Cutaneous tuberculosis in children: The Indian perspective

Abstract

Cutaneous tuberculosis continues to be a significant medical problem even with the advent of highly effective antituberculous drugs. It constitutes about 1.5% of all extra pulmonary tuberculosis. The prevalence in children varies from 18 to 54% in India. There is no gender predilection and the infection occurs with increased frequency in 10-14 year age group. Intrafamilial source of TB has been observed very frequently. A concomitant TB lymphadenitis is most common while involvement of other systemic organs like lung, bone and abdomen has also been observed. Protective efficacy of BCG is debatable and not yet fully defined. Of all the clinical types, scrofuloderma (SFD) is the most commonly encountered variant followed by lupus vulgaris (LV) and tuberculosis verrucosa cutis (TBVC). Lichen scrofulosorum (LS) is generally found to be associated with systemic TB focus in about 72% of cases. The impact of HIV on childhood cutaneous TB seems to be minimal. Similar to adults, the diagnosis of cutaneous tuberculosis relies mainly on histopathology, culture on LJ medium or radiometric BACTEC 460 TB culture system and PCR. In addition Mantoux positivity and a positive therapeutic trial with anti-tubercular drugs may be a good pointer to tubercular infection. A thorough clinical evaluation and exhaustive investigations to pin-point associated systemic focus is advocated as the latter has an impact on the duration of treatment. Cutaneous TB in children is treated as per the recommendations of therapy for extrapulmonary TB.

Tuberculosis verrucosa cutis: case report of a diagnostic challenge

“…6 Of all the clinical types, scrofuloderma is the most commonly encountered followed by lupus vulgaris and then TVC. 2 Most cases of TVC are due to accidental exogenous inoculation of M. tuberculosis in previously infected or sensitized individuals with moderate to high degree of slowly evolving cell mediated immunity. Lesions begin as an asymptomatic warty papule which may be mistaken for a viral wart.…”

“…1 Cutaneous tuberculosis constitutes a minor proportion (1.5%) of extrapulmonary tuberculosis. 2 It is a mycobacterial infection caused by Mycobacterium tuberculosis (in a majority of cases) or Mycobacterium bovis and under certain conditions the Bacillus Calmette Guerin (BCG), the attenuated strain of M. bovis. Current prevalence of cutaneous tuberculosis in India is 0.7% of all skin out-patients.…”

Lichen Scrofulosorum in a Patient with Tuberculous Cervical Lymphadenopathy: A case report

“…This can be seen in a study by Varshney et al, which reports that the overall incidence of cutaneous manifestations of TB was found to be 0.7% (131 of 18,720 patients), slightly higher than the incidence demonstrated in other studies from India [1]. The incidence of lichen scrofulosorum (LS), a tuberculid and therefore a form of CTB, varies between 2% and 11.4% in different studies among the cases of CTB but it has been reported as high as 23.5% to 33% in children [1,2].…”

Clinical, Radiological and Inmunological Features in Children with Pulmonary Tuberculosis: A Review

“…Cutaneous TB was a significant medical problem in certain countries. In a recent review from India [13] it was reported that its prevalence varied from 18 to 54%. Spinal TB was a rare disease found in children, which needed a higher index of suspicion for diagnosis, but caused important systemic symptoms [14], and might lead to a difficult differencial diagnosis [15].…”