1362. A Case Series of Miliary Tuberculosis in North West London

Abstract

BackgroundMiliary tuberculosis (mTB) is a severe presentation of TB with high mortality. We reviewed data from a cohort of patients with mTB in an area of London serving an ethnically diverse population with the highest TB endemicity in the UK.MethodsRetrospective analysis of laboratory and medical records, radiology and microbiology results of patients with mTB identified from the London TB register from 2012 to 2019 from London North West Hospitals University NHS Trust.Results60 cases with mTB were recorded. 67% of the patients were male. Median age at diagnosis was 36 years (range 13 to 88 years). 60% of patients were South Asian ethnicity. Two patients were HIV positive and 4 had received anti-TNF treatment. 73% (44 patients) patients had miliary nodular opacities on chest radiograph. Of the 16 patients with no chest radiograph evidence of mTB, 14 had computed tomography (CT) of the chest which confirmed miliary nodules. Eleven patients were sputum acid-fast bacilli (AFB) smear-positive, and in 49 patients, culture of sputum isolated Mycobacterium tuberculosis. Ten patients did not have any positive microbiology but were treated for mTB on clinico-radiological basis. Forty patients had fully-sensitive TB; 2 were isoniazid-resistant and 1 multi-drug-resistant. 5 patients in our cohort also had spinal TB. Evidence of cerebral TB was found in 5/17 patients who had a CT brain. Tuberculomas were seen in 10/24 patients who had magnetic resonance imaging (MRI). Only 8 patients had both CT and MRI; MRI revealed2 patients with cerebral TB that CT did not, but this was not statistically significant (P = 0.1573). 7 patients were investigated with lumbar puncture, of which cerebrospinal fluid was smear and culture negative for all. All patients were treated with standard therapy with a mean length of treatment of 11 months. 33 patients have completed therapy. 7 patients died and 2 were lost to follow-up. Those who died had a mean age of 69 years compared with those who survived (44.2 years).ConclusionThe diagnosis of mTB requires a high index of suspicion for central nervous system disease. Our cohort demonstrates that spinal disease needs to be considered in addition to cerebral TB, for which MRI may be the preferred imaging modality. Mortality in our cohort was associated with older age.Disclosures All authors: No reported disclosures.