Skórne postacie gruźlicy – postępowanie diagnostyczne i terapia

Tuberculosis is an infectious, granulomatous disease caused byMycobacterium tuberculosis. It is still a major global health problem forboth developing and developed countries. In 2009, around 9 million ofnew cases of tuberculosis around the world and 1.7million deaths werenoted. All countries are affected, but the majority of cases occur inAfrica (30%) and Asia (50%). Cases reported in Europe representapproximately 6% of all those reported worldwide. Cutaneous tuberculosismay manifest either as a primary (previously uninfected host) orsecondary (pre-sensitized host) forms. There is a wide spectrum of clinicalpictures with lupus vulgaris (high immunity) at one end and tuberculosis cutis orificialis (low immunity) at the other, bridged by tuberculosisverrucosa and scrofuloderma (moderate immunity). Cutaneoustuberculosis is one of the most difficult diagnoses to make for dermatologists,not only because they have to consider a wide differentialdiagnosis but also because of the difficulty in obtaining microbiologicalconfirmation. The diagnosis relies mainly on histopathology, cultureon Löwenstein-Jensen medium or the radiometric TB culture systemand amplification of bacterial DNA with polymerase chain reaction(PCR). Despite all the advances in microbiology, the isolation ofM. tuberculosis in culture is still a gold standard. Therapy of tuberculosisis also complicated. Both pulmonary and extrapulmonary tuberculosisare treated with similar drugs according to World Health OrganisationGuidelines. There are around 0.5 million new multidrug resistant casesof tuberculosis (MDR-TB) every year. Treatment of MDR-TB is morechallenging and the cure rates range 50% to 70%.