Don’t Ignore TB: Early Detection Is Key to Successful Treatment

Dr Ravi Gowda
May 30
6 min read

Updated: Jun 6

TB has been around for thousands of years. In fact, it's been found in the fossilised, skeletal remains of humans from half a million years ago.

TB is considered an infection of a bygone area and the common misconception in the Western world at least, is that it’s been virtually eradicated. However, TB is still a clear and present danger with a rapid rise of the number of cases of TB diagnosed in the England in 2023. More than 4000 people were diagnosed in the England, a 11% increase compared to 2022. Although the cases were mostly people born outside of the UK, there was a 5% increase and people born in the UK.

In this article, we will emphasise the importance of:

the awareness of TB and that it still exists
detection and thus improving treatment outcomes
early treatment
TB vaccination
reducing transmission and ultimately saving lives.

What is TB?

TB is a chronic bacterial disease usually affecting the lungs, but not always, in fact, nearly 50% of TB cases can be outside the lungs. It can affect practically any part of your body like your bones, eyes, brain, skin, etc. Doctors often refer to the infection as “The great masquerader” because the symptoms of TB can often mimic other diseases leading to a delay in diagnosis. This means affected individuals become really unwell before the penny eventually drops and they finally get the TB treatment.

Cause of TB

Tuberculosis is caused by slowly growing bacteria called Mycobacterial tuberculosis. And this is the crucial part; because it grows so slowly, everything else, like the symptoms and signs of TB are also very insidious and therefore initially get ignored as minor symptoms.

How is TB spread?

A common symptom of TB is a cough. When a person with TB begins to cough, they expel fine droplets containing the bacteria into the air called aerosols. It's these aerosols that other people breathe in and then become infected themselves. People who are coughing up mucus are especially infectious and should be isolated until they've had at least two weeks of TB treatment.

Doctors and social scientists have always considered TB as a disease of the poor and the destitute. It also affects people who are frail, elderly, very young or unwell with other medical conditions. The homeless, alcoholics, the malnourished and those who live in poor housing conditions are particularly vulnerable. Evidence for this became clear when the rate of TB rapidly declined when housing conditions and nutrition improved.

Why early detection matters

TB is entirely preventable and curable but a delay in diagnosis and treatment means that people are more likely to spread the disease to others as well as presenting with the advanced symptoms and signs of TB. This makes TB treatment much more difficult with people succumbing to the disease.

But it doesn't have to be this way. By implementing simple measures such as introducing a new entrant latent TB screening programme, we can reduce the incidence of active TB by as much 19%.

But what does this mean?

Recently, the United Kingdom introduced screening for TB for all new arrivals from a country with a high incidence of TB. The screening test they used is a molecular test called an ‘IGRA’ (interferon gamma releasing essay) TB test that identifies people with both active and 'latent 'TB. Some people have TB that doesn't cause any symptoms and is simply ‘sleeping’ and this is called latent TB. People who have latent TB can eventually develop active TB symptoms and spread the disease to other people.

This is why it’s so important to identify people with latent TB. At Health Klinix we do the same TB test to identify people with both latent and active TB.

The symptoms of TB

As we've already discussed, early symptoms can be mild and therefore often ignored:

Persistent cough (This is often gradual and insidious but if a cough lasts more than two weeks and you're coughing up mucus or blood you should see a doctor and they should be thinking about the possibility of TB).

Coughing blood or mucus

Fatigue (Although this is somewhat non-specific, if you get fatigue with some of the other symptoms, think TB).

Weight loss

High temperature & fever

Night sweats

Loss of appetite
Swollen glands
The lymph glands in your neck are commonly affected by TB but you can get swollen glands anywhere including your armpits or in your groin.

How to test for TB

If you have any symptoms of signs of tuberculosis, your family doctor may order any number of TB tests. Remember TB is often a difficult diagnosis to make and sometimes we as doctors will need to rely on your symptoms as well as a combination of TB tests.

Tuberculin Skin Test (TST) or Mantoux Test:

In this test a doctor or a nurse may inject a tiny amount of the weakened TB bacteria into your skin to see if your immune system reacts to it. We don’t do this at Health Klinix because we don't think it's the best test It's prone to errors and relies on the healthcare professional interpretation of the reaction of the skin reaction.

Interferon-Gamma Release Assay (IGRA) Blood Test:

We think this is a much better test to see if your body has been exposed to TB. The main drawback with this test is that it doesn't always tell us whether the TB disease is active or late (sleeping TB). It might also mean that you may have been simply exposed to it in the past but don't have any current infection. At Health Klinix, we perform the Quantiferon® test but other clinics may offer an alternative test call the T-Spot®.

Chest X-ray

This is useful for diagnosing lung TB but it doesn't always help us if the TB is active somewhere else in your body.

4. Sputum tests

We can collect sputum from a patient suspected of having symptoms of lung TB and either have a look under the microscope to see if we can see the bacteria or try and grow it. The drawbacks are that not everyone will cough up sputum and you might still have TB even if we can’t always grow the bacteria.

Biopsy
- This is when we can take a sample of cells or tissue from an affected part of your body such as a swollen gland.

Challenges in TB Detection

We've come a long way over the last century in reducing the burden of TB around the world. This has been achieved through better housing and lifting people out of poverty. Early detection and TB treatment have played an important role too. Despite this, 10.8 million people still fell ill with TB around the world in 2023 and a staggering 1.8 million died as a result. So why are people still falling ill and dying of TB?

The three primary reasons:

Stigma and misinformation lead to delayed healthcare seeking.

Being diagnosed with TB is often a taboo subject in some cultures. Having TB is perceived to be a sign of poverty and belonging to lower social classes in some parts of the world, as a consequence, people often delay in seeking healthcare.

Health disparities and access issues in underserved communities.

If you're poor, destitute, living in overcrowded conditions or find it difficult to access healthcare, then not only are you more likely to get TB, your diagnosis might also get missed. But it's not all doom and gloom because these underserved communities can get early diagnosis and treatment. A good example of this is the early screening and TB treatment initiatives by Newham Council in London which has the highest incidence of TB in the UK.

Similarity of TB symptoms to other common illnesses.

In the 35 years I've been practising medicine, I’ve found TB to be one of the most difficult diagnoses to make even though I’m an infectious disease specialist. As previously discussed, the onset of the signs and symptoms of TB is often very slow and gradual which means that both doctors and patients can end up trivialising symptoms. TB can also mimic cancers, other infections such as syphilis, and inflammatory conditions like autoimmune diseases. So being aware of the symptoms of TB and having a high index of suspicion in those at risk, will increase the chances of an earlier diagnosis.

How to prevent TB

Although early diagnosis and treatment is important in preventing tuberculosis, TB vaccination (BCG) plays an important role in preventing you from getting the severe forms of TB such as TB meningitis (Inflammation of the lining of the brain)

For more information on TB vaccination and treatment take a look at our previous article on TB: The basics of TB prevention: what everyone should know

Finally…

We want you to lead a healthier, fitter and happier life. This also means unshackling yourself of the stigma associated with TB. We can help you with this.

If you're worried that you might have tuberculosis or you’re high risk of getting it, you can get tested at Health Klinix or alternatively you can contact your GP thought the NHS for a free test.

If the tests are negative, then why not consider a TB vaccination (BCG vaccination) to protect yourself? Health Klinix can offer the BCG vaccination at competitive prices from skilled and trusted healthcare professionals.

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