During 2023, 4,850 people developed tuberculosis (TB) in England, provisional figures from the UK Health Security Agency suggest. 

Mycobacterium tuberculosis spreads by coughing and, probably, on the breath. A new meta-analysis suggests that over 80 per cent of TB patients do not have persistent cough, so health services may need to “rethink large aspects of how we identify people with TB”.

The meta-analysis included 620,682 participants from surveys in eight African and four Asian countries. Overall, 82.8 per cent of TB patients had no persistent cough and 62.5 per cent had no cough at all. Indeed, 27.7 per cent of people infected with M. tuberculosis did not develop TB symptoms (cough, fever, chest pain, night sweats and weight loss). 

Persistent cough is often the trigger for a TB diagnosis, so people without cough may face long diagnostic delays or remain undiagnosed. 

Delayed and under-diagnosed TB could pose a particular problem among women. TB without persistent or any cough or TB symptoms were more common among women than men (by 21, 24 and 18 per cent respectively, the last not statistically

“Our results indicate the probable reason why, despite huge efforts to diagnose and treat the disease, the tuberculosis burden across Africa and Asia is hardly declining,” says study author Frank Cobelens, professor of global health at Amsterdam University Medical Centre. 

“We need to really rethink large aspects of how we identify people with TB,” Professor Cobelens adds. “It is clear that current practice, especially in the most resource-poor settings, will miss large numbers of patients with TB. We should instead focus on X-ray screening and the development of new inexpensive and easy-to-use tests.”