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Questions and Answers
What is the relative risk of TB infection in patients receiving anti-TNF-$ treatment?
What is the relative risk of TB infection in patients receiving anti-TNF-$ treatment?
- 5% to 10%
- 1.5% to 17% (correct)
- 10% to 20%
- 0.5% to 5%
Which therapy demonstrates a higher risk of TB infection compared to others?
Which therapy demonstrates a higher risk of TB infection compared to others?
- Corticosteroid therapy
- Anti-IL immunobiological therapy
- Soluble TNF-$ receptor therapy
- Anti-TNF-$ monoclonal antibody therapy (correct)
What is a potential benefit of using anti-IL immunobiological therapies?
What is a potential benefit of using anti-IL immunobiological therapies?
- Higher efficacy in autoimmune diseases
- Better safety profile (correct)
- Increased risk of TB reactivation
- Broader immunosuppressive effects
What role do Th17-related cytokines play in relation to M.tuberculosis?
What role do Th17-related cytokines play in relation to M.tuberculosis?
Which of the following is a characteristic of soluble TNF-$ receptor therapy?
Which of the following is a characteristic of soluble TNF-$ receptor therapy?
What is the primary concern with anti-TNF-$ therapies?
What is the primary concern with anti-TNF-$ therapies?
What factor may contribute to the differing risks of TB infection between treatments?
What factor may contribute to the differing risks of TB infection between treatments?
Which two monoclonal antibodies are mentioned as examples of anti-TNF-$ therapies?
Which two monoclonal antibodies are mentioned as examples of anti-TNF-$ therapies?
What kind of lesions are typically characterized by central necrosis and ulceration covered by crusts?
What kind of lesions are typically characterized by central necrosis and ulceration covered by crusts?
Which type of inflammatory infiltrate is found in the upper dermis?
Which type of inflammatory infiltrate is found in the upper dermis?
Which condition is NOT included in the differential diagnosis of the lesions described?
Which condition is NOT included in the differential diagnosis of the lesions described?
What characteristic finding occurs after treatment or spontaneous resolution of the lesions?
What characteristic finding occurs after treatment or spontaneous resolution of the lesions?
What is a common feature of the histopathology associated with these skin lesions?
What is a common feature of the histopathology associated with these skin lesions?
What type of cells may be present in the granulomatous infiltrate?
What type of cells may be present in the granulomatous infiltrate?
Which organism has been associated with some cases of these lesions as demonstrated by PCR?
Which organism has been associated with some cases of these lesions as demonstrated by PCR?
Who was the first to describe erythema induratum of Bazin?
Who was the first to describe erythema induratum of Bazin?
What is the likelihood of developing tuberculosis for immunocompetent individuals over their lifetime?
What is the likelihood of developing tuberculosis for immunocompetent individuals over their lifetime?
Which immune cells play a critical role in the defense against mycobacterial infections?
Which immune cells play a critical role in the defense against mycobacterial infections?
What percentage of tuberculosis cases are represented by extrapulmonary TB?
What percentage of tuberculosis cases are represented by extrapulmonary TB?
Which of the following conditions is classified as extrapulmonary tuberculosis?
Which of the following conditions is classified as extrapulmonary tuberculosis?
What is the primary etiological agent of cutaneous tuberculosis?
What is the primary etiological agent of cutaneous tuberculosis?
What does lupus vulgaris indicate in terms of immune response in cutaneous tuberculosis?
What does lupus vulgaris indicate in terms of immune response in cutaneous tuberculosis?
Which statement accurately represents the relationship between T-cells and mycobacterium tuberculosis?
Which statement accurately represents the relationship between T-cells and mycobacterium tuberculosis?
What is a significant feature of scrofuloderma in cutaneous tuberculosis?
What is a significant feature of scrofuloderma in cutaneous tuberculosis?
What is the preferred location of a painful ulcer due to tuberculous etiology in the lesions described?
What is the preferred location of a painful ulcer due to tuberculous etiology in the lesions described?
Which of the following is NOT a clinical variant of the lesions described?
Which of the following is NOT a clinical variant of the lesions described?
What initial appearance is noted for the lesions caused by mycobacterioses?
What initial appearance is noted for the lesions caused by mycobacterioses?
Which area is NOT commonly affected by mycobacterioses according to the information provided?
Which area is NOT commonly affected by mycobacterioses according to the information provided?
How may oral cavity lesions extend according to the disease description?
How may oral cavity lesions extend according to the disease description?
What serious complication may arise from long-term lesions as described in the literature?
What serious complication may arise from long-term lesions as described in the literature?
Which of the following is a common feature of the painful ulcers described?
Which of the following is a common feature of the painful ulcers described?
What effect does untreated disease have on the affected anatomical sites?
What effect does untreated disease have on the affected anatomical sites?
What are the typical microscopic findings in EIB/NV?
What are the typical microscopic findings in EIB/NV?
Which of the following is NOT identified in EIB/NV lesions?
Which of the following is NOT identified in EIB/NV lesions?
What is the purpose of Mycobacterium tuberculosis direct tests?
What is the purpose of Mycobacterium tuberculosis direct tests?
Which technique is most frequently used in laboratories for detecting AFB?
Which technique is most frequently used in laboratories for detecting AFB?
In the context of cutaneous tuberculosis diagnosis, what types of biological material can be analyzed?
In the context of cutaneous tuberculosis diagnosis, what types of biological material can be analyzed?
What is typically observed in chronic lesions of EIB/NV?
What is typically observed in chronic lesions of EIB/NV?
Which condition is NOT part of the differential diagnosis for EIB/NV?
Which condition is NOT part of the differential diagnosis for EIB/NV?
Which of the following histological alterations is commonly associated with EIB/NV?
Which of the following histological alterations is commonly associated with EIB/NV?
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Study Notes
T-Cell Immune Response and Tuberculosis
- 10% risk of developing tuberculosis (TB) in immunocompetent individuals over a lifetime; risk increases to 10% annually for HIV-infected individuals.
- Extrapulmonary TB accounts for 20% of TB cases, affecting organs like pleura, bones, urinary tract, and meninges.
Cutaneous Tuberculosis (CTB)
- CTB is a rare form of TB, representing 1-2% of all forms; primarily caused by Mycobacterium tuberculosis, occasionally by Mycobacterium bovis and the BCG vaccine strain.
- First described in 1826 by Théophile Laënnec, who later died from the disease.
- Identifies various forms of CTB, including lupus vulgaris (high cell immunity) and scrofuloderma (lower cell immunity).
Clinical Manifestations
- Lesions usually present as yellowish erythematous papules/nodules progressing to painful ulcers; can occur in genital, oral, and other areas.
- Specific rare cases include painful ulcers on labia majora in young females; lesions often display features like ulceration and scarring.
- Multiple skin lesion variants exist: psoriasiform, eczema-like, annular, ulcerative, and hypertrophic lesions, causing significant deformities.
Histopathology
- Granulomatous inflammation with epithelioid cells; multinucleated giant cells detected in some cases.
- Lack of detectable M. tuberculosis in special stains, though PCR can identify its DNA.
Differential Diagnosis
- CTB must be differentiated from conditions like lichen planus, erythema nodosum, and other skin ailments resembling TB.
- Ernest Bazin described erythema induratum, with similar granulomatous characteristics requiring differential diagnosis from other inflammatory skin conditions.
Diagnosis of Cutaneous Tuberculosis
- Diagnosis may involve the Ziehl-Neelsen technique for staining biological material; sensitivity for detecting bacillus is low.
- Risk of TB infection in patients on anti-TNF therapies ranges from 1.5% to 17%, with monoclonal antibodies posing a higher risk than soluble TNF receptor treatments.
Immunological Insights
- Th17-related cytokines are suggested to enhance protection against primary M. tuberculosis infections.
- New immunobiologicals targeting interleukins aim for better safety in patients, potentially reducing TB reactivation risks compared to TNF-$ inhibitors.
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