PDF(Pubmed)
Abstract：
Cutaneous tuberculosis (CTB) and its paucibacillary forms are rare and difficult to diagnose, especially in immunocompromised patients with significant comorbidity. The aim of the study was to introduce the modern concept of the microbiome and diagnostic chain into clinical practice (patient-centered care) with the presentation of an atypical form of cutaneous tuberculosis with necrotizing non-healing ulcers leading to polymicrobial infection.
The study material included samples from sputum, broncho-alveolar lavage and skin ulcer, taken from a patient developing cutaneous tuberculosis. The microbiological investigation was performed, and identification of the isolates was carried out using genotyping and the matrix-assisted laser desorption ionization-time of flight mass spectrometry.
The immunocompromised patient with humoral abnormality (plasma cell dyscrasia) and severe paraproteinemia developed multiorgan tuberculosis. Although cutaneous manifestation preceded systemic and pulmonary symptoms (approximately half a year), the mycobacterial genotyping confirmed the same MTB strain existence in skin ulcers and the respiratory system. Therefore, the infectious chain: transmission, the portal of entry, and bacterial spreading in vivo, were unclear. Microbial diversity found in wound microbiota (among others Gordonia bronchialis, Corynebacterium tuberculostearicum, Staphylococcus haemolyticus, and Pseudomonas oryzihabitans) was associated with the spread of a skin lesion. The in vitro biofilm-forming capacity of strains isolated from the wound may represent the potential virulence of these strains. Thus, the role of polymicrobial biofilm may be crucial in ulcer formation and CTB manifestation.
Severe wound healing as a unique biofilm-forming niche should be tested for Mycobacterium (on species and strain levels) and coexisting microorganisms using a wide range of microbiological techniques. In immunodeficient patients with non-typical CTB presentation, the chain of transmission and MTB spread is still an open issue for further research.
The study material included samples from sputum, broncho-alveolar lavage and skin ulcer, taken from a patient developing cutaneous tuberculosis. The microbiological investigation was performed, and identification of the isolates was carried out using genotyping and the matrix-assisted laser desorption ionization-time of flight mass spectrometry.
The immunocompromised patient with humoral abnormality (plasma cell dyscrasia) and severe paraproteinemia developed multiorgan tuberculosis. Although cutaneous manifestation preceded systemic and pulmonary symptoms (approximately half a year), the mycobacterial genotyping confirmed the same MTB strain existence in skin ulcers and the respiratory system. Therefore, the infectious chain: transmission, the portal of entry, and bacterial spreading in vivo, were unclear. Microbial diversity found in wound microbiota (among others Gordonia bronchialis, Corynebacterium tuberculostearicum, Staphylococcus haemolyticus, and Pseudomonas oryzihabitans) was associated with the spread of a skin lesion. The in vitro biofilm-forming capacity of strains isolated from the wound may represent the potential virulence of these strains. Thus, the role of polymicrobial biofilm may be crucial in ulcer formation and CTB manifestation.
Severe wound healing as a unique biofilm-forming niche should be tested for Mycobacterium (on species and strain levels) and coexisting microorganisms using a wide range of microbiological techniques. In immunodeficient patients with non-typical CTB presentation, the chain of transmission and MTB spread is still an open issue for further research.
摘要：
■皮肤结核（CTB）及其小杆菌形式罕见且难以诊断，尤其是在具有显著合并症的免疫功能低下患者中。该研究的目的是将微生物组和诊断链的现代概念引入临床实践（以患者为中心的护理），并呈现非典型形式的皮肤结核，坏死性非愈合性溃疡导致多微生物感染。
■研究材料包括痰液样本，支气管肺泡灌洗和皮肤溃疡，取自发展为皮肤结核的患者。进行了微生物调查，并使用基因分型和基质辅助激光解吸电离飞行时间质谱对分离物进行鉴定。
■患有体液异常（浆细胞发育不良）和严重副蛋白血症的免疫受损患者发展为多器官结核。尽管皮肤表现先于全身和肺部症状（大约半年），分枝杆菌基因分型证实皮肤溃疡和呼吸系统中存在相同的MTB菌株。因此,感染链：传播，入口的门户，和细菌在体内传播，不清楚。在伤口微生物群中发现的微生物多样性（除其他外，结核杆菌，溶血葡萄球菌，和假单胞菌）与皮肤病变的传播有关。从伤口分离的菌株的体外生物膜形成能力可以代表这些菌株的潜在毒力。因此，微生物生物膜在溃疡形成和CTB表现中的作用可能至关重要。
■应使用广泛的微生物技术对作为独特的生物膜形成生态位的严重伤口愈合进行分枝杆菌（在物种和菌株水平上）和共存微生物的测试。在具有非典型CTB表现的免疫缺陷患者中，传输链和MTB传播仍然是一个有待进一步研究的问题。
■研究材料包括痰液样本，支气管肺泡灌洗和皮肤溃疡，取自发展为皮肤结核的患者。进行了微生物调查，并使用基因分型和基质辅助激光解吸电离飞行时间质谱对分离物进行鉴定。
■患有体液异常（浆细胞发育不良）和严重副蛋白血症的免疫受损患者发展为多器官结核。尽管皮肤表现先于全身和肺部症状（大约半年），分枝杆菌基因分型证实皮肤溃疡和呼吸系统中存在相同的MTB菌株。因此,感染链：传播，入口的门户，和细菌在体内传播，不清楚。在伤口微生物群中发现的微生物多样性（除其他外，结核杆菌，溶血葡萄球菌，和假单胞菌）与皮肤病变的传播有关。从伤口分离的菌株的体外生物膜形成能力可以代表这些菌株的潜在毒力。因此，微生物生物膜在溃疡形成和CTB表现中的作用可能至关重要。
■应使用广泛的微生物技术对作为独特的生物膜形成生态位的严重伤口愈合进行分枝杆菌（在物种和菌株水平上）和共存微生物的测试。在具有非典型CTB表现的免疫缺陷患者中，传输链和MTB传播仍然是一个有待进一步研究的问题。
