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피부결핵증의 항상균 배양에 관한 연구

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 (A) study on the culture of skin tuberculosis 
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Mycobacteriosis cutie is largely classified to localized forms and examthematous

forms and it is subdivided into five diseases in detail, each. They are 1) primary

tuberculous complex, 2) lupus vulgaris, 3) tuberculous verrucosa cutis, 4)

scrofuloderma, and 5) tuberculosis cutis orificialis in localized forms and 1)

tuberculous miliaris disseminata, 2) lupus miliaris disseminata faciae, 3)

papulonecrotic tuberculid, 4) lichen scrofulosorum and 5) erythema indurarum in

exanthematous forms.

Rich (1944) insisted on that, the pathogenesis of cutaneous tuberculosis was

essentially the same as that for tuberculosis on general. He said that all forms of

cutaneous tuberculosis were produced by th local action of the bacillus of

tuberculosis. In th formerly termed true tuberculosis such as lulus, and animal

inoculations of tissue were successful. In other forms represented by the

tuberculids, the bacillus of tuberculosis was found only in the earliest stages

before the true clinical and histological picture had developed. Its short tissues

and this fact explained the failure to find the microorganisms in this lesions, or

reproduced the affection by inoculations in animals, in cases sufficiently

developed to be recognizable clinically and histologically.

The other generally accepted view is that the mycobateriosis cutis, especially

the type in the category of tuberculids are caused by the hematogenous

dissemination of tubercle bacilli from a focus, often extrapul-in location, into

the skin , where they are rapidly destroyed. and Roeckle (1960) agreed with above

mentioned plausible theories with the background of their hypothesis that was; the

skin was hyperagic. And Miescher (1951) also insisted that, skin had a decreased


But according to Flegel (1957), if the skin was in a state of hyperegic reaction,

the focus from which the dissemination was taking place was also should be in a

hyperegic state and vice versa should be right. And moreover, Sulzverger (1940)

declared that whenever microorganisms or their products were being overcome or

neotralized by local reactions, tubercles or tuberculoid structures had a tendency

appear. So the theories of differemt immunologic state between the skin and focus

were discarded. After that many authors proposed three factors against a tuberculos

etiology of tuberculids.

First, inoculation of tissue from lesion into guinea pigs and culturing of such

tissue have given no evidence for tuberculosis. Second, active tuberculosis occurs

no greater frequency in patients with tuberculids than in the general population.

Third, tuberculids does not respond to antituberculous treatment but respond to the

administration of corticosteroids.

According to Eberhartinger(1963), Schneider and Undeutsch(1965), in erythma

induratum the primary event is a vasculitis of subcutaneous and veins. And any fat

necrosis following vascular damage develop that it was a relic of the times when a

tuberculoid histology was tantamount to tuberculosis.

In this condition we decided to clarify that whether the mycobacteriosis cutis,

especially the disease in the category of tuberculids, could be originated from

mycobacteria tuberculosis in fact or not.

Eleven patients, whose clinical diagnosis were skin tuberculosis or very similar

to those disease such as erythema nodosum, were biopsied by 5mm puncher after 2%

procaine injection on their two of skin lesions, the early one for the culture of

tubercle bacilli and the old one for histopathological study, on the O.P.D of

dermatologic department in Severance Hospital.

Those biopsied material of early lesion was digested with proper amount of 4%

NaOH and fragmented in tissue grinder about 10 minutes. After that, it was

centrifuged in rotating speed of 3500 r.p.m. for 30 minutes, and neutralized by 8%

HCl after adding phenol red drop by drop. Again it was centrifuged by same as

previous method and it's supernatant was discarded. The remnants of precipitin was

inoculated on Ogawa's tuberculous media in incubator at 37℃.

Finally the acid-fast tubercle bacilli have been grown on the Owaga's media three

months after its first inoculation. The inoculation material was biopsied from the

patient of eighteen year-old girl, whose and histopathological diagnosis was

erythema induratum. from the result of this study, we got the strong confidence

that in spite of its culture, the erythema induratum can be or in evidently caused

from mycobacterium tuberculosis.

It may be early yet to say that erythema induratum is originated from tubercle

bacilli but it is considered to be a truth in Korea, with the result of tjos study.
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