous tuberculosis

For a definitive diagnosis of cutaneous tuberculosis the demonstration of mycobacteria is essential, but this is generally not possible in skin lesions. Routinely available techniques have poor sensitivity and are time consuming, therefore, delaying the institution of timely therapy. The high sensitivity and speed of polymerase chain reaction (PCR) for the detection of infectious agents has prompted investigators to use this technique for the detection of Mycobacterium tuberculosis in body fluids such as cerebrospinal fluid or pleural fluid. In the present study, PCR was used to examine punch biopsy specimens from the affected skin of 10 patients with clinical diagnoses of tuberculosis verrucosa cutis, lupus vulgaris, scrofuloderma, papulonecrotic tuberculide and erythema induratum. A control group of 20 patients included individuals having skin manifestations with definite clinical diagnoses other than cutaneous tuberculosis, such as leprosy, fungal mycetoma, chronic bullous disease of childhood and pemphigus vulgaris. The PCR amplified products were dot hybridized with a probe which was random prime labelled with 32P. The results were compared with routine microbiological and histological findings. Among the test group, six of 10 (60%) were positive for M. tuberculosis by PCR, although their histopathology showed non-specific chronic inflammation with no definite diagnosis. Microbiological investigations, including acid-fast bacillus smear and culture, were positive in a single case of scrofuloderma. All patients in the control group were negative by PCR for M. tuberculosis. The data indicate that the combination of dot hybridization with PCR markedly increased the sensitivity and specificity of PCR. This may be a useful tool in the diagnosis of tuberculosis when conventional methods fail.     

Nonhealing vegetating plaque on the finger: tuberculosis verrucosa cutis

Tuberculosis verrucosa cutis is an uncommon form of tuberculosis that typically presents as a chronic warty plaque. It develops in individuals with moderate to high immunity to Mycobacterium tuberculosis due to inoculation of an open wound. We present the case of a Somali man born in the United Kingdom who presented with a nonhealing ulcer on the right hand of 10 years' duration. The patient was diagnosed with tuberculosis verrucosa cutis based on clinical suspicion, which was confirmed by several investigations including strongly positive results of a Mantoux test, IFN-gamma release assay, typical histology on skin biopsy, and polymerase chain reaction (PCR) analysis positive for mycobacterial DNA. Treatment with quadruple antituberculous therapy produced rapid resolution of the ulcer. This unusual condition often is overlooked in the differential diagnosis of nonhealing ulcers, yet it has an excellent prognosis with treatment. A high index of suspicion is required.