Analysis of 30 patients with acupuncture-induced primary inoculation tuberculosis.

Primary inoculation tuberculosis is a skin condition that develops at the site of inoculation of Mycobacterium tuberculosis in tuberculosis-free individuals. This report describes the diagnosis, treatment and >1 year follow-up of 30 patients presenting with acupuncture-induced primary inoculation tuberculosis. Our data provide a deeper insight into this rare route of infection of tuberculosis. We also review effective treatment options.

Erythrodermic psoriasis with regression after prophylaxis with isoniazid and antidepressant therapy: case report.

An 83 year old woman, exhibiting severe psoriasis, was treated conventionally (phototherapy, acitretin, and cyclosporine). After poor clinical results and significant changes in laboratory procedures, those treatments were suspended. She was then being prepared to be submitted to biological treatment, when preliminary results disclosed a 30 mm PPD. Complete improvement occurred [only] after introducing prophylactic therapy for tuberculosis and anti-depressive medication.

Psoríase eritrodérmica com regressão após profilaxia com isoniazida e terapia antidepressiva: relato de caso / Erythrodermic psoriasis with regression after prophylaxis with isoniazid and antidepressant therapy: case report

Mulher idosa apresentou psoríase em placas do tipo grave, com tendência eritrodérmica, e foi submetida a tratamento de acordo com o algoritmo consensual (fototerapia, acitretina, ciclosporina). Resultados clínicos insuficientes, recorrência e agravamento do quadro laboratorial orientaram no sentido da introdução de terapia biológica. A avaliação preliminar revelou PPD de 30mm. A resolução completa das lesões se verificou quando realizada profilaxia antituberculose e administrado antidepressivo.

An 83 year old woman, exhibiting severe psoriasis, was treated conventionally (phototherapy, acitretin, and cyclosporine). After poor clinical results and significant changes in laboratory procedures, those treatments were suspended. She was then being prepared to be submitted to biological treatment, when preliminary results disclosed a 30mm PPD. Complete improvement occurred [only] after introducing prophylactic therapy for tuberculosis and anti-depressive medication.

Cutaneous tuberculosis after mesotherapy: report of six cases.

INTRODUCTION: Cutaneous tuberculosis as a result of a needle injection is a rare event; it generally occurs among medical and laboratory personnel and among patients receiving percutaneous treatment. OBJECTIVE: Six patients are presented who developed cutaneous tuberculosis after mesotherapy cosmetic treatment. MATERIAL AND METHODS: One to four months after injection of an unknown product as treatment for obesity and cellulites, five women and a man developed papules, nodules and drainage of wax like material at the inoculated sites; this was interpreted clinically as a non tuberculous mycobacterium infection. Skin biopsies were taken for a histopathologic study; the biopsy and exudates were cultured to make a phenotypic identification. Polymerase chain reaction and restriction enzyme pattern analyses (PCR-restriction pattern analysis)) procedures were applied to the skin biopsies. RESULTS: Mycobacterium tuberculosis was confirmed in the culture and by PRA analysis in the paraffin-embedded biopsies. The patients had never had tuberculosis. Their thoracic X rays were normal and the size of the tuberculin reaction was 17 to 20 mm. Five patients recovered with antituberculosis treatment and the sixth spontaneously healed after the removal of the largest cutaneous module. No satellite adenopathy or recurrences were observed. CONCLUSIONS: A previously undescribed mode of acquisition cutaneous tuberculosis was described. This was the second incident of a demonstrated cutaneous tuberculosis following mesotherapy in Colombia. Skin lesions induced by injections must be tested to detect mycobacterias to include M. tuberculosis.

[Soft-tissue infections due to non-tuberculous mycobacteria following mesotherapy. What is the price of beauty]. / Infecciones en tejidos blandos por micobacterias no tuberculosas secundarias a mesoterapia. 'Cuánto vale la belleza?

INTRODUCTION: Mesotherapy is widely used In Latin America for cosmetic purposes, particularly in obese individuals. We describe the clinical and epidemiological characteristics, microbiological diagnosis, treatment and follow-up of patients from Caracas (Venezuela) with soft tissue infection caused by non-tuberculous mycobacteria following mesotherapy. METHODS: Between March 2002 and December 2003, we evaluated 49 cases of skin and soft tissue infection following mesotherapy. Specimens obtained from the lesions and 15 products used in the mesotherapy procedure were cultured for the presence of non-tuberculous mycobacteria. Isolated mycobacteria were identified by PCR restriction fragment length polymorphism analysis of the hsp65 gene. RESULTS: Infection by non-tuberculous mycobacteria was confirmed in 81.6% of the 49 cases. Mycobacterium abscessus and M. fortuitum were the most common species, but M. chelonae, M. peregrinum, M. simiae and a new species that was designated "M. cosmeticum" were also isolated. Patients were treated with species-specific antibiotic agents for 3 to 18 months. Investigation into the source of the infection revealed that 21 patients were clustered within 3 different outbreaks and two products were found to be contaminated with M. fortuitum and M. abscessus, respectively. CONCLUSIONS: Physicians should be alerted to the possibility of infection by non-tuberculous mycobacteria in patients with a history of mesotherapy who develop late-onset skin and soft tissue infection, particularly if they do not respond to conventional antibiotic treatment.

Infecciones en tejidos blandos por micobacterias no tuberculosas secundarias a mesoterapia. ¿Cuánto vale la belleza? / Soft tissue infections due to non-tuberculous mycobacteria following mesotherapy. What is the price of beauty?

Introducción. La mesoterapia se utiliza mucho en Latinoamérica con fines cosméticos, especialmente en pacientes con obesidad. En este estudio se describen las características clínicas y epidemiológicas, el diagnóstico microbiológico, el tratamiento y el seguimiento de infecciones por micobacterias no tuberculosas en un grupo de pacientes en Caracas (Venezuela) con antecedentes de mesoterapia. Metodología. Entre marzo de 2002 y diciembre de 2003 se evaluaron 49 pacientes con infección en la piel y tejidos blandos secundaria a mesoterapia. Se tomaron muestras de las lesiones para el aislamiento de micobacterias y se elaboró una ficha clínica. Además, se analizaron 15 productos utilizados en mesoterapia. Las micobacterias aisladas fueron identificadas a través del polimorfismo de fragmentos de restricción del gen hsp65. Resultados. De los 49 pacientes evaluados, en el 81,6% se confirmó una infección por micobacterias no tuberculosas. Las especies más comunes fueron Mycobacterium abscessus y M. fortuitum pero también se aislaron M. chelonae, M. peregrinum, M. simiae y una nueva especie que fue designada M. cosmeticum. Los pacientes recibieron tratamiento específico para cada especie durante un período de 3 hasta 18 meses. La investigación de la fuente de infección reveló que 21 pacientes estaban agrupados en tres brotes y se encontraron dos productos contaminados, uno con M. fortuitum y otro con M. abscessus. Conclusiones. Los médicos deben estar atentos ante aquellos pacientes con antecedentes de mesoterapia que desarrollen tardíamente lesiones en piel y tejidos blandos, que no respondan al tratamiento antimicrobiano convencional, ya que éstas podrían ser causadas por micobacterias no tuberculosas (AU)

Introduction. Mesotherapy is widely used In Latin America for cosmetic purposes, particularly in obese individuals. We describe the clinical and epidemiological characteristics, microbiological diagnosis, treatment and follow-up of patients from Caracas (Venezuela) with soft tissue infection caused by non-tuberculous mycobacteria following mesotherapy. Methods. Between March 2002 and December 2003, we evaluated 49 cases of skin and soft tissue infection following mesotherapy. Specimens obtained from the lesions and 15 products used in the mesotherapy procedure were cultured for the presence of non-tuberculous mycobacteria. Isolated mycobacteria were identified by PCR restriction fragment length polymorphism analysis of the hsp65 gene. Results. Infection by non-tuberculous mycobacteria was confirmed in 81.6% of the 49 cases. Mycobacterium abscessus and M. fortuitum were the most common species, but M. chelonae, M. peregrinum, M. simiae and a new species that was designated "M. cosmeticum" were also isolated. Patients were treated with species-specific antibiotic agents for 3 to 18 months. Investigation into the source of the infection revealed that 21 patients were clustered within 3 different outbreaks and two products were found to be contaminated with M. fortuitum and M. abscessus, respectively. Conclusions. Physicians should be alerted to the possibility of infection by non-tuberculous mycobacteria in patients with a history of mesotherapy who develop late-onset skin and soft tissue infection, particularly if they do not respond to conventional antibiotic treatment (AU)

[Mycobacterial bovis BCG cutaneous infections following mesotherapy: 2 cases]. / BCGite cutanée après mésothérapie: 2 cas.

INTRODUCTION: Infectious complications following mesotherapy are usually due to ordinary bacteria or atypical mycobacteria. We report two new cases of mycobacterial bovis BCG infections following mesotherapy. To our knowledge only one case has already been reported. CASES REPORTS: A 52 year-old woman developed vaccinal MERIEUX BCG cutaneous abscesses following mesotherapy. Identification was made by a novel class of repeated sequences: Mycobacterial interspersed repetitive units. Despite prolonged anti-tuberculous therapy, complete remission was not obtained and surgical excision was performed. The second case was a 49 year-old man who developed a mycobacterial bovis BCG cutaneous abscess (Connaught) after mesotherapy, the regression of which was obtained with anti-tuberculous therapy. DISCUSSION: The severity of these two mycobacterial infections following mesotherapy illustrate the potential risks of mesotherapy. Identification is possible by molecular biology techniques (PCR and sequencing). The origin of this infection is unclear and therapeutic decision is difficult. Some authors recommend anti-tuberculous therapy but surgical excision may be necessary as in our cases.

Tuberculose cutânea no Brasil / Cutaneous tuberculosis in Brazil

Os aspectos clínicos, a epidemiologia, a etiopatologia e o diagnóstico da doença foram apresentados e debatidos pelos relatores do grupo de trabalho e médicos que participaram da reuniäo na qualidade de assistidos. As formas clínicas mais comuns no Brasil foram mencionadas, destacando-se o escofuloderma, a tuberculose cutânea indurativa de Bazin e a tuberculide papulóide necrótica. Criticou-se a ficha epidemiológica da Divisäo de Pneumologia Sanitária do Ministério da Saúde, em que a tuberculose cutânea näo aparece especificada, sendo registrada no item Outros. Uma revisäo dos principais estudos etiopatogênicos, o polimorfismo lesional e o grande acontecimento dos imunodeprimidos, principalmente os portadores da Aids, mereceram atençäo especial dos participantes. No diagnóstico foi ressaltada a grande contribuiçäo da técnica da PCR, que permite identificar a presença de raríssimas micobactérias, contribuindo para a precisäo diagnóstica.