Study Finds One Person a Week Dies with Undiagnosed Tuberculosis in England

A new study has revealed that, on average, one person every week in England dies with undiagnosed tuberculosis (TB), highlighting concerns that opportunities to detect and treat the disease are being missed despite rising infection rates.

Researchers say many of these cases are only identified after death, describing postmortem TB diagnoses as the "ultimate diagnostic delay" and calling for every such case to trigger a formal investigation within the NHS.

The findings come as tuberculosis cases in England continue to climb, reaching their highest level in a decade. In 2024, the country recorded 9.4 cases per 100,000 people—just below the World Health Organization's threshold for a low-incidence country. Experts believe that figure could surpass the benchmark when 2025 data becomes available.

Although TB is most commonly diagnosed in younger people born outside the UK, the study found a different pattern among patients whose illness was only discovered after death. These individuals were more likely to be older, British-born men, suggesting healthcare professionals may be overlooking tuberculosis in patients who do not fit the traditional risk profile.

Dr. Eleanor Morgan, a resident doctor at Liverpool University Hospitals NHS Foundation Trust and co-author of the research, said clinicians should remain alert to the possibility of TB even in patients who appear to be at lower risk.

She stressed that reducing delays in diagnosis will be essential if England hopes to eliminate tuberculosis, allowing more patients to receive life-saving treatment before the disease becomes fatal.

The research also found that people living outside London and those with a history of alcohol or drug misuse were more likely to receive a TB diagnosis only after death.

Young children under the age of four were also identified as a higher-risk group. Researchers believe this may be due to their developing immune systems, vague symptoms, and the difficulties doctors face when collecting suitable samples for laboratory testing.

Tuberculosis remains the world's deadliest infectious disease, causing approximately 1.23 million deaths and more than 10 million new illnesses globally in 2024.

Despite its impact, TB is both preventable and curable with antibiotic treatment. Recent medical advances have also shortened treatment times, including for patients with drug-resistant strains.

Dr. Tom Wingfield, senior author of the study and a specialist at the Liverpool School of Tropical Medicine, said the NHS should treat postmortem TB diagnoses in the same way it investigates preventable hospital safety failures.

He argued that every unexpected TB death should prompt a thorough review to identify missed opportunities for diagnosis and improve patient care in the future.

While acknowledging the recent increase in TB cases is concerning, Wingfield emphasized there is no reason for public panic. He noted that tuberculosis can be effectively treated when identified early, and improving awareness among healthcare providers is key to preventing avoidable deaths and reducing community transmission.

Researchers also noted that available data could not determine whether tuberculosis directly caused each patient's death or was discovered alongside another fatal condition. However, they said both scenarios suggest opportunities for earlier diagnosis may have been missed.

Public health experts have linked the recent resurgence of tuberculosis to disruptions in global TB detection and treatment services during the COVID-19 pandemic. They also warn that reductions in international health funding could further hinder efforts to control the disease worldwide in the coming years.