4 years' experience of head and neck tuberculosis in a south London hospital

Abstract

SUMMARYIn a south London department of otorhinolaryngology and head and neck surgery, 33 cases of tuberculosis were diagnosed in 4 years. The most common presentation was cervical adenitis (58%) and in some cases the initial investigations suggested malignant disease. Most of the patients were of non-British origin but none proved to be HIV seropositive. Fine-needle aspiration was positive for tuberculosis in 7 of 19 patients. 21 patients required a surgical procedure for diagnosis. INTRODUCTIONTuberculosis (TB) is the world's leading cause of death from a single infective agent and a rising incidence has caused the World Health Organization to declare the disease a global emergency. 1,2 Among the factors associated with the reversal of a previous decline are increased global travel and a rising prevalence of immunodeficiency through HIV infections or drug therapy. In the UK, pulmonary tuberculosis is the most common manifestation but extrapulmonary disease is likewise increasing. Here we review four years' experience of head and neck tuberculosis-a condition that can present diagnostic and therapeutic challenges. METHODSWe retrospectively reviewed the case notes of all patients with proven extrapulmonary tuberculosis seen in the Otorhinolaryngology and Head and Neck Department of University Hospital Lewisham from December 1999 to January 2004. (All patients had then been referred to a TB clinic in the Department of Chest Medicine for further management.) Routine tests included full blood count, C-reactive protein and a chest X-ray. Patients with neck, thyroid and salivary gland masses underwent ultrasoundguided fine-needle aspiration, with cytological and microbiological examination including staining for acid-fast bacilli (Ziehl-Neelsen). Where tuberculosis was suspected, sputum samples were obtained for Ziehl-Neelsen staining.In patients with inconclusive results further biopsies were taken for microbiological analysis, including culture on Löwenstein-Jensen medium, and histological assessment. Patients with proven TB were subsequently counselled and tested for HIV at the chest clinic. RESULTS33 patients were seen over the study period, 21 male 12 female, mean age 40 years (range 21-75). 15 had a history of previous TB contact. 18 were of South Asian origin and only 'Caucasian'. In 19 patients (58%), the presenting feature was cervical lymphadenitis. In addition, 9 had salivary gland TB, 2 laryngeal TB, and 1 each nasopharyngeal, hypopharyngeal and ear TB. 21 patients required some sort of surgical procedure for diagnosis (Figure 1). In 12 patients the disease was producing constitutional symptoms such as fever, weight loss or night sweats. None of the patients proved to be HIV positive. 16 had evidence of TB on their chest X-ray.The modes of microbiological and histopathological assessment were Ziehl-Neelsen stain 12/33, Mycobacterium tuberculosis culture 18/29 and histopathology 21/21. No patient had an atypical mycobacterial infection but in 2 the organism was resistant-in one case to streptomycin and in t...

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