Phimosis tuberculosis rash

　　Mycobacterium tuberculosis belongs to the genus Mycobacterium and is acid-fast. According to their pathogenicity, they can be divided into human, bovine, avian, murine, and other types. The main pathogen causing skin tuberculosis in humans is the human strain, followed by the bovine strain. Rothe et al. inoculated lupus vulgaris into guinea pigs and isolated 82% human strains and 18% bovine strains. The pathogenicity of bovine tuberculosis is higher in the UK, accounting for 50% of lupus vulgaris and scrofula in London in 1957, while other countries generally report 5% to 25%.

　　Mycobacterium tuberculosis is a thin, slightly curved acid-fast bacillus that requires oxygen and is intracellular. It is difficult to distinguish between human and bovine strains of Mycobacterium tuberculosis in terms of morphology. The composition of Mycobacterium tuberculosis is very complex, mainly consisting of polysaccharides, lipids, and proteins, in addition to a small amount of minerals and water. Polysaccharides do not have strong antigens, although they can produce antibodies after injection into animals. The immediate-type skin reaction to tuberculin is also caused by polysaccharide antigens. The most important antigen is the protein of Mycobacterium tuberculosis, which is known to have several different compositions and can cause T lymphocytic immunity and变态反应. In allergic patients, the delayed-type tuberculin reaction is caused by them. Mycobacterium tuberculosis contains about 30 clearly antigenic substances, but none of them show any relation to toxicity. Lipids can cause monocytosis, infiltration of epithelioid cells and lymphocytes, and the formation of tuberculous nodules.

　　Most scholars report that the toxicity of Mycobacterium tuberculosis is weakened in local skin tuberculosis foci. The toxicity of the Mycobacterium tuberculosis cultured from different foci on the same patient is not uniform. Griffith found, based on a large amount of data, that only 30% of bovine strains and 27% of human strains have toxicity. There are reports that 50% to 90% of the pathogens of lupus vulgaris have their toxicity weakened to be similar to that of BCG. In most types of skin lesions, there are very few bacteria, but a large number of bacteria can be seen in primary tuberculosis or acute miliary tuberculosis.

　　Phimosis tuberculosis rash is a special form of manifestation of tuberculosis bacteria spreading to the skin through blood, often accompanied by pulmonary tuberculosis or other internal tuberculosis foci. In recent years, some people have speculated that papular necrotic tuberculosis rash may be a form of angiitis based on vascular pathological changes.

　　Patients with low immunity may develop tuberculosis in other parts of the body, such as pulmonary tuberculosis (often with a history of low fever, night sweats, and weight loss), peritoneal tuberculosis, lymph node tuberculosis, bone tuberculosis, renal tuberculosis, etc. During the clinical diagnosis and treatment process, it is necessary to further complete chest X-rays, B-ultrasound, as well as CT, MRI, etc., for comprehensive analysis and judgment to determine whether there are complications of tuberculosis in the above-mentioned parts. It is also necessary to differentiate from other penile papular skin diseases, such as HPV infection, HSV-2 infection, which can be confirmed by HPV-IgM and HSV-2-IgM.

　　Initially, red or normal skin-colored papules or small nodules the size of millet to peas appear, which are firm to the touch. The nodules can be absorbed naturally or suppurate, necrotize, ulcerate, forming circular or irregular ulcers, with slightly perforated ulcer edges, a gray necrotic scale at the base, purulent secretion, and an infiltrative erythema around. They start as solitary, become multiple in the middle, and can merge with each other. There is a sense of pressure, and post-healing atrophic scars are left. They are more common in young and middle-aged adults, often occur around the glans and the margin of the corona, have a chronic course, can occur repeatedly, and are often accompanied by other tuberculosis.

　　To prevent the occurrence of tuberculosis, the following points should be noted:

　　1. Strengthen health education to make young people understand the hazards and modes of transmission of tuberculosis. Develop good hygiene habits such as not spitting on the ground. The sputum of tuberculosis patients should be incinerated or disinfected with medication.

　　1. Regular physical examinations should be conducted for adolescents to achieve early detection, isolation, and treatment. In addition, BCG vaccine should be administered to infants and young children on schedule to produce immunity and reduce the incidence of tuberculosis.

　　2. If symptoms such as low fever, night sweats, dry cough, and blood streaks in sputum are found, it is necessary to go to the hospital for a check-up in time. After confirming tuberculosis, treatment should be started immediately with streptomycin, rifampicin, and ethambutol. At the same time, attention should be paid to increasing nutrition to enhance physical fitness. As long as it is detected in time and treated thoroughly, tuberculosis can be completely cured.

　　3. Tuberculosis is a disease caused by Mycobacterium tuberculosis, which is transmitted through the respiratory tract, mainly through droplets expelled when the patient coughs, sneezes, or speaks loudly. Therefore, in order to avoid infection, it is necessary to develop good hygiene habits. Cover your mouth with a handkerchief when sneezing, avoid facing others; ventilation should be frequent in the room, and more attention should be paid in crowded places; it is also necessary to exercise more to enhance immunity.

　　1. Histopathological examination

　　The upper dermis and the entire epidermis have localized necrosis, with non-specific inflammatory cell infiltration around the necrotic tissue, surrounded by tuberculous structures, and thickened blood vessel walls or thrombosis.

　　2. Laboratory examination

　　1. OT test

　　An intradermal injection is made on the inner side of the patient's forearm with skin test solutions of different tuberculin concentrations. The first skin test solution has a concentration of 0.1 milliliters containing 1 unit of tuberculin, and the local redness and swelling after injection for 48 hours, with a hard nodule diameter of 0.5 to 2 centimeters, is considered positive (+); redness and swelling with a hard nodule diameter above 2 centimeters, or even with blisters or necrosis, is considered strongly positive (++).

　　2. Polymerase Chain Reaction

　　Take secretions from the skin lesion for detection of Mycobacterium tuberculosis DNA, this method has high specificity and sensitivity, but requires certain equipment. If contamination occurs during detection, false positives may occur.

　　3. Purified Protein Derivative Test

　　Penile tuberculosis rash can show a positive reaction.

　　Nutritional value of crayfish meat

　　1. Nourishing Yin and Tonifying Deficiency

　　Crayfish meat is rich in protein and trace elements, which has a good nourishing effect on the body

　　2. Antituberculosis

　　Crayfish also has antituberculosis effects, and eating crayfish is very beneficial for the recovery from tuberculosis.

　　During the onset of the disease or for a period of time after the disease is cured, seafood such as fish, shrimp, and crabs, as well as poultry products and刺激性 foods such as scallions, garlic, and chili should be restricted or avoided. It is advisable to eat more vegetables and fruits rich in vitamin C, vitamin A, and B-group vitamins.

　　3. Suitable Foods

　　Sesame seeds, soybeans, jujube, honey, walnuts, watermelons, carrots, cauliflower, egg yolks, milk, mushrooms, peanuts, sunflower seeds, pumpkin seeds, etc.

　　First, local treatment

　　1% iodophor for external use, 2/d, or 500ml of 0.9% normal saline mixed with 320,000U of gentamicin, local wet敷, 3-4/d.

　　Second, systemic treatment

　　If there is only penile tuberculosis rash without visceral tuberculosis, systemic treatment may not be necessary. If there is visceral tuberculosis, 2-3 kinds of drugs should be combined for treatment, and the course of treatment is generally 3-6 months. Commonly used drugs include:

　　1. Isoniazid

　　Has inhibitory and killing effects on Mycobacterium tuberculosis, effective for various skin tuberculosis, 100mg per dose for adults, 3/d.

　　2. Streptomycin

　　Can inhibit the proliferation of Mycobacterium tuberculosis, should be used in combination with other antituberculosis drugs such as isoniazid in clinical practice, 1g/d for adults, intramuscular injection.

　　3. Sodium Salicylate

　　Has a bacteriostatic effect on Mycobacterium tuberculosis, 8-12g/d for adults, taken in four doses.

　　4. Rifampicin

　　Can inhibit the synthesis of Mycobacterium tuberculosis, 450-600mg/d for adults, taken on an empty stomach in the morning.