Bacteriological survey of tuberculous lymphadenitis in southeast England, 1981-1989

The aim was to detect any changing trends in the nature and incidence of tuberculous lymphadenitis in southeast England and to determine whether there is any evidence for an increase in this disease that could be related to HIV infection.

Mycobacteria isolated from patients with lymphadenitis in the years 1981 to 1989 were identified. Information was available on the age, sex, and ethnic origin of the patients and the anatomical site from which the mycobacterium was isolated.

The Public Health Laboratory Service Regional Tuberculosis Centre at Dulwich, which receives over 95% of mycobacteria isolated in southeast England.

From 1980 to 1989, cultures were received from 1817 patients with mycobacterial lymphadenitis: 1677 were M tuberculosis, 25 M bovis, 21 M africanum, and 94 were other (environmental) species. In comparison with a survey conducted in the same region in 1973-80, the number of ethnic Indian subcontinent patients with lymphadenitis due to M tuberculosis had dropped by 30% and the number of European patients had dropped by 43% and showed a continuing decline and a shift towards an older age group. By contrast, there was a 20% increase in the number of cases due to environmental mycobacteria. The number of species causing such infections had increased and a greater proportion of patients were adults. Three patients infected by environmental mycobacteria were known to be HIV positive.

The incidence of lymphadentis due to M tuberculosis is declining but cases due to environmental mycobacteria are increasing, with a greater diversity of species and more adult patients. There is no conclusive evidence for an impact of HIV infection on the incidence and nature of mycobacterial lymphadenopathy in southeast England, but this cannot be ruled out.