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Dermatology

Mycobacterial Infections

Built from Dermatology, 5th Edition

The first 25 slides of Mycobacterial Infections
The first 25 slides, exactly as they appear. The full deck has 188 content slides.

What’s inside

4 sections · 188 slides

  1. 01

    Overview

    • What are mycobacteria
    • Why mycobacterial disease is rising
    • Mycobacteria that cause cutaneous disease
    • How mycobacteria are grouped (Runyon system)

    4 slides

  2. 02

    Hansen Disease (Leprosy)

    A chronic infection of the skin and peripheral nerves caused by Mycobacterium leprae

    • Key features of Hansen disease
    • A disease known since antiquity
    • Naming the disease
    • How common is Hansen disease
    • New leprosy cases worldwide, 2021
    • Hansen disease in the United States
    • How Hansen disease spreads
    • Hansen disease as a zoonosis
    • The organism and where it lives in the body
    • Why some people get sick and others do not
    • More susceptibility genes
    • The clinical-immunologic spectrum of Hansen disease
    • Clinical-immunologic spectrum of Hansen disease
    • The tuberculoid (strong-immunity) immune response
    • The lepromatous (weak-immunity) immune response
    • Clues from the antibody phenolic glycolipid-1 (PGL-1)
    • Classifying Hansen disease
    • Classification of Hansen disease across the spectrum - LL
    • Classification of Hansen disease across the spectrum - BL
    • Classification of Hansen disease across the spectrum - BB
    • Classification of Hansen disease across the spectrum - BT
    • Classification of Hansen disease across the spectrum - TT
    • Classification of Hansen disease across the spectrum - I
    • The WHO operational classification
    • Cutaneous findings in paucibacillary and multibacillary leprosy
    • Examining the peripheral nerves
    • Nerve enlargement in lepromatous Hansen disease
    • The lepromatous form - clinical picture
    • Lepromatous Hansen disease - clinical appearance
    • Lepromatous Hansen disease - forearm nodules
    • Lepromatous Hansen disease - leonine facies
    • Late sequelae of lepromatous disease
    • Sequelae of Hansen disease
    • Histoid and Lucio leprosy - two distinct variants
    • Borderline leprosy - features in between
    • Mid-borderline (BB) leprosy
    • Borderline tuberculoid leprosy
    • The tuberculoid form - clinical picture
    • Tuberculoid Hansen disease - clinical appearance
    • Tuberculoid leprosy - plaque with central hypopigmentation
    • Reactions - a complication of treatment
    • Leprosy reactions - reversal reaction, ENL, and Lucio phenomenon
    • Type 1 (reversal) reactions
    • Type 2 reactions (erythema nodosum leprosum)
    • Lucio phenomenon
    • The two major types of leprosy reactions compared - Type 1 - reversal reaction
    • The two major types of leprosy reactions compared - Type 2 - erythema nodosum leprosum
    • Leprosy reactions - clinical spectrum
    • Type 1 upgrading reaction - facial involvement
    • Erythema nodosum leprosum
    • Erythema nodosum leprosum - three cases
    • Lucio phenomenon - retiform purpura and ulcers
    • Three histopathologic patterns
    • Lepromatous pattern on biopsy
    • Tuberculoid pattern on biopsy
    • Borderline and indeterminate patterns
    • Confirming the diagnosis - slit-skin smear and biopsy
    • PCR testing for Hansen disease
    • PCR testing requirements for M. leprae and M. lepromatosis
    • Submitting specimens for expert review
    • US specimen submission protocol for Hansen disease
    • US pathology consultation request form
    • Blood tests and the lepromin (Mitsuda) test
    • A trap for other diagnostic tests
    • Preventing disability
    • Clinical differential diagnosis of Hansen disease
    • WHO multidrug therapy (MDT) for Hansen disease
    • WHO 2018 treatment guidelines for Hansen disease
    • WHO 2018 treatment guidelines for Hansen disease (continued)
    • WHO 2018 treatment guidelines for Hansen disease (continued)
    • WHO 2018 treatment guidelines for Hansen disease (continued)
    • Treatment in the United States
    • How well does treatment work
    • Alternative and future drugs
    • Treating leprosy reactions
    • Outlook and prevention

    76 slides

  3. 03

    Cutaneous Tuberculosis

    Skin disease caused by Mycobacterium tuberculosis, from direct inoculation to disseminated infection

    • Key features of cutaneous tuberculosis
    • A disease traced through history
    • How common is cutaneous tuberculosis
    • Tuberculosis incidence rates worldwide, 2021
    • The organism itself
    • From infection to disease
    • How a tuberculous granuloma forms
    • Stages of granuloma formation in tuberculosis
    • Host genetics and immune defense
    • Two routes into the skin
    • Tuberculous chancre
    • Tuberculosis verrucosa cutis
    • Scrofuloderma
    • Scrofuloderma with bone involvement
    • Tuberculous mastitis
    • Orificial tuberculosis
    • Tuberculous ulcer of the tongue
    • Lupus vulgaris - overview
    • Lupus vulgaris - clinical spectrum
    • Lupus vulgaris - patterns and sites
    • Miliary tuberculosis and tuberculous gumma
    • What early cutaneous TB looks like under the microscope
    • Clinical presentations of cutaneous tuberculosis compared - Tuberculous chancre
    • Clinical presentations of cutaneous tuberculosis compared - TB verrucosa cutis
    • Clinical presentations of cutaneous tuberculosis compared - Scrofuloderma
    • Clinical presentations of cutaneous tuberculosis compared - Scrofuloderma (continued)
    • Clinical presentations of cutaneous tuberculosis compared - Orificial tuberculosis
    • Clinical presentations of cutaneous tuberculosis compared - Lupus vulgaris
    • Clinical presentations of cutaneous tuberculosis compared - Acute miliary TB
    • Clinical presentations of cutaneous tuberculosis compared - Tuberculous gumma
    • What are tuberculids
    • Papulonecrotic tuberculid
    • Lichen scrofulosorum
    • Erythema induratum (nodular vasculitis)
    • Erythema induratum - under the microscope
    • BCG vaccination and its complications
    • BCG vaccination site complication (BCGitis)
    • Complication of BCG immunotherapy injection
    • Testing for TB infection - skin test vs blood test
    • IFN-gamma release assays versus tuberculin skin testing - Tuberculin skin test
    • IFN-gamma release assays versus tuberculin skin testing - IFN-gamma release assays
    • Test pitfalls and molecular diagnosis
    • Treating cutaneous tuberculosis
    • Targets of the antituberculous agents
    • Classes, activity, and cross-resistance of antituberculous agents
    • Classes, activity, and cross-resistance of antituberculous agents (continued)
    • Multidrug-resistant and extensively drug-resistant tuberculosis
    • Drug regimens for culture-positive pulmonary tuberculosis - Intensive phase - drugs
    • Drug regimens for culture-positive pulmonary tuberculosis - Intensive phase - interval & doses
    • Drug regimens for culture-positive pulmonary tuberculosis - Continuation phase - drugs
    • Drug regimens for culture-positive pulmonary tuberculosis - Continuation phase - interval & doses
    • Drug regimens for culture-positive pulmonary tuberculosis - Total doses
    • Drug regimens for culture-positive pulmonary tuberculosis - Comments
    • New drugs for resistant tuberculosis
    • Vaccines - present and future

    55 slides

  4. 04

    Non-tuberculous Mycobacterioses

    Skin infections from environmental mycobacteria other than M. leprae and M. tuberculosis

    • Key features of non-tuberculous mycobacterioses
    • Discovery and where these organisms live
    • Who is most at risk of severe infection
    • A hazard of modern cosmetic and medical procedures
    • Classifying and treating NTM species
    • Mycobacterium ulcerans (Buruli ulcer) - overview
    • Where Buruli ulcer occurs
    • How Buruli ulcer causes such severe, painless damage
    • Buruli ulcer - clinical course
    • Grading severity and diagnosis
    • Buruli ulcer - undermined indurated border
    • Treating Buruli ulcer
    • Mycobacterium marinum - fish tank and swimming pool granuloma
    • How M. marinum infection happens
    • Clinical patterns of M. marinum infection
    • Diagnosing and treating M. marinum
    • Mycobacterium kansasii
    • M. kansasii - clinical picture and diagnosis
    • Rapidly growing mycobacteria - overview
    • How rapid-grower infections happen
    • Clinical features of rapid-grower infections
    • Suppurative lymphadenitis from M. fortuitum inoculation
    • Mycobacterium chelonae infection
    • Diagnosing and treating rapid growers
    • Mycobacterium avium complex (MAC) - overview
    • Clinical features of MAC infection
    • MAC - pathology, diagnosis, and treatment
    • Mycobacterium haemophilum
    • M. haemophilum - clinical picture, diagnosis, treatment
    • Mycobacterium scrofulaceum
    • M. scrofulaceum - diagnosis and treatment
    • Treatment of non-tuberculous mycobacterial infections by species - Local treatment
    • Treatment of non-tuberculous mycobacterial infections by species - Systemic medications (alone or combined)
    • ~130,000
    • Putting it all together
    • References
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    • Dermatology, 5th Edition (2-Volume Set)

    53 slides