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Kaul S, Jakhar D, Mehta S, Singal A. Cutaneous tuberculosis. Part II: Complications, diagnostic workup, histopathologic features, and treatment. J Am Acad Dermatol 2023; 89:1107-1119. [PMID: 35149148 DOI: 10.1016/j.jaad.2021.12.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/12/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
Despite the availability of effective treatment regimens for cutaneous tuberculosis, challenges to disease control result from delayed diagnosis, infection with multidrug-resistant mycobacterial strains, and coinfection with HIV. Delayed diagnosis can be mitigated when dermatologists are sensitized to the clinical signs and symptoms of infection and by the incorporation of appropriate diagnostic tests. All cases of cutaneous tuberculosis should be confirmed with histopathology and culture with or without molecular testing. In each case, a thorough evaluation for systemic involvement is necessary. Mycobacteria may not be isolated from cutaneous tuberculosis lesions and therefore, a trial of antituberculosis treatment may be required to confirm the diagnosis. The second article in this 2-part continuing medical education series describes the sequelae, histopathology, and treatment of tuberculosis.
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Affiliation(s)
- Subuhi Kaul
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois
| | | | - Shilpa Mehta
- Division of Dermatology, John H Stroger Hospital of Cook County, Chicago, Illinois.
| | - Archana Singal
- Department of Dermatology, University College of Medical Sciences & GTB Hospital, Delhi, India
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Behera B, Jain S, Mohapatra L, Masatkar V, Panda S. A Clinico-Histopathological Study of Lupus Vulgaris at a Tertiary Care Centre. Cureus 2023; 15:e42710. [PMID: 37575838 PMCID: PMC10420341 DOI: 10.7759/cureus.42710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 08/15/2023] Open
Abstract
Background and objectives Lupus vulgaris is a chronic, progressive, paucibacillary form of cutaneous tuberculosis that occurs in persons with moderate to high immunity. Due to its varied clinical presentation, it can masquerade as different dermatological conditions. This study describes the demographic patterns and varieties of clinical manifestations that can be possible in this curable illness. Methods This study was conducted over two years and included 19 patients with histopathologically confirmed lupus vulgaris in Odisha, India. Demographic data, clinical features, and response to treatment are presented. Results Thirteen cases (68.4%) were seen in adults and six (31.6%) in pediatric patients. The lower limbs were the more affected (n=10), followed by the upper limb (6), the face (2), and the chest (1). All but one patient had plaque-type lesions. On histopathology, all showed a tuberculoid granuloma with no demonstration of acid-fast bacilli with Ziehl-Neelsen staining. Conclusion In the present study, the incidence was mostly observed in the young and higher activity age groups (5-40 years). Plaque-type lesions were most commonly encountered. In histopathology, all the cases had tubercular granuloma-type lesions without any incidence of malignant transformations. All the patients responded well to conventional multi-drug anti-tubercular chemotherapeutic regimens.
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Affiliation(s)
- Binodini Behera
- Department of Dermatology, Pandit Raghunath Murmu Medical College, Baripada, IND
| | - Sonal Jain
- Department of Dermatosurgery and Hair Transplantation, CUTIS Hospital, Bengaluru, IND
| | - Liza Mohapatra
- Department of Dermatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | | | - Sibaram Panda
- Department of Dermatology, Pandit Raghunath Murmu Medical College, Baripada, IND
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Singal A, Kaur I, Jakhar D, Pandhi D, Grover C, Gandhi V. Clinicoepidemiological characteristics of cutaneous tuberculosis in 1458 Indian patients: a retrospective analytical study from a tertiary care center. Int J Dermatol 2022; 61:1012-1022. [PMID: 35583803 DOI: 10.1111/ijd.16267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/27/2022] [Accepted: 04/23/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Tuberculosis (TB) has been one of the most challenging infectious diseases globally. Cutaneous tuberculosis (CTB) accounts for 0.5-2% of extrapulmonary TB and is often missed owing to its varying morphology and paucibacillary nature. METHODS In this retrospective analytical study, we share our 22-year experience to describe the clinicoepidemiological features and treatment response of CTB in 1458 Indian patients. In each patient, detailed history was followed by clinical examination, hematological and biochemical investigations, Mantoux testing, chest x-ray, and other specialized investigations to detect coexisting systemic foci. Clinical diagnosis of CTB was confirmed on histopathology/cytology and response to standard antitubercular treatment (ATT). All details were recorded on a predesigned proforma. RESULTS Of 1458 eligible patients, 803 were children. The mean disease duration was 15.3 months. Lupus vulgaris (40.4%) was the most common clinical variant, followed by scrofuloderma (32.7%) and lichen scrofulosorum (15.2%). Other variants included tuberculosis verrucosa cutis, gumma, tuberculids, and inoculation TB. Multiple clinical variants were observed in 3.6% of patients. A total of 41.4% of patients had coexistent systemic foci; in lymph nodes (50.4%), lungs (35.6%), bone (10.3%), and abdomen (5.8%). TB foci were also observed at uncommon locations like the eye, central nervous system, and genital organs. Treatment response to ATT was favorable in 99.2%. INTERPRETATION The burden of CTB still persists in developing countries. The diagnosis is often missed due to the wide spectrum of clinical and histological presentations. Awareness among clinicians of varying aspects of CTB is of paramount importance for early diagnosis and management and will significantly prevent morbidity and disease complications.
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Affiliation(s)
- Archana Singal
- Department of Dermatology & STD, University College of Medical Sciences & GTB Hospital (University of Delhi), Delhi, India
| | | | | | - Deepika Pandhi
- Department of Dermatology & STD, University College of Medical Sciences & GTB Hospital (University of Delhi), Delhi, India
| | - Chander Grover
- Department of Dermatology & STD, University College of Medical Sciences & GTB Hospital (University of Delhi), Delhi, India
| | - Vijay Gandhi
- Department of Dermatology & STD, University College of Medical Sciences & GTB Hospital (University of Delhi), Delhi, India
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Puri P, Raut S, Nair D, Jain AK, Kathuria S. Role of GeneXpertMTB/RIF in the diagnosis of cutaneous tuberculosis. Indian J Tuberc 2022; 69:42-47. [PMID: 35074150 DOI: 10.1016/j.ijtb.2021.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND cutaneous involevemtn is an important extrapulmonary manifestation of tuberculosis. It is a paucibacillary condition and has diverse clinical presentations. Sufficient data is not available regarding role of GeneXpertMTB/RIF in cutanoues tuberculosis. METHODS in this study, BacT/Alert3D and response to antitubercular therapy were taken as gold standard and performance of GeneXpertMTB/RIF was evaluated against it in clinically and histopathologically suspected cases of cutaneous tuberculosis. RESULTS forty seven patients were included in the study of which commonest presentation was scrofuloderma (42.6%) followed by lupus vulgaris (40.4%). Granulomatous inflammation on histopathology was seen in 75.5% patients on skin biopsy. Sic patients had extracutaneous focus of tuberculosis. In 14 (29.79%), culture of skin biopsy was positive for M. tuberculosis and all showed complete response to ATT in 6 months. GeneXpertMTB/RIF detected M. tuberculsois in 4 samples. CONCLUSION GeneXpertMTB/RIF is not a reliable tool for diagnosis of cutaneous tuberculosis. Clinic-histopathological correlation along with response to ATT is needed for confirmation of diagnosis of cutaneous tuberculosis.
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Affiliation(s)
- Poonam Puri
- Department of Dermatology & STD, Safdarjung Hospital & Vardhaman Mahavir Medical College, India
| | - Saurabh Raut
- Department of Dermatology & STD, Safdarjung Hospital & Vardhaman Mahavir Medical College, India
| | - Deepthi Nair
- Department of Microbiology, Safdarjung Hospital & Vardhaman Mahavir Medical College, India
| | - A K Jain
- National Institute of Pathology, India
| | - Sushruta Kathuria
- Department of Dermatology & STD, Safdarjung Hospital & Vardhaman Mahavir Medical College, India.
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Singal A, Kaur I, Pandhi D, Gandhi V, Jakhar D, Grover C. Clinico-epidemiological profile of lichen scrofulosorum: a 22-year, single-center, retrospective study. Int J Dermatol 2021; 60:1278-1284. [PMID: 34181284 DOI: 10.1111/ijd.15737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/22/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lichen scrofulosorum (LS) represents immunologic reaction to the Mycobacterium tuberculosis antigen and presents with subtle, asymptomatic, grouped follicular papules over the trunk and shows good therapeutic response to antitubercular drugs. OBJECTIVE To study the clinical and epidemiological characteristics of patients diagnosed with LS. MATERIALS AND METHODS A single-center retrospective review of patients diagnosed with LS from 1997 to 2018 was conducted. The data pertained to clinico-epidemiological profile, BCG vaccination, Mantoux positivity, laboratory investigations, coexistent focus of tuberculosis, and response to antitubercular treatment (ATT). RESULTS LS cases constituted 15.2% (221/1458) of all the patients diagnosed with cutaneous tuberculosis (CTB). Of these, 156 (70.5%) were pediatric patients. All patients presented with multiple follicular and perifollicular grouped papules. The trunk was the most common site involved (98.6%), followed by lower limb (25.33%), upper limb (15.83%), face (5%), and external genitalia (3.6%). Evidence of BCG vaccination and Mantoux test positivity was observed in 52.03 and 83.2%, respectively. Coexistent TB focus was detected in 134 (60.6%) patients in lymph nodes, lungs, abdomen, and unusual sites such as intracranial, endometrium, and eye. Twenty-eight patients (12.66%) had coexistent other clinical forms of CTB. Clinical diagnosis of LS was confirmed on histology that revealed chiefly periappendageal epithelioid cell granuloma. Response to ATT was good with complete resolution of lesion in 8-12 weeks. CONCLUSION LS appears to be an underdiagnosed entity. Subtle and asymptomatic lesions of LS are often missed, thereby necessitating a high index of suspicion and appropriate evaluation of the underlying TB focus.
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Affiliation(s)
- Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital (University of Delhi), Delhi, India
| | | | - Deepika Pandhi
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital (University of Delhi), Delhi, India
| | - Vijay Gandhi
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital (University of Delhi), Delhi, India
| | | | - Chander Grover
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital (University of Delhi), Delhi, India
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Hussain A, Mahdi WA, Alshehri S, Bukhari SI, Almaniea MA. Application of Green Nanoemulsion for Elimination of Rifampicin from a Bulk Aqueous Solution. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5835. [PMID: 34071692 PMCID: PMC8199170 DOI: 10.3390/ijerph18115835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 01/08/2023]
Abstract
The study aimed to prepare green nanoemulsion (GNE) multi-components ((water/dimethyl sulfoxide-transcutol/isopropyl alcohol/capmul MCM C8 (CMC8)) to remove rifampicin (RIF) from a contaminated aqueous bulk solution. Pseudo ternary phase diagrams dictated several batches of GNE prepared following the reported method. Selected nanoemulsions (NF1-NF5) were characterized for morphology, globular size, size distribution (polydispersity index, PDI), viscosity, zeta potential, refractive index (RI), and free-thaw kinetic stability. They were investigated for percent removal efficiency (%RE) of RIF from the bulk aqueous solution for varied time intervals (10-60 min). Finally, scanning electron microscopy-energy dispersive x-ray (SEM-EDX) and inductive coupled plasma-optical emission system (ICP-OE) were used to confirm the extraction of trace content of dimethyl sulfoxide (DMSO) and others in the treated water. Considering the data obtained for globule size, PDI, viscosity, zeta potential, freeze-thaw stability, and refractive index, NF5 was the most suitable for RIF removal. The largest %RE value (91.7%) was related to NF5, which may be prudent to correlate with the lowest value (~39 nm) of size (maximum surface area available for contact adsorption), PDI (0.112), and viscosity (82 cP). Moreover, %RE was profoundly influenced by the content of CMC8 and the aqueous phase. These two phases had immense impact on the viscosity, size, and RI. The percent content of water, Smix, and CMC8 were 15% w/w), 60% w/w, and 25% w/w, respectively in NF5. SEM-EDX and ICP-OE confirmed the absence of DMSO and other hydrophilic components in the treated water. Thus, efficient NF5 could be a promising option to the conventional method to decontaminate the polluted aqueous system.
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Affiliation(s)
- Afzal Hussain
- Department of Pharmaceutics, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia; (W.A.M.); (S.A.); (S.I.B.); (M.A.A.)
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Mahdi WA, Hussain A, Altamimi MA, Alshehri S, Bukhari SI, Ahsan MN. Experimental Solubility, Thermodynamic/Computational Validations, and GastroPlus-Based In Silico Prediction for Subcutaneous Delivery of Rifampicin. AAPS PharmSciTech 2021; 22:116. [PMID: 33763801 DOI: 10.1208/s12249-021-01987-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/10/2021] [Indexed: 12/30/2022] Open
Abstract
We focused to explore a suitable solvent for rifampicin (RIF) recommended for subcutaneous (sub-Q) delivery [ethylene glycol (EG), propylene glycol (PG), tween 20, polyethylene glycol-400 (PEG400), oleic acid (OA), N-methyl-2-pyrrolidone (NMP), cremophor-EL (CEL), ethyl oleate (EO), methanol, and glycerol] followed by computational validations and in-silico prediction using GastroPlus. The experimental solubility was conducted over temperature ranges T = 298.2-318.2 K) and fixed pressure (p = 0.1 MPa) followed by validation employing computational models (Apelblat, and van't Hoff). Moreover, the HSPiP solubility software provided the Hansen solubility parameters. At T = 318.2K, the estimated maximum solubility (in term of mole fraction) values of the drug were in order of NMP (11.9 × 10-2) ˃ methanol (6.8 × 10-2) ˃ PEG400 (4.8 × 10-2) ˃ tween 20 (3.4 × 10-2). The drug dissolution was endothermic process and entropy driven as evident from "apparent thermodynamic analysis". The activity coefficients confirmed facilitated RIF-NMP interactions for increased solubility among them. Eventually, GastroPlus predicted the impact of critical input parameters on major pharmacokinetics responses after sub-Q delivery as compared to oral delivery. Thus, NMP may be the best solvent for sub-Q delivery of RIF to treat skin tuberculosis (local and systemic) and cutaneous related disease at explored concentration.
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Wankhade V, Supekar B, Singh R, Ghanate T, Bhat D. Clinical spectrum of cutaneous tuberculosis in Central India: A retrospective study. Indian Dermatol Online J 2021; 12:826-833. [PMID: 34934717 PMCID: PMC8653751 DOI: 10.4103/2229-5178.330811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: Extrapulmonary tuberculosis (EPTB) is a significant health problem in both developing and developed countries. In India, cutaneous TB constitutes about 0.1% to 2% of the total skin diseases attending outpatients. Aim and objectives: To study the clinical spectrum and therapeutic outcome in cutaneous TB. Material and Methods: Medical records of diagnosed cases of cutaneous TB from June 2015 to June 2018 were analyzed retrospectively with respect to epidemiology, clinical features, investigations, and treatment outcome. Statistical analysis was done using mean, median, and proportion. Results: Fifty-two patients with cutaneous TB were recruited. Females (61.53%) outnumbered males. The most common age group affected was 21–30 years (32.69%) followed by 41–50 years (30%). Lupus vulgaris was the most common clinical type with head and neck being the most common site of involvement. Mantoux positivity was reported in 67.30% of patients while raised ESR in 71.15% of patients. Two patients had serology positive for HIV. Conclusive evidence of TB on histopathology was reported in 86.53%. Excellent response was observed in cases of lupus vulgaris, scrofuloderma, and tuberculosis verrucosa cutis. Conclusion: This retrospective analysis emphasizes the importance of clinicopathological correlation and therapeutic response in cutaneous TB. Although positive results of ESR, Mantoux reactivity, and TB cultures facilitate the clinical diagnosis, negative results should not exclude the diagnosis of cutaneous TB. This prominent case detection in the era of the Revised National TB Control Programme, in short period of time signifies health burden of cutaneous TB in this part of Maharashtra.
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Altamimi MA, Hussain A, Imam SS, Alshehri S, Singh SK, Webster TJ. Transdermal delivery of isoniazid loaded elastic liposomes to control cutaneous and systemic tuberculosis. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Hussain A, Altamimi MA, Alshehri S, Imam SS, Singh SK. Vesicular elastic liposomes for transdermal delivery of rifampicin: In-vitro, in-vivo and in silico GastroPlus™ prediction studies. Eur J Pharm Sci 2020; 151:105411. [DOI: 10.1016/j.ejps.2020.105411] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/05/2020] [Accepted: 06/02/2020] [Indexed: 12/24/2022]
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Hussain A, Altamimi MA, Alshehri S, Imam SS, Shakeel F, Singh SK. Novel Approach for Transdermal Delivery of Rifampicin to Induce Synergistic Antimycobacterial Effects Against Cutaneous and Systemic Tuberculosis Using a Cationic Nanoemulsion Gel. Int J Nanomedicine 2020; 15:1073-1094. [PMID: 32103956 PMCID: PMC7027864 DOI: 10.2147/ijn.s236277] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/14/2019] [Indexed: 01/10/2023] Open
Abstract
Purpose This study demonstrated improved transdermal delivery of rifampicin-loaded cationic nanoemulsion gel to treat systemic and cutaneous tuberculosis using capmul, labrasol, and acconon, which exert anti-Mycobacterium activities. This approach enhanced drug permeation across the skin, increased therapeutic efficacy, and reduced dose-related side effects. Methods Design Expert® was used to optimize formulations (Smix ratio and capmul as independent factors), which were prepared using a slow spontaneous titration method. The optimized nanoemulsion was incorporated into carbopol gel to allow for topical application and comparative assessments. Nanoemulsions and gels were evaluated for size, size distribution, shape, zeta potential, percent spread, viscosity, in vitro hemolysis, in vitro release, and ex vivo skin permeation and deposition. A mechanistic evaluation was performed using scanning electron microscopy. Furthermore, in vivo pharmacokinetic and irritation studies were performed. Results The optimized cationic nanoemulsion (OCNE-1) was characterized by small particle size (≤100 nm), had optimal viscosity, percent spread, zeta potential, and percent drug release, and was hemocompatible. The OCNE-1T gel exhibited higher permeation flux (51.32 ± 0.5 µg/cm2 hr), permeation coefficient (2.566 ± 0.08 cm/hr), drug deposition (994.404 µg/cm2), and enhancement ratio (7.16) than those of the OCNE-1 nanoemulsion or drug solution. Scanning electron microscopy was used to characterize the mechanism of enhanced permeation. An In vivo study showed that the Cmax and area under the curve following transdermal application were 4.34- and 4.74-fold higher than those following oral administration. Conclusion Transdermal delivery of rifampicin could be a promising alternative to conventional approaches to treat systemic and local tuberculosis, and other bacterial infections.
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Affiliation(s)
- Afzal Hussain
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammad A Altamimi
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sultan Alshehri
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Syed Sarim Imam
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Faiyaz Shakeel
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sandeep Kumar Singh
- Department of Pharmaceutical Sciences, Birla Institute of Technology, Ranchi, Jharkhand, India
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Abstract
As a nascent and emerging field that holds great potential for precision oncology, nanotechnology has been envisioned to improve drug delivery and imaging capabilities through precise and efficient tumor targeting, safely sparing healthy normal tissue. In the clinic, nanoparticle formulations such as the first-generation Abraxane® in breast cancer, Doxil® for sarcoma, and Onivyde® for metastatic pancreatic cancer, have shown advancement in drug delivery while improving safety profiles. However, effective accumulation of nanoparticles at the tumor site is sub-optimal due to biological barriers that must be overcome. Nanoparticle delivery and retention can be altered through systematic design considerations in order to enhance passive accumulation or active targeting to the tumor site. In tumor niches where passive targeting is possible, modifications in the size and charge of nanoparticles play a role in their tissue accumulation. For niches in which active targeting is required, precision oncology research has identified targetable biomarkers, with which nanoparticle design can be altered through bioconjugation using antibodies, peptides, or small molecule agonists and antagonists. This review is structured to provide a better understanding of nanoparticle engineering design principles with emphasis on overcoming tumor-specific biological barriers.
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Tshisevhe V, Mbelle N, Peters RP. Cutaneous tuberculosis in HIV-infected individuals: Lessons learnt from a case series. South Afr J HIV Med 2019. [DOI: 10.4102/sajhivmed.v20i1.895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Vulvar Tuberculosis Cutis Orificialis Concomitant to Pulmonary Tuberculosis: A Case Report. Am J Dermatopathol 2018; 40:908-911. [PMID: 29877894 DOI: 10.1097/dad.0000000000001182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Tuberculosis (TB) is a common condition with increasing incidence worldwide. Cutaneous TB represents a small portion of extrapulmonary TB. Health care professionals must be aware of cutaneous forms of TB to avoid delay in diagnosis and treatment. We present a case of a 59-year-old woman with vulvar TB cutis orificialis in association with pulmonary TB without any other involvement of genitourinary system. We discuss epidemiological aspects, classification, treatment, range of histopathological patterns, and use of ancillary techniques for diagnosis.
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Agarwal P, Singh EN, Agarwal US, Meena R, Purohit S, Kumar S. The role of DNA polymerase chain reaction, culture and histopathology in the diagnosis of cutaneous tuberculosis. Int J Dermatol 2017; 56:1119-1124. [DOI: 10.1111/ijd.13708] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/01/2017] [Accepted: 06/23/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Puneet Agarwal
- Department of Skin, STD and Leprosy; S.M.S. Medical College & Hospital; Jaipur Rajasthan India
| | - Elangbam Nelson Singh
- Department of Skin, STD and Leprosy; S.M.S. Medical College & Hospital; Jaipur Rajasthan India
| | - Uma Shankar Agarwal
- Department of Skin, STD and Leprosy; S.M.S. Medical College & Hospital; Jaipur Rajasthan India
| | - Ramsingh Meena
- Department of Skin, STD and Leprosy; S.M.S. Medical College & Hospital; Jaipur Rajasthan India
| | - Saroj Purohit
- Department of Skin, STD and Leprosy; S.M.S. Medical College & Hospital; Jaipur Rajasthan India
| | - Surendra Kumar
- Department of Skin, STD and Leprosy; S.M.S. Medical College & Hospital; Jaipur Rajasthan India
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Unusual Sites of Cutaneous Tuberculosis: A Report of Two Cases. Case Rep Dermatol Med 2017; 2017:7285169. [PMID: 28348900 PMCID: PMC5350300 DOI: 10.1155/2017/7285169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/19/2016] [Accepted: 01/09/2017] [Indexed: 12/02/2022] Open
Abstract
Cutaneous tuberculosis (CTB) is an uncommon small subset of extrapulmonary tuberculosis, comprising 1–1.5% of all extrapulmonary tuberculosis manifestations, which manifests only in 8.4–13.7% of all tuberculosis cases. Lupus vulgaris (LV) and tuberculosis verrucosa cutis (TBVC) are forms of reinfection tuberculosis and often occur in presensitized patients, by exogenous inoculation. We report two cases of cutaneous tuberculosis at unusual sites. A 35-year-old female having a forehead lesion for 2 years was diagnosed as having tuberculosis verrucosa cutis and another 16-year-old girl with lesion in left axilla for 10 years was proven to have lupus vulgaris. The delayed diagnosis was possibly due to lower clinical suspicion due to the presentation of CTB at unusual sites. This highlights the importance of keeping TB as an important differential as misdiagnosis or delayed diagnosis of this entity can lead to prolonged morbidity.
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Spelta K, Diniz LM. CUTANEOUS TUBERCULOSIS: A 26-YEAR RETROSPECTIVE STUDY IN AN ENDEMIC AREA OF TUBERCULOSIS, VITÓRIA, ESPÍRITO SANTO, BRAZIL. Rev Inst Med Trop Sao Paulo 2016; 58:49. [PMID: 27410909 PMCID: PMC4964318 DOI: 10.1590/s1678-9946201658049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/20/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Tuberculosis is a serious health problem in Brazil so that the knowledge on the aspects of cutaneous tuberculosis is medically important. OBJECTIVE To assess the characteristics of patients with cutaneous tuberculosis treated at the Cassiano Antonio Moraes University Hospital, located in the city of Vitória, State of Espírito Santo, Brazil. METHODS This is a retrospective, descriptive, observational and cross-sectional study using the medical records of 29 patients with cutaneous tuberculosis treated at the Dermatology and Pulmonology services of the hospital from 1986 to 2011. The inclusion criterion was the confirmation of cutaneous tuberculosis taking into account clinical, epidemiological, immunological, and bacteriological findings, as well as the response to specific treatment. RESULTS Of the 29 studied patients; 18 (62%) were women with average age of 37 years; the predominant clinical condition was erythema induratum of Bazin in 12 (41.4%) cases; and the cutaneous lesions were in the lower limbs in 19 (65.8%) patients. Extra-cutaneous involvement occurred in eight (27.6%) cases. The tuberculin tests were positive in 15 (79%) individuals and the assessment of the infectious agent was negative in most of the investigated cases. CONCLUSION The study found a low frequency (0.44%) of cutaneous tuberculosis in an endemic area of tuberculosis. There was a predominance of infection in women aged thirty to forty years. Erythema induratum was the most common clinical condition, affecting mainly the lower limbs, in contrast to other Brazilian studies that found scrofuloderma as the most common manifestation, predominating in the cervical region of male children and adolescents.
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Affiliation(s)
- Karla Spelta
- Federal University of Espírito Santo, Medical Graduate Program. Vitória, ES, Brazil
| | - Lucia M Diniz
- Federal University of Espírito Santo, Medical Graduate Program. Vitória, ES, Brazil
- Federal University of Rio de Janeiro, Medical Graduate Program. Rio de Janeiro, RJ, Brazil
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Kara A, Bayram N, Ergin M, Devrim I. Ulcerated Skin Nodule on the Chest. Pediatr Dermatol 2016; 33:349-50. [PMID: 27176806 DOI: 10.1111/pde.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ahu Kara
- Department of Pediatric Infectious Diseases, Dr Behçet Uz Pediatrics and Surgery Training and Research Hospital, Izmir, Turkey
| | - Nuri Bayram
- Department of Pediatric Infectious Diseases, Dr Behçet Uz Pediatrics and Surgery Training and Research Hospital, Izmir, Turkey
| | - Malik Ergin
- Department of Pathology, Dr Behçet Uz Pediatrics and Surgery Training and Research Hospital, Izmir, Turkey
| | - Ilker Devrim
- Department of Pediatric Infectious Diseases, Dr Behçet Uz Pediatrics and Surgery Training and Research Hospital, Izmir, Turkey
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19
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Cutaneous tuberculosis overview and current treatment regimens. Tuberculosis (Edinb) 2014; 95:629-638. [PMID: 26616847 DOI: 10.1016/j.tube.2014.12.006] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 12/17/2014] [Indexed: 02/06/2023]
Abstract
Tuberculosis is one of the oldest diseases known to humankind and it is currently a worldwide threat with 8-9 million new active disease being reported every year. Among patients with co-infection of the human immunodeficiency virus (HIV), tuberculosis is ultimately responsible for the most deaths. Cutaneous tuberculosis (CTB) is uncommon, comprising 1-1.5% of all extra-pulmonary tuberculosis manifestations, which manifests only in 8.4-13.7% of all tuberculosis cases. A more accurate classification of CTB includes inoculation tuberculosis, tuberculosis from an endogenous source and haematogenous tuberculosis. There is furthermore a definite distinction between true CTB caused by Mycobacterium tuberculosis and CTB caused by atypical mycobacterium species. The lesions caused by mycobacterium species vary from small papules (e.g. primary inoculation tuberculosis) and warty lesions (e.g. tuberculosis verrucosa cutis) to massive ulcers (e.g. Buruli ulcer) and plaques (e.g. lupus vulgaris) that can be highly deformative. Treatment options for CTB are currently limited to conventional oral therapy and occasional surgical intervention in cases that require it. True CTB is treated with a combination of rifampicin, ethambutol, pyrazinamide, isoniazid and streptomycin that is tailored to individual needs. Atypical mycobacterium infections are mostly resistant to anti-tuberculous drugs and only respond to certain antibiotics. As in the case of pulmonary TB, various and relatively wide-ranging treatment regimens are available, although patient compliance is poor. The development of multi-drug and extremely drug-resistant strains has also threatened treatment outcomes. To date, no topical therapy for CTB has been identified and although conventional therapy has mostly shown positive results, there is a lack of other treatment regimens.
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20
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Santos JBD, Figueiredo AR, Ferraz CE, Oliveira MHD, Silva PGD, Medeiros VLSD. Cutaneous tuberculosis: diagnosis, histopathology and treatment - part II. An Bras Dermatol 2014; 89:545-55. [PMID: 25054739 PMCID: PMC4148266 DOI: 10.1590/abd1806-4841.20142747] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/05/2013] [Indexed: 04/12/2023] Open
Abstract
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.
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21
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Pai VV, Naveen KN, Athanikar SB, Dinesh US, Divyashree A, Gupta G. A clinico-histopathological study of lupus vulgaris: A 3 year experience at a tertiary care centre. Indian Dermatol Online J 2014; 5:461-5. [PMID: 25396129 PMCID: PMC4228641 DOI: 10.4103/2229-5178.142497] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Lupus vulgaris is the most common form of cutaneous tuberculosis in adults. Lupus vulgaris is caused by hematogenous, lymphatic, or contiguous spread from elsewhere in the body. histologically it is charecterised by typical tubercles with or without caseation, surrounded by epitheloid histiocytes and multinucleate giant cells in the superficial epidermis with prominent peripheral lymphocytes. MATERIALS AND METHOD All cases of clinically and histopathologicaly diagnosed lupus vulgaris over the previous five years were included in the study. RESULTS Fourteen cases of lupus vulgaris cases reported during the study period with eaqual incidence among males and females. DISCUSSION Plaque type of lupus vulgaris was the most common type. Histopathologically tubercular granulomas were seen in all cases as compared to other studies. CONCLUSION Different patterns of lupus vulgaris are reported.
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Affiliation(s)
| | | | - S B Athanikar
- Department of Dermatology, Goa Medical College, Bambolim, India
| | - U S Dinesh
- Department of Pathology, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
| | - A Divyashree
- Department of Dermatology, Goa Medical College, Bambolim, India
| | - Gaurang Gupta
- Department of Dermatology, Goa Medical College, Bambolim, India
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22
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Nimisha E, Gupta G. Penile lupus vulgaris: a rare presentation of primary cutaneous tuberculosis. Int J STD AIDS 2014; 25:969-70. [PMID: 25318855 DOI: 10.1177/0956462414532448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Esther Nimisha
- Department of Skin, VD & Leprosy, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Gaurang Gupta
- Dermatology and Cosmetology, Skinplus Clinic, Greater Kailash, New Delhi, India
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23
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Das CK, Mahapatra A, Das MM, Sahoo D, Chayani N. Coexistence of cutaneous tuberculosis (scrofuloderma) and hanseniasis-a rare presentation. J Clin Diagn Res 2014; 8:141-2. [PMID: 24701508 PMCID: PMC3972534 DOI: 10.7860/jcdr/2014/7050.4033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/19/2013] [Indexed: 11/24/2022]
Abstract
Cutaneous tuberculosis, pulmonary tuberculosis and hanseniasis are all caused by different spp. of Mycobacterium, an intracellular pathogen whose development depends on impaired cell mediated immunity. Scrofuloderma is the most common variant of cutaneous tuberculosis, which is characterized by a direct extension of the skin which overlies the infected lymph gland, bone or joint, that breaks down to form an undermined ulcer. We are reporting a rare association of Scrofuloderma (cutaneous tuberculosis) with Hanseniasis (leprosy) in an adult male whose immune status was controversial.
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Affiliation(s)
- Chandan Kumar Das
- Doctoral Student, Department of Microbiology,S.C.B Medical College, Cuttack, Odisha, India
| | - Ashoka Mahapatra
- Associate Professor, Department of Microbiology,AIIMS Bhubaneswar, Odisha, India
| | - Manasi Manaswini Das
- Doctoral Student, Department of Pharmacology,SCB Medical College, Cuttack, Odisha, India
| | - Debasish Sahoo
- Senior Resident, Department of Microbiology,SCB Medical College, Cuttack, Odisha, India
| | - Nirupama Chayani
- Professor and Head, Department of Microbiology,SCB Medical College, Cuttack, Odisha, India
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Halim MS, Ahmed SQ, Junaid M, Bashir MR. Tuberculosis verrucosa cutis in a patient with keloid over ear lobule. BMJ Case Rep 2013; 2013:bcr-2013-010294. [PMID: 23845683 DOI: 10.1136/bcr-2013-010294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tuberculosis (TB) is a global health problem with predominance in resource-poor countries. Extrapulmonary TB constitutes approximately 10% of the cases and can present as different forms depending on the route of entry. Cutaneous TB is a small subset of the extrapulmonary TB. Cutaneous TB can either be of primary origin or secondary origin or it can be a part of a systemic infection. TB verrucosa cutis (TBVC) is the exogenous reinfection of TB in a previously sensitised patient. Routine cultures do not have a high yield in TBVC due to the paucibacillary nature of the organism. Here we are presenting a rare case of a patient who developed in a keloid over the right ear lobule following ear piercing. This has only been presented once in the previous literature and for the first time in the head and neck region.
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25
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Asadi Gharabaghi M. Cutaneous tuberculosis caused by isoniazid-resistant Mycobacterium tuberculosis. BMJ Case Rep 2012; 2012:bcr-2012-006253. [PMID: 22761237 DOI: 10.1136/bcr-2012-006253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cutaneous tuberculosis constitutes an uncommon presentation of extrapulmonary tuberculosis, especially among immune-competent patients. Here, there is a report of a 38-year-old man who presented with non-pruritic skin plaques, caused by isoniazid-resistant Mycobacterium tuberculosis, over his buttock, inguinal area and earlobe.
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