Dermatologic Manifestations of Pulmonary Disease

What To Know About Tuberculosis And Skin Rash

Tuberculosis (TB) is a bacterial infection that usually affects the lungs but can spread to other parts of the body, including the skin. Once it reaches the skin, TB can cause a variety of lesions, most often on the legs, hands, or face.

In the United States, TB is often caused by bacteria called Mycobacterium tuberculosis (M. Tuberculosis). However, different bacteria can cause TB in other countries.

TB might be inactive and not cause symptoms, but if the bacteria multiply in the body, the symptoms can cause severe chest pain, a long-lasting cough that brings up blood and phlegm, and other symptoms of infection such as fever, chills, and appetite loss.

However, TB can spread to other organs and systems, including the glands, brain, bones, and skin.

This article explains the skin symptoms of tuberculosis.

Doctors refer to TB skin symptoms as cutaneous TB. Various different types of skin lesions can develop, including:

nodules

papules, which are small hard pimples or swellings on the skin

pustules

ulcers

plaques, which are rough, solid, flat-topped skin lesions

If tuberculosis infects the skin directly, it will generally appear up to 4 weeks after the bacteria enter the body.

At first, it forms a papule before developing into a shallow ulcer that is not painful. Nodules under the skin near lymph nodes are known as sporotrichoid lesions, and these may develop along with swollen lymph nodes, according to older 2013 information.

Types of skin TB

Different causes and types of cutaneous TB lead to different symptoms. These include:

Lupus vulgaris: This ongoing type of skin TB gets worse over time and occurs after reinfection by a different type of Mycobacterium to the first. It features small papules that merge into plaques known as apple-jelly nodules due to their jelly-like texture.

Miliary TB: This causes very small spots that start to kill tissue, becoming ulcers and abscesses. General sickness often occurs alongside these skin symptoms. Miliary TB can develop after TB spreads to the skin from the blood, largely in children and those with compromised immune systems.

Orificial TB: This causes shallow ulcers where the mucosal lining meets skin, known as mucocutaneous junctions, such as around the anus or nostrils. These ulcers generally point to advanced TB that has led to Mycobacterium reaching the mucocutaneous junctions.

Scrofuloderma: These firm lesions eventually become ulcers, but they do not cause pain. They can heal without treatment over several years, but scrofuloderma lesions can leave severe scars. Scrofuloderma spreads to the skin from a lymph node or bone infection, usually on the neck or jawline.

TB verrucosa cutis: This forms a purple or red-brown growth that resembles a wart. Most commonly, it develops on the hands, feet, elbows, and buttocks. Lesions can last for years but may resolve without treatment. Verrucosa cutis may develop after a person who already has TB receives a vaccination.

Sometimes, a primary TB infection of the skin will heal only for lupus vulgaris or TB verrucosa cutis to develop in the same location.

Some types, such as lupus vulgaris, may also increase the risk of skin cancers such as squamous cell carcinoma for 10% of people. This may develop in cutaneous TB scars around 25 to 30 years after the original infection.

M. Tuberculosis may directly enter the skin or spread there via the bloodstream. When TB enters the skin directly, it may be a rare response to an injected vaccine, such as the Bacille Calmette-Guerin (BCG) vaccine.

Tattoos, piercings, or other skin injuries can also lead to TB passing the skin barrier.

TB can also spread to the skin from underlying focal points of infection, such as a lymph node or bone.

Most often, TB spreads through the air when an individual with TB speaks or coughs. M. Tuberculosis can stay airborne for several hours and spreads more readily in places with little circulation, such as a closed vehicle. People with a higher risk of acquiring M. Tuberculosis may include:

people who regularly come into close contact with those who have symptoms of TB

residents of or visitors to a country or community with a high prevalence of TB

those in crowded communities, such as prisons, long-stay hospitals, and care homes for older adults

individuals who work in healthcare settings such as hospitals

However, even in regions that experience TB more often than the United States, including China, the Indian subcontinent, and sub-Saharan Africa, fewer than 0.1% of people develop cutaneous TB.

This equates to around 1% to 2% of people who experience symptoms of TB outside the lungs. It may be more common in global regions with a higher prevalence of HIV or other conditions that reduce the ability of the immune system to counter infections.

People can take a course of TB medication to treat active or inactive TB. Treating inactive TB can prevent symptoms from occurring. This usually involves taking a combination of medications for 3 to 9 months, depending on the treatment plan.

Medications for TB include:

ethambutol

isoniazid

pyrazinamide

rifampicin

moxifloxacin

rifapentine

However, drug-resistant TB requires treatment with different medications.

Some lesions, such as lupus vulgaris or scrofuloderma, may require surgical removal. Lupus vulgaris often gets worse without treatment. Tuberculosis verrucosa cutis and scrofuloderma may heal without treatment, but they can also worsen.

Even though some skin lesions are slow-healing, full recovery often occurs after using muti-drug therapy. Reconstructive plastic surgery may also be necessary to address damage by some lesions.

TB can enter the skin directly or through the blood, lymph nodes, or bones if it moves beyond the lungs. A range of conditions can cause severe nodules, ulcers, pustules, and plaques that vary in progression, outlook, and self-healing ability.

Cutaneous TB is very rare, even in people who develop TB outside of the lungs. It is more likely in people who have compromised immune systems.

Treatment includes multi-drug therapy, and doctors may recommend surgically removing lesions for some types of cutaneous TB.

What Are The Symptoms Of A UTI In Older Adults?

Urinary tract infections (UTIs) are common in older adults. They may be more likely to have atypical UTI symptoms, such as delirium, confusion, or loss of appetite.

A urinary tract infection (UTI) is an infection in part of the urinary system, which includes the kidneys, ureters, bladder, and urethra.

The "classic" symptoms include a more urgent need to urinate, burning or pain when urinating, and cloudy urine, among others. But some older adults may not exhibit these symptoms, particularly if they have a catheter or experience complications.

a more urgent or frequent need to urinate

burning, discomfort, or pain when urinating

feeling pressure in the lower abdomen or pelvis

cloudy, thick, bloody, or odorous urine

the bladder not feeling empty after urination

However, some older adults can have different symptoms to these. According to a 2022 review, they may be more likely to have:

People who care for older adults should be aware of this, as what seem like behavior changes could be a sign of an infection.

If a person has any of the above symptoms, they should seek medical advice. Treating a UTI early can help prevent it from spreading.

If a UTI spreads to the kidneys, a person may experience:

fever

chills

pain in the lower abdomen, flank, or back

nausea

vomiting

People with these symptoms need immediate medical care. Untreated kidney infections can be very painful and cause severe complications.

Why are symptoms different in seniors?

Doctors are not sure why additional symptoms such as delirium occur in older adults.

A 2022 review says this could occur because of the inflammation caused by the infection. As the brain ages, it may become more vulnerable to the effects of this inflammation, resulting in delirium or confusion.

Alternatively, people with other health conditions may be more likely to develop both delirium or UTIs because of shared risk factors.

More research is necessary to understand how delirium develops.

Usually, bacteria entering the urinary tract is the cause of UTIs. The most common of these is Escherichia coli, a type of bacteria that is commonly present in stool and can enter the urinary system through the urethra.

Rarely, fungi can cause UTIs.

Older adults may be more likely to get UTIs for a range of reasons, many of them age-related. They include:

It is important for caregivers to be aware of these risk factors and observe any cognitive changes that could indicate a UTI, particularly in those with dementia.

UTIs can potentially lead to severe complications without treatment, such as:

Kidney damage

An untreated UTI can spread to the kidneys and cause kidney damage or disease.

Kidney infections are serious and require intravenous antibiotics and hospitalization.

Sepsis

Another complication of UTIs is sepsis.

Sepsis is a life-threatening condition in which the infection spreads to the bloodstream and then throughout the body. Untreated sepsis can lead to septic shock and eventually death.

Sepsis can cause other complications including organ dysfunction, amputations, and chronic pain disorders. Even if a person has treatment for sepsis, complications may occur.

If doctors suspect that a UTI is present, they will test a urine sample in the office or send it to a laboratory for analysis.

A urine culture can confirm which bacteria are causing the infection. Knowing the specific type of bacteria allows the doctor to determine a suitable treatment plan.

A condition called asymptomatic bacteriuria is also common in older adults. ASB occurs when there are bacteria in the urine, but they do not cause any signs of infection.

Although ASB is common in older adults, it does not typically require treatment, unless it causes other clinical symptoms.

The standard treatment for a UTI is antibiotics, which kill the bacteria causing the infection. Doctors will prescribe an antifungal medication instead if a fungus is causing the UTI.

It is essential that people take the medication precisely according to the prescription, even if they begin to feel better. Completing the entire prescription will help to destroy all of the infectious bacteria.

Intravenous antibiotics

More advanced cases of UTI, such as those that lead to sepsis, septic shock, or kidney infection, may require hospitalization and intravenous antibiotics.

It is common for someone with sepsis or septic shock to have other medical complications that also require medical care.

Taking steps to prevent a UTI is vital for people who have a higher risk of getting one, including older adults.

Methods of preventing a UTI include:

drinking plenty of fluids

using the bathroom promptly when the urge to urinate begins

taking time to empty all the urine

wiping from front to back after going to the toilet

changing incontinence pads or underwear when wet

Vaginal estrogen may be suitable for helping people reduce their risk of UTIs during and after menopause.

making drinks visible and easy to access

giving the adult with dementia a brightly colored cup or bottle

monitoring fluid intake

prompting the person to use the bathroom regularly

encouraging exercise and a balanced diet with enough fiber

washing the genitals at least once per day

avoiding the use of talc, perfumed soaps, or other potential irritants on the genitals

People in a nursing home or long-term care facility often depend on others to take preventive measures against UTIs for them.

It is important for family members to ensure that older adults have sufficient, appropriate care to meet their needs.

Older adults are also more likely to experience symptoms such as delirium or hallucinations when they have an infection. Fever, lower back pain, and vomiting may indicate a more serious infection.

Anyone who is unsure if they or another adult could have a UTI should speak with a doctor for advice. Treating UTIs early can prevent complications.

All The Symptoms Of 'world's Most Deadliest Disease' After 289 Cases Found In Ireland

TUBERCULOSIS belongs in history books - but Ireland is still facing a big challenge to erradicate the illness completely.

The contagious bug has been dubbed one of the most deadly infections in the world and it's still very much present here.

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Tuberculosis is known as one of the world's deadliest diseasesCredit: Getty

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Ireland's rate of the disease is still far higher than expectedCredit: Alamy

There were a staggering 289 cases of TB reported in Ireland last year, which equates to an incidence rate of 5.6 per 100,000 population.

Today is World Tuberculosis Day - and people are being reminded of the signs and symptoms to watch out for.

The contagious infectious disease is caused by the bacteria Mycobacterium tuberculosis and affects millions of people worldwide.

The disease mostly affects the lungs but can also impact other parts of the body - including the kidneys, spine and brain.

TB spreads through the air when an infected person coughs, sneezes, or talks, releasing bacteria that can be inhaled by others.

Although Ireland has seen a major decline in TB incidence over the past few decades, the country still faces challenges in achieving the WHO End TB Strategy target.

And the Health Protection Surveillance Centre has issued an alert on World TB Day.

They said: "The theme of World TB Day 2025 - 'Yes! We Can End TB: Commit, Invest, Deliver', is a bold call for hope, urgency, and accountability. 

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"World TB Day, observed annually on March 24, amplifies the urgency of ending tuberculosis - once again one of the world's deadliest infectious diseases."

HSE explain how the Emergency Department works and what to expect

"TB continues to devastate millions globally, inflicting severe health, social, and economic consequences.

"Although there has been a significant decline in the incidence of TB in Ireland in recent decades, 289 cases were still notified in 2024, equating to an incidence rate of 5.6 per 100,000 population."

The WHO's End TB Strategy aims for an 80 per cent reduction in TB cases globally between 2015 and 2030, and Ireland is expected to meet this target with fewer than 139 cases by 2030.

However, Ireland did not meet the 2024 target of 139 cases - as the number of cases reported was more than double this figure.

TB SYMPTOMS

THERE are seven key signs of the illness to watch out for.

Persistent cough: A cough lasting more than three weeks, often with phlegm or blood

Fever: A high temperature that may come with chills and sweating

Weight loss: Unexplained weight loss, even when you're not trying to lose weight

Fatigue: Ongoing tiredness or weakness that doesn't improve with rest

Chest pain: Pain or discomfort in the chest, especially when coughing or breathing

Blood in sputum: Coughing up blood or blood-streaked mucus

Loss of appetite: A major decrease in your desire to eat

The HSPC added: "As a low-incidence country (<10 cases per 100,000), Ireland should be aiming to achieve the WHO End TB Strategy target of an 80 per cent reduction in TB cases between 2015 and 2030.

"This would have equated to approximately 139 cases being diagnosed in Ireland last year, less than half of what was actually diagnosed."

In the past decade, the Covid-19 pandemic has had a negative impact on TB control efforts both globally and in Ireland.

The HSE has since published Ireland's first National TB Strategy which strives to end the disease nationwide by 2030.

This strategy outlines a collaborative approach to TB control, and brings together various sectors to address TB effectively in the country.

The HSE said that a major focus of the strategy is addressing health inequities and ensuring equitable access to TB care, particularly for vulnerable groups.

In the 1950s, nearly 7,000 TB cases were reported annually in Ireland, but the rate of infection has steadily declined since then.

With an early diagnosis, the disease can be prevented, and appropriate treatment can also cure those with it.

Anyone experiencing TB symptoms should contact their GP immediately.

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