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• National Survey of Childhood Tuberculosis
  J Brian S Coulter
  Published on: 6 October 2003

• Published on: 6 October 2003

  National Survey of Childhood Tuberculosis

  • J Brian S Coulter, Senior Lecturer/Consultant Physician

  Dear Editor

  In the National Survey of Childhood Tuberculosis for 1998 peripheral lymph node disease (31) accounted for 32% of the total (96) cases in white children compared to 19% in the other ethnic groups.[1]

  The authors rightly state that “mycobacteria other than M. tuberculosis can cause higher rates of lymphadenitis”. Perhaps a large proportion of the cervical lymph node disease in the white gro...

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  Dear Editor

  In the National Survey of Childhood Tuberculosis for 1998 peripheral lymph node disease (31) accounted for 32% of the total (96) cases in white children compared to 19% in the other ethnic groups.[1]

  The authors rightly state that “mycobacteria other than M. tuberculosis can cause higher rates of lymphadenitis”. Perhaps a large proportion of the cervical lymph node disease in the white group may have been due to environmental mycobacteria. It would be interesting to know how many of the white group had lymphadenitis confined to the cervical (or parotid) area, with normal chest Xrays and no contact with tuberculosis.

  In the period 1982-2003, 100 patients (two thirds of whom were white) with tuberculosis were seen at the Royal Liverpool Children’s NHS Trust – Alder Hey, of whom only 8 (8%) had peripheral node disease all in the cervical area. Five of the 8 cases also had evidence of pulmonary disease. The three without pulmonary disease were non-white teenagers (when evidence of earlier pulmonary disease may have resolved). Of the two white children (2% of the total) both were young (4-6 years) and had pulmonary disease in addition.

  In the period 1990-2003 we recorded 104 cases of environmental mycobacteria (which is an underestimate) virtually all in the cervical or parotid area and most were between 2-4 years of age. Only one was non-white; a two year old Bangladeshi born in the UK who had not had BCG.

  Thus in Liverpool the epidemiology of tuberculous and environmental mycobacterial cervical lymphadenopathy differ in ethnic group, age range and associated pulmonary disease. The Liverpool data support the suggestion by the authors that tuberculous lymphadenitis may have been over diagnosed in the white group. In future surveys more stringent criteria for diagnosis of tuberculous lymphadenopathy might provide a clearer picture.

  In the 1998 survey, of 176 cases with pulmonary disease, specimens were obtained from 64 (36%) of which 43 (67%) were culture-positive and 20 had smear-positive disease (table 4). Presumably, most of these were adolescents able to expectorate sputum. In the current Notification Form, there is provision for recording type of specimen. It would be interesting to know what proportion had gastric washings or induced sputum.

  Reference

  (1) Balasegaram S, Watson JM, Rose AMC et al. A decade of change: tuberculosis in England and Wales. Arch Dis Child 2003;88:772-777.

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  Conflict of Interest:
  None declared.

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