Clinical relevance and prognostic impact of the classification between multibacillary and paucibacillary forms of cutaneous tuberculosis: A 24-year retrospective multicenter study

IF 3.1 4区医学 Q2 DERMATOLOGY

Annales De Dermatologie Et De Venereologie Pub Date : 2024-11-22 DOI:10.1016/j.annder.2024.103324

V. Bérot , G. Monsel , E. Lecorche , M. Halabi-Tawil , D. Maalouf , V. Pourcher , A. Aubry , E. Cambaud , A. Petit , E. Caumes

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引用次数: 0

Abstract

Objectives

Cutaneous tuberculosis (CTB) may be over-diagnosed due to imprecise diagnostic criteria or overlooked where mycobacterial investigations are negative. We evaluated the distinction between multibacillary and paucibacillary forms of CTB, as well as drug resistance and cure rates according to the results of mycobacterial investigations.

Methods

We included retrospectively all patients diagnosed with CTB from 1995 to 2018 in two hospitals in Paris. Clinical forms were classified according to dermatological descriptions, into multibacillary (e.g. gumma, scrofuloderma, orificial TB) and paucibacillary forms (lupus vulgaris, verrucous tuberculosis, papulonecrotic tuberculids, nodular panniculitis). A distinction was made between microbiologically confirmed CTB and presumed CTB forms, which were treated presumptively. Cure was defined as the complete resolution of CTB in patients who completed anti-tuberculosis treatment.

Results

Among the 124 patients with CTB, the most common forms were nodular panniculitis (30.6%), scrofuloderma (22.6%), gumma (18.6%), and lupus vulgaris (12.1%). Tuberculosis was confirmed in 78 patients (62.9%), among whom 13 (16.7%) exhibited resistance to anti-tuberculous drugs, and 46 were presumptively treated. Mycobacterial investigations were significantly more frequently positive for multibacillary (88.2%) than for paucibacillary CTB (39.3%) (p < 10⁻⁶). Patients with mycobacterial evidence of CTB exhibited significantly better cure rates than patients without (96.7% vs. 66.7%, p < 10⁻⁴), particularly among those with nodular panniculitis (100% vs. 63.0%, p < 10⁻³).

Conclusion

The distinction between paucibacillary and multibacillary CTB is relevant. Resistant strains may be isolated. Antituberculosis drugs should be prescribed with caution in cases of panniculitis in the absence of evidence of mycobacterial infection.

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多脓疱型和少脓疱型皮肤结核分类的临床意义和预后影响：一项为期 24 年的多中心回顾性研究。

目的：皮肤结核（CTB）可能因诊断标准不精确而被过度诊断，或在分枝杆菌检查阴性时被忽视。我们根据分枝杆菌检查的结果，评估了多脓疱型和贫脓疱型 CTB 的区别，以及耐药性和治愈率：我们回顾性地纳入了1995年至2018年在巴黎两家医院确诊的所有CTB患者。根据皮肤病学描述，将临床形式分为多疱疹型（如牙龈瘤、瘰疬性皮肤病、人工肺结核）和贫疱疹型（寻常狼疮、疣状肺结核、丘疹性肺结核、结节性泛发性肺结核）。经微生物学确诊的 CTB 与推测的 CTB 形式有所区别，前者属于推测性治疗。治愈的定义是完成抗结核治疗的患者 CTB 完全消退：结果：在 124 名 CTB 患者中，最常见的 CTB 类型为结节性泛发性皮肤炎（30.6%）、瘰疬性皮肤病（22.6%）、牙龈肿痛（18.6%）和寻常狼疮（12.1%）。78 名患者（62.9%）确诊为肺结核，其中 13 人（16.7%）对抗结核药物有抗药性，46 人接受了推定治疗。在分枝杆菌检查中，多枝杆菌阳性率（88.2%）明显高于普通型 CTB 阳性率（39.3%）（P-6）。有分枝杆菌证据的 CTB 患者的治愈率明显高于无分枝杆菌证据的患者（96.7% 对 66.7%，P-4），尤其是结节性泛发性 CTB 患者（100% 对 63.0%，P-3）：结论：区分贫乳头状瘤和多乳头状瘤 CTB 是有意义的。可能会分离出耐药菌株。在没有分枝杆菌感染证据的情况下，应慎用抗结核药物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annales De Dermatologie Et De Venereologie 医学-皮肤病学

CiteScore

1.40

自引率

0.00%

发文量

审稿时长

81 days

期刊介绍： Les Annales de dermatologie sont le rendez-vous mensuel incontournable de toute la dermatologie francophone, grâce à leur comité de rédaction qui assure une sélection rigoureuse des articles selon les normes de l''édition scientifique internationale. Une revue didactique, véritable aide à la pratique médicale quotidienne Pour compléter et enrichir la partie scientifique, la rubrique Formation médicale continue propose aux lecteurs des textes didactiques et interactifs (Cas pour diagnostic, Notes de pharmacovigilance, la Question du praticien, Dermatologie chirurgicale, la Sélection bibliographique du mois...) qui les font bénéficier d''une formation post-universitaire diversifiée et de qualité. La revue consacre également un espace pour la publication de questions des lecteurs auxquelles des experts apportent une réponse.