Miliary tuberculosis in Edinburgh--a comparison between 1984-1992 and 1954-1967

We have reviewed the records of 29 patients notified with miliary tuberculosis in Edinburgh from 1984 to 1992 and compared our findings with those for the 40 patients previously reported in Edinburgh from 1954 to 1967. The incidence of miliary tuberculosis has not changed. Respiratory symptoms of cough and dyspnoea were commoner in 1984-1992 (P < 0.001) perhaps reflecting the increase in mean age at presentation (73.5 vs. 59.4 years; P < 0.001). Mortality was 50% in 1984-1992, significantly higher (P < 0.05) than the 25% recorded in 1954-1967. Forty percent of cases in both time periods were of cryptic miliary disease. The diagnosis of cryptic disease tended to be made more often post-mortem and less often by a trial of anti-tuberculosis chemotherapy in 1984-1992. Our findings emphasize the current poor outcome associated with a diagnosis of miliary tuberculosis. It is important to consider this diagnosis in elderly patients with unexplained pyrexia and implement a trial of specific anti-tuberculosis chemotherapy to confirm it.