CUTANEOUS TUBERCOLOSIS IN TIGRAY, ETHIOPIA

Morrone A., Terranova M., Padovese V.

21° WORLD CONGRESS OF DERMATOLOGY
Buenos Aires, September 30 – October 5 2007

Introduction Tuberculosis (TB) is still a serious problem in both developing and developed countries and his resurgence in the era of human immunodeficiency virus (HIV) has rejuvenated the interest in this global health problem. In Ethiopia, prevalence rate of the infection was 533 over 100.000 inhabitants for 2004. Cutaneous tuberculosis (CT) represents only 2% of extra-pulmonary locations.
Patients and Methods We report 102 patients observed in the Italian Dermatological Centre (IDC) in Mekele, capital of Tigray, the northern region of Ethiopia, between January and December 2006. Clinical diagnosis was confirmed with fine-needle aspiration cytology (FNAC) and Ziehl Neelsen (ZN) or Methylene blue staining (showing acid fast bacilli (AFB) or caseation necrosis) and histological investigations. ST represented 0.92% of total diagnosis done in the IDC during 2006.
Results During one year of clinical activity, 102 cases of cutaneous tuberculosis were observed; among these, female represented 53.5% of cases and paediatric cases were 13 (12.7% of cases). Scrofuloderma and lichen scrofulosorum represented the most prevalent clinical manifestations while lupus vulgaris, TB verrucosa cutis and gumma were few cases. The first affected area for scrofuloderma was the axilla followed by thoracic area; for lichen scrofulosorum it was represented by limbs. Among our patients, 20 were HIV positive (19.6% of total cases). History of persistent skin lesions after complete cycle of anti-TB treatment in many of our patients, confirm presence of drug resistance to TB infection in this area as reported in the literature.
Conclusion TB represents spread infection in all Ethiopia. Delayed diagnosis and treatment of TB results in severe disease and a higher mortality; it also leads to an increased period of infectivity in the community. CT, an important extra-pulmonary form, is commonly seen in our dermatological practice in Ethiopia in adult as well as paediatric patients. This form should be studied and recognized because it may indicate visceral forms of tuberculosis and help diagnosis of first or relapsing infection as well as drug-resistance cases.
References
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• Global tuberculosis control. WHO report 2006.
(http://www.who.int/GlobalAtlas/predefinedReports/TB/PDF_Files/ET_2004_Detailed.pdf)
• Eyob G et al. Drug susceptibility of Mycobacterium tuberculosis in HIV-infected and -uninfected Ethiopians and its impact on outcome after 24 months of follow-up. Int J Tuberc Lung Dis 2004 ;8(11):1388-91.