Research shows older men are among those most likely to be diagnosed with tuberculosis (TB) after they have passed away.
One person a week dies in England with undiagnosed TB, according to a new study published in the journal Thorax. The research shows older, British-born men were among those most likely to have the disease diagnosed only after death.
Experts warn that healthcare workers might be overlooking the possibility of the disease in patients who do not fit traditional risk profiles. They say TB diagnosed after death should be treated as a ‘never event’ in the NHS, prompting urgent investigation.
Dr Eleanor Morgan, co-author of the study and a resident doctor at Liverpool University Hospitals NHS Foundation Trust, said: ‘As TB rates continue to rise, we need to keep asking: ‘Could this be TB?’, even in people who do not fit the usual risk profiles.
‘If England is to eliminate TB, reducing delays in diagnosis will be essential so that fewer people miss the opportunity to receive effective treatment.’
The study found the risk of postmortem diagnosis was higher in people living outside London and in those with a history of drug or alcohol misuse. It also found children aged under four were at higher risk, which researchers said could be due to underdeveloped immune systems and difficulties in collecting samples from young children.
The latest government data shows TB rates in England are at a 10-year high, with 9.4 cases per 100,000 people in 2024. This is just below the World Health Organisation’s definition of a ‘low incidence country’ of 10 cases per 100,000 – a level expected to be breached when 2025 figures are published.
TB is an airborne bacterial infection that mainly affects the lungs and is considered the world’s deadliest infectious disease. It can be fatal if left untreated, but it is curable with antibiotics.
Anyone can catch TB by breathing in bacteria from someone with an active lung infection. However, it is most common in people who have prolonged close contact with someone with the disease, were born in or have travelled to countries where TB is more common, or have weakened immune systems.
India, the Philippines, China, Nigeria and Pakistan are among the countries with the highest burden of TB. Together, they account for more than 87% of new cases worldwide.
Dr Tom Wingfield, of the Liverpool School of Tropical Medicine and the paper’s senior author, said: ‘TB is preventable, treatable and curable’.
He added that deaths ‘should trigger learning, not blame, so that services can identify where opportunities were missed and prevent the next avoidable death’.
The researchers said limitations to their data meant they could not determine whether patients died from TB or with TB due to other causes.
Dr Paul Cleary, a consultant epidemiologist at the UK Health Security Agency and another author of the study, said the cases might ‘represent missed opportunities to identify and treat the disease earlier, as well as to prevent possible transmission to others’.
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