Introduction London has a high incidence of TB with north-east London having amongst the highest rates of TB in the U. K. Microbiological analysis is the gold standard method of diagnosis for patients with TB. A recent review of patients with TB lymphadenitis demonstrated that a significant proportion of these patients were diagnosed on histology alone. This proportion increased in patients over 60 years old, suggesting that tissue or fluid specimens were not routinely analysed in this group.
Aims To ascertain whether age is a factor in influencing the diagnostic pathway, particularly the use of invasive tests, in investigating individuals with lymphadenopathy in this high-incidence area for TB.
Methods A retrospective analysis was undertaken of patients with TB lymphadenitis from 2009 – 2011 diagnosed by the Barking, Havering and Redbridge Hospitals NHS Trust TB service using the London TB register.
Results 308 patients over the age of 18 years were identified with TB lymphadenitis. Of 281 patients between 18 – 65 years, 15.3% (43) had no specimen sent for analysis. 2/27 (7.4%) of patients >65 years had no specimen sent for analysis.
Conclusion Previous work has shown that in individuals over 60 years old, TB lymphdenitis was diagnosed predominantly on histology only (80%). Younger patients were more likely to have diagnosis confirmed on microbiology.
This study demonstrates that increasing age is not a factor in influencing the diagnostic pathway, particularly the use of invasive tests, in investigating patients with lymphadenitis. However, in spite of the high incidence of TB, the biopsy specimens obtained from patients from all age groups are not routinely sent for microbiological analysis.