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Non-pulmonary tuberculosis – a case report: importance and pitfalls of diagnosis Hannah Pepper Rebecca Davies Ceri Hughes Steve Thomas Miranda Pring Martin Hetzel Dental Update 2024 43:5, 707-709.
Professor and Consultant in Oral and Maxillofacial Surgery, Division of Oral and Maxillofacial Surgery, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK
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
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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