“Subclinical tuberculosis”: a person-centred critique

<title>Extract</title> There is a problem with “subclinical” tuberculosis (TB). The World Health Organization (WHO) divides “asymptomatic TB” into those with and without bacteriological confirmation [1]. In contrast, a recent consensus paper begins with the diagnosis of TB based on current diagnostic tools, with differing likelihoods of giving a true diagnosis, and the clinical and often subjective terms “macroscopic pathology”, “infectiousness” and “symptoms” to give two definitions of “subclinical” and “asymptomatic” TB [2]. A recent systematic review and meta-analysis of “subclinical” and “minimal” tuberculosis has shown how difficult it can be to apply current diagnostic tools in a consistent manner [3]. The concern is that there is a large population with transmissible TB disease that is not detected except in prevalence studies. Rather than stigmatising a group of individuals as being responsible for the persisting TB pandemic, we need to consider the barriers that need to be overcome to enable their early diagnosis (figure 1, see “person-centred perspective”).