GPs play an important role in spotting tuberculosis (TB) cases alongside other members of the healthcare team.
Delay in diagnosis is a concerning area in identifying and treating TB.

Guidance and strategy

Guidance issued by NICE identifies the role played by GPs and other primary care staff at the front line of TB diagnosis. It aims to increase awareness among health professionals to support early diagnosis and minimise spread of infection and deaths from the disease.

The guidance follows the publication of a joint strategy on TB from UK Health Security Agency (UKHSA) and NHS England that outlines a number of actionable areas, one of which is improving access to services and ensuring early diagnosis.

Role of GPs

High-risk groups include people living in more deprived areas of the country, the unemployed, those with drug or alcohol problems, homeless people or those who have spent time in prison.

Eighty per-cent of patients will clear an initial infection and most patients presenting with clinical disease can be cured if treated correctly. A small proportion of patients with latent TB will develop clinical disease, but one person with active TB may infect between 10 and 15 other people every year. Therefore, early diagnosis is essential in preventing significant morbidity and mortality.

Avoiding diagnosis delays

Many of the delayed diagnosis cases seen by us in recent years were of spinal TB, where patients were treated symptomatically with pain relief for some time before the diagnosis was made.

In other cases, patients were initially diagnosed as having lung cancer but were later shown to have TB.

The symptoms that patients who have TB can present with are many and varied, and can mimic other illnesses. This can make identification of this infection difficult.

We advise clinicians, particularly those who work with patients who are at high-risk of infection, to actively consider TB as a differential diagnosis.

MDU advice

Familiarise yourself with the NICE guidance and advice from your local TB multidisciplinary team.
Consider TB in your differential diagnosis, particularly among high-risk groups (see above) and when a patient's symptoms fail to respond to initial therapy.
Seek a specialist opinion if patients fail to respond to treatment.
Make sure patients understand when to seek further advice if their condition doesn't improve, and record that this safety netting advice has been given.
Keep good records of significant negatives as well as positive findings in the history and examination.

Avoiding TB diagnosis delays

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