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Patients presenting with symptoms suggestive of tuberculosis often receive little more than screening for active tuberculosis. While it makes sense to focus on tuberculosis in highly endemic areas, the rise of non-communicable disease - specifically chronic respiratory diseases - means it is increasingly important to care appropriately for patients considered as presumptive tuberculosis who are subsequently found not to have tuberculosis.
 
There has been no previous systematic attempt to look at what proportion of patients in sub-Saharan Africa with presumptive tuberculosis are subsequently found not to have tuberculosis. Nor has there been any attempt to summarise alternative diagnoses in these patients. Our systematic review found that nearly half of all patients with presumed tuberculosis were subsequently found not to have tuberculosis with few studies reporting alternative diagnoses.
 
With an estimated 1.4million tuberculosis cases notified in sub-Saharan Africa in 2019, our data suggests this figure represents only half of all symptomatic patients presenting with presumptive tuberculosis. A further 1.4million patients with presumed tuberculosis may have missed alternative diagnoses and unmet needs. The ability of health systems to respond proactively to these patients is imperative and to do so these patients will need better global characterisation of their respiratory conditions in multiple contexts.
 
Preprint: