References

World Health Organisation (www.who.int/en/). Tuberculosis Fact Sheet No 104 copyright 2011 [updated November 23rd 2010].
Health Protection Agency UK. Tuberculosis in the UK: Annual Report on Tuberculosis Surveillance in the UK 2009 copyright 2011 [updated November 2010].
National Institute for Health and Clinical Excellence UK (www.nice.org.uk). Tuberculosis clinical diagnosis and management and measures for its prevention and control NICE clinical guidelines 117 copyright 2011 [updated March 2011].
Department of Health UK (www.gov.uk/dh). Stopping tuberculosis in England. An Action Plan from the Chief Medical Officer October 2004 crown copyright 2011 [updated 2004].
National Institute for Health and Clinical Excellence UK. Improving Outcomes in Head and Neck Cancer copyright 2011 [updated March 2010].
Control and prevention of tuberculosis in the United Kingdom: recommendations 2000. Thorax. 2000; 55:887-901
Chemotherapy and management of tuberculosis in the UK: recommendations 1998. Thorax. 1998; 53:536-548

Non-pulmonary tuberculosis – a case report: importance and pitfalls of diagnosis

From Volume 43, Issue 5, June 2016 | Pages 487-490

Authors

Hannah Pepper

OMFS ST3, MBChB, MRCS

(hbpepper@hotmail.com)

Articles by Hannah Pepper

Rebecca Davies

BChD, MFDS RCS, MSc DDR

SpR Dental and Maxillofacial Radiology, Bristol and Birmingham

Articles by Rebecca Davies

Ceri Hughes

BDS, FDS RCS, MBChB, FRCS(OMFS), FRACDS(OMS)

Specialist Registrar, Department of Oral and Maxillofacial Surgery, Southmead Hospital, Bristol.

Articles by Ceri Hughes

Steve Thomas

FRCS(OMFS), FRACDS(OMS)

Professor and Consultant in Oral and Maxillofacial Surgery, Division of Oral and Maxillofacial Surgery, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK

Articles by Steve Thomas

Miranda Pring

PhD, FRCPath

Consultant Senior Lecturer Oral and Maxillofacial Pathology

Articles by Miranda Pring

Martin Hetzel

MD, FRCP

Consultant in Respiratory and General Medicine, Department of Oral and Maxillofacial/Head and Neck Surgery, Bristol Dental Hospital and Respiratory Medicine, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin Street, Bristol BS1 2LY, UK

Articles by Martin Hetzel

Abstract

A case of tuberculosis presenting as a neck lump is highlighted. Tuberculosis is on the increase. There are national and international strategies to improve the management of tuberculosis in the United Kingdom, and raising clinical awareness of tuberculosis is an important part of that strategy. Neck lumps can present in the dental setting and the differential diagnosis should include tuberculosis, with referral to an appropriate multidisciplinary team. Special tests to aid diagnosis are helpful but not completely discriminating. Tuberculosis is a notifiable disease and it must be treated by a designated specialist medical team.

CPD/Clinical Relevance: Tuberculosis is a differential diagnosis for a persistent neck lump and clinicians should understand the problems of diagnosis and the importance of appropriate referral for treatment in the national and international strategy to reduce this disease.

Article

Twentieth century public health measures and effective medication reduced tuberculosis incidence but, since 1987, this trend has reversed due to immigration and re-activation in the elderly population. Worldwide it remains a concern, having caused 1.3 million deaths in 2008.1

Tuberculosis mainly affects urban areas in the United Kingdom which is attributable to immigration from countries with high rates of tuberculosis. London is the worst affected, with a rate of 44/100,000 and Bristol has a relatively high rate of 18/100,000.2 The increase in tuberculosis has led to the development of guidelines by the National Institute for Clinical Excellence (NICE) and the Chief Medical Officer suggesting the need for an increased awareness among healthcare professionals.3,4,5

Tuberculosis is spread by droplets from individuals with pulmonary tuberculosis (with the exception of bovine tuberculosis from the ingestion of unpasteurized milk), and the majority of infected individuals eliminate the infection. In 20% of cases the infection becomes latent and can then re-activate. In the younger population, re-activation within a few years of initial infection occurs in around half of cases.4 Tuberculosis can present as pulmonary and/or non-pulmonary tuberculosis.6 Non-pulmonary tuberculosis is found more commonly in the ethnic minorities than in white, United Kingdom-born residents.3

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