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Agentul etiologic: (1882) BACILUL KOCH

Genul Mycobacterium

M. patogene: M. tuberculosis, M. bovis

M. atipice: M. kansasii (Kansas), M. marinum, M.scrofulaceum, M. flavescens, M.

gordonae, M. obuense, M. gilvum, M.duvali, M. szulgai, M. intracellulare, M.xenopi (littorale), M. ulcerans, M. buruli,M. terrae, M. fortuitum (minetti, giae),

M. chelonae.

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Incidenta: invers proportionala cu nivelulsocio-economic; in tarile dezvoltate aupondere relativ mai crescuta imbolnavirile

cu M. atipice TBC pulmonare: 80% din total; frecventa

TBC cutanate e proportionala cu aafectarilor pulmonare

In tara noastra TBC constituie inca oproblema serioasa de sanatate publica

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APRECIEREA NATURII TBCA UNEI LEZIUNI CUTANATE

1. Evidentierea BK -col. ZN

2. Cultivarea BK pe mediuLoewenstein

3. Inoculare pozitiva la cobai

Criterii MAJORE

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Caile de infectare

a tegumentului

Exogena

Endogena

HETEROINFECTII

oameni bolnavi

animale

mediu (obiecte contaminate)

AUTOINOCULARE

focare proprii deschise

PRIN CONTIGUITATE

PE CALE LIMFATICA

PE CALE HEMATOGENA

Focar subiacent

(ggl, osteo-artic)

Focar profund

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Boli diferite ca aspect clinic si prognostic

Calea (modul) de infectare Starea/ integritatea organului cutanat

Tipul agentului patogen Starea imuna in momentul infectarii

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1. PLAN

2. PROEMINENT

3. ULCERAT

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Reactii de tip ide Pot aparea in legatura cu o infectie

Bacteriana bacteride Ex: TBC tuberculide

Micotica micidide (dermatofiti dermatofitide;levuri levuride)Virala viruside

Sunt expresia unei reactii alergice de tip intarziat la Ag(leziunile nu contin Ag responsabil dar IDR la Ag e pozitivTipul agentului patogen

Aspectul lor clinic nu orienteaza asupra cauzei

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FORME CLINICE

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FORME CLINICE

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FORME CLINICE

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MANIFESTARI CLINICE

CUTANEO-MUCOASEINDETER-

MINATA

TUBERCULOIDA BORDERLINE LEPROMA-

TOASA

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MANIFESTARI NERVOASE

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MANIFESTARI NERVOASE

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INDETER-

MINATA

TUBERCULOIDA BORDERLINE LEPROMA-

TOASA

paralizii,

+/- ulceratii

trofice

+ +, severe,

precoce,

asimetrice, cu

mutilatii

+ +, severe,

precoce

+, mai putin

precoce, mai

simetrice, cu

mutilatii

MANIFESTARI NERVOASE

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INDETER-

MINATA

TUBERCULOIDA BORDERLINE LEPROMA-

TOASA

ALTE MANIFESTARI

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INDETER-

MINATA

TUBERCULOIDA BORDERLINE LEPROMA-

TOASA

EVOLUTIE

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INDETER-

MINATA

TUBERCULOIDA BORDERLINE LEPROMA-

TOASA

BACTEIOLOGIE

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INDETER-

MINATA

TUBERCULOIDA BORDERLINE LEPROMA-

TOASA

HISTOPATOLOGIC

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INDETER-

MINATA

TUBERCULOIDA BORDERLINE LEPROMA-

TOASA

REACTIA MITSUDA= IDR LA LEPROMINA (extract sterilizat

de b. Hansen tatoo)