Millions of undiagnosed cases compromise control efforts

In the often quiet world of international health authorities, the words of Guy Marks, president of the International Union Against Tuberculosis and Lung Diseases, stand out. On the occasion of World Tuberculosis Day, Sunday March 24, the professor warns in a press release: Incidence of the bacterial infectious disease in the most affected countries (Bangladesh, China, India, Nigeria, Pakistan, Democratic Republic of Congo…) rate decreases “terribly slow”.

“We must have the courage to accept that the current strategy is to end TB (this) The country is not delivering the results we hope for. he says.

His main source of frustration: screening flaws. According to the World Health Organization (WHO), Koch’s bacillus, which causes this disease, will kill 1.3 million people in 2022, while of the estimated 10.6 million new cases, 3.1 million are unknown to health services. Experts have called them the “missing millions”. Difficulties in accessing care partly explain this gap.

But, Mr. According to Marcus, patients often go undiagnosed. “Because they don’t feel or recognize the symptoms.” Consequently, union judges “important” to make “Comprehensive Investigation”

Population numbers in high incidence contexts, excluding symptomatic people and at-risk groups.

“Screening standards will be reviewed”

Some studies have attempted to assess the proportion of subclinical tuberculosis, ie with few or no symptoms; A meta-analysis appeared in the journal The Lancet Infectious Diseases On 12 March. Researchers led by Professor Frank Kobelens of the Amsterdam Institute for Global Health and Development reviewed twelve studies including 600,000 people, including 1,900 patients in Africa and Asia. They tested three definitions of subclinical tuberculosis: “no persistent cough for more than two weeks,” “no cough at all,” and “no symptoms” of cough, fever, chest pain, night sweats, and weight loss. .

The analysis estimates that the proportion of subclinical tuberculosis reaches 59% according to the first definition, 40% according to the second definition and 20% according to the third. But these are only imprecise results: according to the researchers, the considered studies may have missed patients due to errors in lung radiodiagnosis or missing or unused confirmatory biological cultures. Once these biases were corrected, 83% of patients had no cough for more than two weeks and 62% had no cough at all.

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