Introduction: Little is known about how tuberculosis (TB) presents to primary care in low-incidence countries.

Aim: We aimed to describe the primary care presentation of adults with TB in England.

Methods: Demographic and clinical data were extracted from English primary care records in the Clinical Practice Research Datalink (CPRD) Aurum database. All patients aged ?18 years and diagnosed with TB from 2011 to 2020 were eligible. Signs and symptoms of interest were identified through a rapid literature review and discussion with patients and healthcare professionals.  

Results: 12,844 eligible patients were identified. Age at diagnosis ranged from 18 to 95 years and 45% were female. Twenty-four% had pulmonary disease, 11% had extra-pulmonary disease and the site was unspecified in 65%. In the year before diagnosis, cough, back pain, lymph node masses and chest pain affected 2757 (21%), 1401 (11%), 1193 (9%) and 989 (8%) patients, respectively. The least reported symptoms were spinal deformity, chills and renal masses (all affecting <0.01% of patients). Symptoms normally associated with TB, such as weight loss (4% of patients), fever (3%), fatigue (3%) and night sweats (1%), were infrequent. Relative timing of symptoms varied. Forty-eight% of patients with back pain, 85% with night sweats and haemoptysis and 77% with fever presented for the first time in the 6 months before diagnosis. In the month before diagnosis, 8% of those with back pain, 45% with spinal deformity and 19% with cough presented for the first time.

Conclusion: Guidelines for the early identification of TB should be updated to reflect the range of symptoms and their relative timings presenting to primary care.