Unlike other important infectious disease priorities, TB is unique in that active infection is not readily confirmable through a simple blood test.

Microbiological diagnosis requires a sputum specimen, and so you can only confirm TB disease in patients who are symptomatic. Our research at the University Teaching Hospital, has demonstrated culture confirmed TB in up to 10% of ‘non-TB suspects’ who could produce sputum (1). Our 2015 autopsy study showed that despite good awareness of the risk TB within the hospital, there are still many undiagnosed cases at post-mortem. In particular 17% of TB cases were undiagnosed and untreated multiple-drug resistant TB (MDR-TB)(2).

In children TB is grossly under-diagnosed, so much so that epidemiological global burden of disease studies do not even mention ‘TB’ or ‘Tuberculosis’ (3, 4). In stark contrast, autopsy studies undertaken by us and other groups in sub-Saharan Africa, have shown that up to 10% of deaths among hospital admissions are due to undiagnosed and untreated TB (5-7). 

At HerpeZ we are trying to address these diagnostic failures through promoting broader screening of both adult and child admissions to the hospital and developing and evaluating new diagnostic tools or strategies. We have recently initiated a study to define the burden of TB in neonates born to mothers with a history of TB infection and we are developing capacity for analysis of TB cultures or fresh clinical specimens by next generation sequencing. We are also interested in nosocomial TB as a threat to both patients and staff working at busy poorly resourced hospitals across the region.