Clinical Infection in Practice · Published 2026-08-01 · DOI 10.1016/j.clinpr.2026.100713
Hannah Ward, Olivia Lucey, Veronica White, John Gribben, Jonathan Lambourne
Background: Tuberculosis (TB) in patients with haematological and solid malignancies is uncommon, and data on the impact of screening cancer patients for latent TB infection (LTBI) is limited. Recent European guidelines describing potential screening approaches prompted a review of TB cases at Barts Cancer Centre, a large specialist oncology centre, to identify the best screening strategy. Methods: Positive Mycobacterium tuberculosis cultures and/or polymerase chain reaction (PCR) results from August 2017 to July 2023 were analysed, and electronic health records were reviewed to identify concomitant cancer diagnoses. Demographics, TB risk factors, clinical presentation, cancer treatment and outcomes were assessed. Results: Sixteen patients with culture-confirmed TB were identified; seven pulmonary cases (of which two also had intrathoracic lymph node (LN) disease), four cases confined to intrathoracic lymph nodes, three disseminated, one pleural and one retropharyngeal with spinal disease. Five (31.3%) had undergone cancer chemotherapy reported to increase TB risk. None had a previous history of TB infection. TB contact was documented clearly in 12 cases of which three (18.8%), extra-pulmonary and disseminated cases, reported historical contact with a TB-infected individual. The median interval between cancer and TB diagnoses was 17 months. Among haematooncology patients; 5/7 (71.4%) developed TB within two months of starting cancer chemotherapy and 5/7 (71.4%) presented with persistent fever. Comparatively, 5/9 (55.6%) solid-oncology cases were incidentally identified through imaging. Conclusion: This retrospective cohort study highlights the rarity of TB infection among cancer patients and identifies the challenges of risk-based screening. No universal risk factor was identified, while some patients lacked any apparent risk factors. These findings advocate for a pre-emptive approach to TB diagnosis, promoting early consideration of investigation of active TB following cancer chemotherapy initiation, particularly in patients with persistent fever and TB risk factors.
Abstract from DOAJ. Public domain (CC0 1.0).
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Ward, H., Lucey, O., White, V., et al. (2026). Tuberculosis in patients with cancer: is screening for latent TB infection necessary?. Clinical Infection in Practice. https://doi.org/10.1016/j.clinpr.2026.100713