{{Short description|Infectious disease}} {{Good article}} {{pp-move-indef}} {{Use dmy dates|date=January 2023}} {{cs1 config|name-list-style=vanc|display-authors=6}}{{Infobox medical condition | name = Tuberculosis | image = Tuberculosis-x-ray-1.jpg | alt = Chest X-ray of a person with advanced tuberculosis | caption = Chest X-ray of a person with advanced tuberculosis: Infection in both lungs is marked by white arrowheads, and black arrows mark the formation of a cavity. | field = Infectious disease, pulmonology | synonyms = Phthisis, phthisis pulmonalis, consumption, white death, great white plague | symptoms = Chronic cough, fever, cough with bloody mucus, weight loss. Latent TB infection is asymptomatic<ref name="WHO_Factsheet_2025"/> | onset = | duration = | causes = ''Mycobacterium tuberculosis''<ref name="WHO_Factsheet_2025"/> | risks = Immunodeficiency<ref name="WHO_Factsheet_2025"/> | diagnosis = CXR, microbial culture, TB skin test, interferon gamma release assay<ref name="WHO_Factsheet_2025"/> | differential = Pneumonia, histoplasmosis, sarcoidosis, coccidioidomycosis<ref>{{cite book | vauthors = Ferri FF |title=Ferri's differential diagnosis: a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders|date=2010|publisher=Elsevier/Mosby|location=Philadelphia, PA|isbn=978-0-323-07699-9|page=Chapter T|edition=2nd}}</ref> | prevention = Screening those at high risk, treatment of those infected, vaccination with bacillus Calmette-Guérin (BCG)<ref name="WHO_Factsheet_2025"/> | treatment = Antibiotics<ref name="WHO_Factsheet_2025"/> | medication = | frequency = 10.7 million new infections per year (2024)<ref name="WHO_Factsheet_2025"/> | deaths = 1.23 million per year<ref name="WHO_Factsheet_2025"/> }}
<!-- Definition and symptoms -->'''Tuberculosis''' ({{IPAc-en|tj|uː|ˌ|b|ɜːr|k|j|uː|ˈ|l|oʊ|s|ɪ|s}} {{respell|tew|BUR|kew|LOH|siss}}, {{IPAc-en|also|ˌ|tj|uː|b|ər|-}} {{respell|TEW|bər|-}}; '''TB'''), also known colloquially as the "'''white death'''", or historically as '''consumption''',<ref name="Chambers-1998">{{cite book|title=The Chambers Dictionary.|year=1998|publisher=Allied Chambers India Ltd.|location=New Delhi|isbn=978-81-86062-25-8|page=352|url=https://books.google.com/books?id=pz2ORay2HWoC&pg=RA1-PA352|url-status=live|archive-url=https://web.archive.org/web/20150906201311/https://books.google.com/books?id=pz2ORay2HWoC&pg=RA1-PA352|archive-date=6 September 2015}}</ref> is a contagious disease usually caused by ''Mycobacterium tuberculosis'' (MTB) bacteria.<ref name="CDC-About-TB-2025">{{Cite web |date=2025-02-27 |title=About Tuberculosis |url=https://www.cdc.gov/tb/about/index.html |access-date=2025-03-14 |website=Centers for Disease Control and Prevention |language=en-us}}</ref> Tuberculosis initially infects the lungs, but it can also spread to other parts of the body.<ref name="WHO_Factsheet_2025">{{Cite web |date=14 March 2025 |title=Tuberculosis (TB) Fact Sheet |url=https://www.who.int/news-room/fact-sheets/detail/tuberculosis |access-date=2025-03-14 |website=World Health Organization |language=en}}</ref> Most infections show no symptoms, in which case it is known as inactive or latent tuberculosis.<ref name="CDC-About-TB-2025" /> A small proportion of latent infections progress to active disease that, if left untreated, can be fatal.<ref name="WHO_Factsheet_2025" /> Typical symptoms of active TB are chronic cough with blood-containing mucus, fever, night sweats, and weight loss.<ref name="WHO_Factsheet_2025" /> Infection of other organs can cause a wide range of symptoms.<ref name="Adkinson-2010">{{cite book | vauthors = Adkinson NF, Bennett JE, Douglas RG, Mandell GL |title=Mandell, Douglas, and Bennett's principles and practice of infectious diseases|year=2010|publisher=Churchill Livingstone/Elsevier|location=Philadelphia, PA|isbn=978-0-443-06839-3|page=Chapter 250|edition=7th}}</ref>
<!-- Cause and diagnosis -->Tuberculosis is spread from one person to the next through the air when people who have active TB in their lungs cough, spit, speak, or sneeze.<ref name="WHO_Factsheet_2025"/><ref name="CDC-About-TB-2025" /> People with latent TB do not spread the disease.<ref name="WHO_Factsheet_2025"/> A latent infection is more likely to become active in individuals with weakened immune systems.<ref name="WHO_Factsheet_2025"/> There are three principal tests for TB: the interferon-gamma release assay (IGRA), the tuberculin skin test, and the nucleic acid amplification test (NAAT).<ref name="WHO_Factsheet_2025" /><ref>{{Cite web |date=2024-06-17 |title=Testing for Tuberculosis |url=https://www.cdc.gov/tb/testing/index.html |access-date=2025-03-14 |website=Centers for Disease Prevention and Control |language=en-us}}</ref><ref name="WHO-Rapid test-2010" />
<!-- Prevention and treatment -->Prevention of TB involves screening those at high risk, early detection and treatment of cases, and vaccination with the bacillus Calmette-Guérin (BCG) vaccine.<ref>{{cite journal | vauthors = Hawn TR, Day TA, Scriba TJ, Hatherill M, Hanekom WA, Evans TG, Churchyard GJ, Kublin JG, Bekker LG, Self SG | title = Tuberculosis vaccines and prevention of infection | journal = Microbiology and Molecular Biology Reviews | volume = 78 | issue = 4 | pages = 650–71 | date = December 2014 | pmid = 25428938 | pmc = 4248657 | doi = 10.1128/MMBR.00021-14 }}</ref><ref name="WHO_Strategy_2008">{{cite book |title=Implementing the WHO Stop TB Strategy: a handbook for national TB control programmes|date=2008|publisher=World Health Organization (WHO)|location=Geneva|isbn=978-92-4-154667-6|page=179|url=https://books.google.com/books?id=EUZXFCrlUaEC&pg=PA179|access-date=17 September 2017|archive-date=2 June 2021|archive-url=https://web.archive.org/web/20210602232631/https://books.google.com/books?id=EUZXFCrlUaEC&pg=PA179|url-status=live}}</ref><ref>{{cite book|vauthors=Harris RE|chapter=Epidemiology of Tuberculosis|title=Epidemiology of chronic disease: global perspectives|date=2013|publisher=Jones & Bartlett Learning|location=Burlington, MA|isbn=978-0-7637-8047-0|page=682|chapter-url=https://books.google.com/books?id=KJLEIvX4wzoC&pg=PA682|access-date=17 September 2017|archive-date=7 February 2024|archive-url=https://web.archive.org/web/20240207093803/https://books.google.com/books?id=KJLEIvX4wzoC&pg=PA682#v=onepage&q&f=false|url-status=live}}</ref> Those at high risk include household, workplace, and social contacts of people with active TB.<ref name="WHO_Strategy_2008"/> Treatment requires the use of multiple antibiotics over a long period of time.<ref name="WHO_Factsheet_2025"/>
<!-- Epidemiology and history -->It is estimated that one-quarter of the world's population, approximately 2 billion people, have latent TB.<ref>{{Cite web |date=29 October 2024 |title=10 facts on tuberculosis |url=https://www.who.int/news-room/facts-in-pictures/detail/tuberculosis |access-date=2025-03-15 |website=World Health Organization |language=en}}</ref> In 2024, TB incidence reached an estimated 10.7 million people and caused 1.23 million deaths, making it the leading cause of death from a single infectious agent worldwide.<ref name="WHO_Factsheet_2025" />
Tuberculosis has been present in humans since ancient times.<ref name="Lawn-2011">{{cite journal |vauthors=Lawn SD, Zumla AI |date=July 2011 |title=Tuberculosis |journal=Lancet |volume=378 |issue=9785 |pages=57–72 |doi=10.1016/S0140-6736(10)62173-3 |pmid=21420161 |bibcode=2011Lanc..378...57L |s2cid=208791546}}</ref> In the 1800s, when it was known as ''consumption'', TB was responsible for an estimated quarter of all deaths in Europe.<ref name="Bloom-1994" /> Both the incidence (new cases) and prevalence (total cases) of TB declined significantly during the 20th century, attributed to improved sanitation, the discovery of effective antibiotics, and the introduction of the BCG vaccination.<ref>{{cite book |url=https://books.google.com/books?id=-W7ch1d6JOoC&pg=PA141 |title=Smallpox, Syphilis and Salvation: Medical Breakthroughs That Changed the World |vauthors=Persson S |publisher=ReadHowYouWant.com |year=2010 |isbn=978-1-4587-6712-7 |page=141 |archive-url=https://web.archive.org/web/20150906192102/https://books.google.com/books?id=-W7ch1d6JOoC&pg=PA141 |archive-date=6 September 2015 |url-status=live}}</ref> However, since the 1980s, antibiotic resistance has become a growing phenomenon, which led to a higher incidence of multidrug-resistant tuberculosis.<ref name="WHO_Factsheet_2025" /><ref>{{Cite web | vauthors = Wall R |date=9 July 2024 |title=Tuberculosis Drug Discovery: Navigating Resistance and Developing New Therapies |url=https://www.lshtm.ac.uk/newsevents/news/2024/tuberculosis-drug-discovery-navigating-resistance-and-developing-new-therapies |access-date=2025-03-15 |website=London School of Hygiene & Tropical Medicine |language=en}}</ref> [[File:En.Wikipedia-VideoWiki-Tuberculosis.webm|thumb|thumbtime=1:00|Video summary (script)|303x303px]] {{TOC limit}}
== History == {{Main|History of tuberculosis}} [[File:Mummy at British Museum.jpg|thumb|An Egyptian mummy in the British Museum – tubercular decay has been found in the spine.]] <!-- Ancient history --> Tuberculosis (<small>RP:</small>{{IPAc-en|tj|uː|ˈ|b|ɜːr|k|j|uː|ˌ|l|oʊ|s|ɪ|s}} {{respell|tew|BER|kew|loh|sis}}, {{IPAc-en|also|ˌ|tj|uː|b|ər|k|j|uː|ˈ|l|oʊ|s|ɪ|s}} {{respell|tew|bər|kew|LOH|sis}}) has existed since antiquity.<ref name="Buzic-2020" /> Skeletal remains show some prehistoric humans (4000 BC) had TB, and researchers have found tubercular decay in the spines of Egyptian mummies dating from 3000 to 2400 BC.<ref>{{cite journal | vauthors = Zink AR, Sola C, Reischl U, Grabner W, Rastogi N, Wolf H, Nerlich AG | title = Characterization of Mycobacterium tuberculosis complex DNAs from Egyptian mummies by spoligotyping | journal = Journal of Clinical Microbiology | volume = 41 | issue = 1 | pages = 359–67 | date = January 2003 | pmid = 12517873 | pmc = 149558 | doi = 10.1128/JCM.41.1.359-367.2003 }}</ref> Genetic studies suggest the presence of TB-like bacteria in South America from about AD 140.<ref>{{cite journal | vauthors = Konomi N, Lebwohl E, Mowbray K, Tattersall I, Zhang D | title = Detection of mycobacterial DNA in Andean mummies | journal = Journal of Clinical Microbiology | volume = 40 | issue = 12 | pages = 4738–40 | date = December 2002 | pmid = 12454182 | pmc = 154635 | doi = 10.1128/JCM.40.12.4738-4740.2002 | bibcode = 2002JCMb...40.4738K }}</ref>
=== Identification === Although Richard Morton established the pulmonary form associated with tubercles as a pathology in 1689,<ref>{{cite journal | vauthors = Trail RR | title = Richard Morton (1637–1698) | journal = Medical History | volume = 14 | issue = 2 | pages = 166–74 | date = April 1970 | pmid = 4914685 | pmc = 1034037 | doi = 10.1017/S0025727300015350 }}</ref> due to the variety of its symptoms, TB was not identified as a single disease until the 1820s. Benjamin Marten conjectured in 1720 that consumption was caused by microbes that were spread by people living close to each other.<ref>{{cite book |vauthors=Marten B |title=A New Theory of Consumptions—More Especially a Phthisis or Consumption of the Lungs |date=1720 |publisher=T. Knaplock |location=London, England |url=https://babel.hathitrust.org/cgi/pt?id=ucm.5320214800&view=1up&seq=7 |access-date=8 December 2020 |archive-date=26 March 2023 |archive-url=https://web.archive.org/web/20230326205015/https://babel.hathitrust.org/cgi/pt?id=ucm.5320214800&view=1up&seq=7 |url-status=live }} P. 51: "The ''Original'' and ''Essential Cause'' ... may possibly be some certain Species of ''Animalcula'' or wonderfully minute living Creatures, ... " P. 79: "It may be therefore very likely, that by an habitual lying in the same Bed with a Consumptive Patient, constantly Eating and Drinking with him, or by very frequently conversing so nearly, as to draw in part of the Breath he emits from his Lungs, a Consumption may be caught by a sound Person; ... "</ref> In 1819, René Laennec claimed that tubercles were the cause of pulmonary tuberculosis.<ref>{{cite book |vauthors=Laennec RT |title=De l'auscultation médiate ... |date=1819 |publisher=J.-A. Brosson et J.-S Chaudé |location=Paris, France |volume=1 |page=20 |url=https://books.google.com/books?id=LcZEAAAAcAAJ&pg=PA20 |language=fr |access-date=6 December 2020 |archive-date=2 June 2021 |archive-url=https://web.archive.org/web/20210602212549/https://books.google.com/books?id=LcZEAAAAcAAJ&pg=PA20 |url-status=live }} From p. 20: ''"L'existence des tubercules dans le poumon est la cause et constitue le charactère anatomique propre de la phthisie pulmonaire (a). (a) ... l'effet dont cette maladie tire son nom, c'est-à-dire, la consumption."'' (The existence of tubercles in the lung is the cause and constitutes the unique anatomical characteristic of pulmonary tuberculosis (a). (a) ... the effect from which this malady [pulmonary tuberculosis] takes its name, that is, consumption.)</ref> J. L. Schönlein first published the name "tuberculosis" (German: ''Tuberkulose'') in 1832.<ref>{{cite book |vauthors=Schönlein JL |title=Allgemeine und specielle Pathologie und Therapie |trans-title=General and Special Pathology and Therapy |date=1832 |publisher=C. Etlinger |location=Würzburg, (Germany) |volume=3 |page=103 |url=https://books.google.com/books?id=zAtbAAAAcAAJ&pg=PA103 |language=de |access-date=6 December 2020 |archive-date=2 June 2021 |archive-url=https://web.archive.org/web/20210602233224/https://books.google.com/books?id=zAtbAAAAcAAJ&pg=PA103 |url-status=live }}</ref><ref>The word "tuberculosis" first appeared in Schönlein's clinical notes in 1829. See: {{cite journal | vauthors = Jay SJ, Kırbıyık U, Woods JR, Steele GA, Hoyt GR, Schwengber RB, Gupta P | title = Modern theory of tuberculosis: culturomic analysis of its historical origin in Europe and North America | journal = The International Journal of Tuberculosis and Lung Disease | volume = 22 | issue = 11 | pages = 1249–1257 | date = November 2018 | pmid = 30355403 | doi = 10.5588/ijtld.18.0239 | s2cid = 53027676 }} See especially Appendix, p. iii.</ref>
In 1865, Jean Antoine Villemin demonstrated that tuberculosis could be transmitted, via inoculation, from humans to animals and among animals.<ref>{{cite journal |vauthors=Villemin JA |title=Cause et nature de la tuberculose |journal=Bulletin de l'Académie Impériale de Médecine |date=1865 |volume=31 |pages=211–216 |url=https://babel.hathitrust.org/cgi/pt?id=hvd.32044103060562&view=1up&seq=215 |trans-title=Cause and nature of tuberculosis |language=fr |access-date=6 December 2020 |archive-date=9 December 2021 |archive-url=https://web.archive.org/web/20211209200251/https://babel.hathitrust.org/cgi/pt?id=hvd.32044103060562&view=1up&seq=215 |url-status=live }}
* See also: {{cite book |vauthors=Villemin JA |title= Études sur la tuberculose: preuves rationnelles et expérimentales de sa spécificité et de son inoculabilité |trans-title=Studies of tuberculosis: rational and experimental evidence of its specificity and inoculability |date=1868 |publisher=J.-B. Baillière et fils |location=Paris, France |url=https://books.google.com/books?id=JFg7AAAAcAAJ&pg=PP7 |language=fr |access-date=6 December 2020 |archive-date=7 February 2024 |archive-url=https://web.archive.org/web/20240207093804/https://books.google.com/books?id=JFg7AAAAcAAJ&pg=PP7#v=onepage&q&f=false |url-status=live }}</ref> Villemin's findings were confirmed in 1867 and 1868 by John Burdon-Sanderson.<ref>Burdon-Sanderson, John Scott. (1870) "Introductory Report on the Intimate Pathology of Contagion." Appendix to: Twelfth Report to the Lords of Her Majesty's Most Honourable Privy Council of the Medical Officer of the Privy Council [for the year 1869], Parliamentary Papers (1870), vol. 38, 229–256.</ref>
[[File:RobertKoch.jpg|upright|thumb|Robert Koch discovered the tuberculosis bacillus.]] Robert Koch identified and described the bacillus causing tuberculosis, ''M. tuberculosis'', on 24 March 1882.<ref>{{cite book | vauthors = Koch R | title = Robert Koch: Zentrale Texte | chapter = Die Ätiologie der Tuberkulose (1882) |series=Klassische Texte der Wissenschaft |orig-date=1882|date=2018|trans-title=The Etiology of Tuberculosis| chapter-url = https://edoc.rki.de/docviews/abstract.php?id=610|volume=19|pages=221–30|doi=10.1007/978-3-662-56454-7_4|isbn=978-3-662-56454-7|access-date=15 June 2021|archive-date=6 November 2018|archive-url= https://web.archive.org/web/20181106191545/https://babel.hathitrust.org/cgi/pt?id=mdp.39015020075001;view=1up;seq=235|url-status=live|publisher=Springer Spektrum|location=Berlin, Heidelberg}}</ref><ref name="CDC-History-2025">{{Cite web |last=CDC |date=2025-02-19 |title=History of World TB Day |url=https://www.cdc.gov/world-tb-day/history/index.html |access-date=2025-12-26 |website=World TB Day |language=en-us}}</ref> In 1905, he was awarded the Nobel Prize in Physiology or Medicine for this discovery.<ref>{{Cite web|title=The Nobel Prize in Physiology or Medicine 1905|url=https://www.nobelprize.org/prizes/medicine/1905/summary/|access-date=7 October 2006|archive-url=https://web.archive.org/web/20061210184150/http://nobelprize.org/nobel_prizes/medicine/laureates/1905/|archive-date=10 December 2006|url-status=live|website=www.nobelprize.org|language=en-US}}</ref>
=== Development of treatments === In Europe, rates of tuberculosis began to rise in the early 1600s to a peak level in the 1800s, when it caused nearly 25% of all deaths.<ref name="Bloom-1994">{{cite book| vauthors = Bloom BR |title= Tuberculosis: pathogenesis, protection, and control|year= 1994|publisher= ASM Press|location= Washington, DC|isbn= 978-1-55581-072-6|url-access= registration|url= https://archive.org/details/tuberculosispath0000unse}}</ref> In the 18th and 19th century, tuberculosis had become epidemic in Europe, showing a seasonal pattern.<ref>{{Cite web| vauthors = Frith J |title=History of Tuberculosis. Part 1 – Phthisis, consumption and the White Plague|url=https://jmvh.org/article/history-of-tuberculosis-part-1-phthisis-consumption-and-the-white-plague/|url-status=live|access-date=26 February 2021|website=Journal of Military and Veterans' Health|archive-date=8 April 2021|archive-url=https://web.archive.org/web/20210408050305/https://jmvh.org/article/history-of-tuberculosis-part-1-phthisis-consumption-and-the-white-plague/}}</ref><ref name="Zürcher_2016">{{cite journal | vauthors = Zürcher K, Zwahlen M, Ballif M, Rieder HL, Egger M, Fenner L | title = Influenza Pandemics and Tuberculosis Mortality in 1889 and 1918: Analysis of Historical Data from Switzerland | journal = PLOS ONE | volume = 11 | issue = 10 | article-number = e0162575 | date = 5 October 2016 | pmid = 27706149 | pmc = 5051959 | doi = 10.1371/journal.pone.0162575 | doi-access = free | bibcode = 2016PLoSO..1162575Z }}</ref> Tuberculosis caused widespread public concern in the 19th and early 20th centuries as the disease became common among the urban poor. In 1815, one in four deaths in England was due to "consumption." By 1918, TB still caused one in six deaths in France.<ref>{{Cite web |last=Now |first=Circulating |date=2018-01-31 |title=Revealing Data: Collecting Data about TB, ca. 1900 |url=https://circulatingnow.nlm.nih.gov/2018/01/31/collecting-data-about-tuberculosis-ca-1900/ |access-date=2026-01-18 |website=Circulating Now from the NLM Historical Collections |language=en-US}}</ref>
Between 1838 and 1845, John Croghan, the owner of Mammoth Cave in Kentucky from 1839 onwards, brought many people with tuberculosis into the cave in the hope of curing the disease with the constant temperature and purity of the cave air; each died within a year.<ref>{{cite web |date=27 February 2004 |title=Kentucky: Mammoth Cave long on history. |url=http://edition.cnn.com/2004/TRAVEL/DESTINATIONS/02/26/mammoth.cave.ap/index.html |archive-url=https://web.archive.org/web/20060813140746/http://edition.cnn.com/2004/TRAVEL/DESTINATIONS/02/26/mammoth.cave.ap/index.html |archive-date=13 August 2006 |access-date=8 October 2006 |work=CNN}}</ref>
Hermann Brehmer opened the first TB sanatorium in 1859 in Görbersdorf (now Sokołowsko) in Silesia.<ref name="McCarthy-2001">{{cite journal |vauthors=McCarthy OR |date=August 2001 |title=The key to the sanatoria |url=http://www.jrsm.org/cgi/pmidlookup?view=long&pmid=11461990 |url-status=live |journal=Journal of the Royal Society of Medicine |volume=94 |issue=8 |pages=413–17 |doi=10.1177/014107680109400813 |pmc=1281640 |pmid=11461990 |archive-url=https://archive.today/20120803180504/http://www.jrsm.org/cgi/pmidlookup?view=long&pmid=11461990 |archive-date=3 August 2012 |access-date=28 September 2011}}</ref> After TB was determined to be contagious, in the 1880s, it was put on a notifiable-disease list in Britain. Campaigns started to stop people from spitting in public places, and the infected poor were "encouraged" to enter sanatoria that resembled prisons. The sanatoria for the middle and upper classes offered excellent care and constant medical attention.<ref name="McCarthy-2001" /> Whatever the benefits of the "fresh air" and labor in the sanatoria, even under the best conditions, 50% of those who entered died within five years ({{circa}} 1916).<ref name="McCarthy-2001" />
Robert Koch did not believe cattle and human tuberculosis were similar, which delayed the recognition of infected milk as a source of infection. During the first half of the 1900s, the risk of transmission from this source was dramatically reduced after the application of the pasteurization process. Koch announced a glycerine extract of the tubercle bacilli as a "remedy" for tuberculosis in 1890, calling it "tuberculin.” Although it was not effective, it was later successfully adapted as a screening test for the presence of pre-symptomatic tuberculosis.<ref>{{cite journal | vauthors = Waddington K | title = To stamp out 'so terrible a malady': bovine tuberculosis and tuberculin testing in Britain, 1890–1939 | journal = Medical History | volume = 48 | issue = 1 | pages = 29–48 | date = January 2004 | pmid = 14968644 | pmc = 546294 | doi = 10.1017/S0025727300007043 }}</ref> World Tuberculosis Day is marked on 24 March each year, the anniversary of Koch's original scientific announcement. When the Medical Research Council was formed in Britain in 1913, it initially focused on tuberculosis research.<ref>{{cite book | vauthors = Hannaway C |title= Biomedicine in the twentieth century: practices, policies, and politics|year= 2008|publisher= IOS Press|location= Amsterdam|isbn=978-1-58603-832-8|page= 233|url= https://books.google.com/books?id=o5HBxyg5APIC&pg=PA233|url-status=live|archive-url= https://web.archive.org/web/20150907185226/https://books.google.com/books?id=o5HBxyg5APIC&pg=PA233|archive-date= 7 September 2015}}</ref>
Albert Calmette and Camille Guérin achieved the first genuine success in immunization against tuberculosis in 1906, using attenuated bovine-strain tuberculosis. It was called bacille Calmette–Guérin (BCG). The BCG vaccine was first used on humans in 1921 in France,<ref>{{cite journal | vauthors = Bonah C | title = The 'experimental stable' of the BCG vaccine: safety, efficacy, proof, and standards, 1921–1933 | journal = Studies in History and Philosophy of Biological and Biomedical Sciences | volume = 36 | issue = 4 | pages = 696–721 | date = December 2005 | pmid = 16337557 | doi = 10.1016/j.shpsc.2005.09.003 }}</ref> but achieved widespread acceptance in the US, Great Britain, and Germany only after World War II.<ref>{{cite journal | vauthors = Comstock GW | title = The International Tuberculosis Campaign: a pioneering venture in mass vaccination and research | journal = Clinical Infectious Diseases | volume = 19 | issue = 3 | pages = 528–40 | date = September 1994 | pmid = 7811874 | doi = 10.1093/clinids/19.3.528 }}</ref>
In 1946, the development of the antibiotic streptomycin made effective treatment and cure of TB a reality. Before the introduction of this medication, the only treatment was surgical intervention, including the "pneumothorax technique", which involved collapsing an infected lung to "rest" it and to allow tuberculous lesions to heal.<ref>{{cite book |url=https://books.google.com/books?id=bVEEHmpU-1wC&pg=PA792 |title=General thoracic surgery |vauthors=Shields T |publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins |year=2009 |isbn=978-0-7817-7982-1 |edition=7th |location=Philadelphia |page=792 |archive-url=https://web.archive.org/web/20150906212146/https://books.google.com/books?id=bVEEHmpU-1wC&pg=PA792 |archive-date=6 September 2015 |url-status=live}}</ref>
By the 1950s, mortality in Europe had decreased by about 90%. Improvements in sanitation, vaccination, and other public-health measures began significantly reducing rates of tuberculosis even before the arrival of streptomycin and other antibiotics, although the disease remained a significant threat.<ref>{{Cite book |last=McKeown |first=Thomas |url=https://doi.org/10.1515/9781400854622 |title=The Role of Medicine |date=1980-12-31 |publisher=Princeton University Press |doi=10.1515/9781400854622 |isbn=978-1-4008-5462-2}}</ref><ref>{{Cite journal |last1=Barberis |first1=I. |last2=Bragazzi |first2=N. L. |last3=Galluzzo |first3=L. |last4=Martini |first4=M. |date=March 2017 |title=The history of tuberculosis: from the first historical records to the isolation of Koch's bacillus |journal=Journal of Preventive Medicine and Hygiene |volume=58 |issue=1 |pages=E9–E12 |issn=1121-2233 |pmc=5432783 |pmid=28515626}}</ref>
=== Drug-resistant tuberculosis === [[File:Multidrug-resistant-tuberculosis-without-extensive-drug-resistance1.png|thumb|A graph showing the trend in estimated prevalence (total cases) and incidence (annual new cases) of MDR-TB from 1990 to 2021]] A few years after the first antibiotic treatment for TB in 1943, some strains of the TB bacteria developed resistance to the standard drugs (streptomycin, para-aminosalicylic acid, and isoniazid).<ref name="Keshavjee-2012">{{Cite journal |last1=Keshavjee |first1=Salmaan |last2=Farmer |first2=Paul E. |date=2012-09-06 |title=Tuberculosis, Drug Resistance, and the History of Modern Medicine |url=http://www.nejm.org/doi/10.1056/NEJMra1205429 |journal=New England Journal of Medicine |language=en |volume=367 |issue=10 |pages=931–936 |doi=10.1056/NEJMra1205429 |pmid=22931261 |issn=0028-4793|url-access=subscription }}</ref> Between 1970 and 1990, there were numerous outbreaks of drug-resistant tuberculosis involving strains resistant to two or more drugs; these strains are called multi-drug resistant TB (MDR-TB).<ref name="Keshavjee-2012" /> The resurgence of tuberculosis, caused in part by drug resistance and in part by the HIV pandemic, resulted in the declaration of a global health emergency by the World Health Organization (WHO) in 1993.<ref>{{cite journal |vauthors=Chaisson RE, Frick M, Nahid P |date=March 2022 |title=The scientific response to TB - the other deadly global health emergency |journal=The International Journal of Tuberculosis and Lung Disease |volume=26 |issue=3 |pages=186–189 |doi=10.5588/ijtld.21.0734 |pmc=8886961 |pmid=35197158}}</ref><ref>{{Cite journal |last=Nakajima |first=Dr Hiroshi |date=July–August 1993 |title=Tuberculosis: a global emergency |url=https://iris.who.int/handle/10665/52639 |journal=World Health, the Magazine of the World Health Organization |volume=46 |issue=4 |page=3 |access-date=26 December 2025}}</ref>
Drug resistance to TB can come in two forms: primary and secondary. Primary drug resistance is caused by person-to-person transmission of drug-resistant TB bacteria. Secondary drug resistance (also called acquired resistance) develops during TB treatment. A person with fully drug-susceptible TB may develop secondary (acquired) resistance during therapy because of inadequate treatment, not taking the prescribed regimen appropriately (lack of compliance), or using low-quality drugs.<ref name="CDC-Overview-2025a">{{cite web |date=6 January 2025 |title=Clinical Overview of Drug-Resistant Tuberculosis Disease |url=https://www.cdc.gov/tb/hcp/clinical-overview/drug-resistant-tuberculosis-disease.html |access-date=26 December 2025 |publisher=U.S. Centers for Disease Control and Prevention}}</ref><ref>{{Cite journal |last=O'Brien |first=R. J. |date=June 1994 |title=Drug-resistant tuberculosis: etiology, management and prevention |journal=Seminars in Respiratory Infections |volume=9 |issue=2 |pages=104–112 |issn=0882-0546 |pmid=7973169 }}</ref>
To fully identify drug resistance and guide treatment, drug susceptibility testing (DST) determines which drugs can kill TB bacteria.<ref name="CDC-DST-2024">{{cite web |date=11 April 2024 |title=Lesson 4. Diagnosis of Tuberculosis - 5. Bacteriological Examination – Drug Susceptibility Testing |url=https://www.cdc.gov/tb/webcourses/TB101/page17050.html |access-date=26 December 2025 |website=TB 101 for Health Care Workers |publisher=U.S. Centers for Disease Control and Prevention}}</ref> WHO guidelines recommend a rapid molecular test, Xpert MTB/RIF, to diagnose TB and simultaneously detect rifampicin resistance.<ref name="Reuters-2010">{{cite news |date=8 December 2010 |title=WHO says Cepheid rapid test will transform TB care |url=https://www.reuters.com/article/idUSTRE6B71RF20101208 |url-status=live |archive-url=https://web.archive.org/web/20101211140847/http://www.reuters.com/article/idUSTRE6B71RF20101208 |archive-date=11 December 2010 |work=Reuters}}</ref><ref name="CDC_Xpert_20242">{{Cite web |date=2024-04-29 |title=Xpert MTB/RIF Assay - A Tool to Diagnose Tuberculosis |url=https://www.cdc.gov/tb/php/laboratory-information/xpert-mtb-rif-assay.html |access-date=2025-04-15 |website=Centers for Disease Control and Prevention |language=en-us}}</ref> DST is crucial for fully identifying drug resistance and guiding treatment.<ref>{{Cite journal |last1=Jang |first1=Jong Geol |last2=Chung |first2=Jin Hong |date=2020-09-04 |title=Diagnosis and treatment of multidrug-resistant tuberculosis |journal=Journal of Yeungnam Medical Science |language=English |volume=37 |issue=4 |pages=277–285 |doi=10.12701/yujm.2020.00626 |issn=2384-0293 |pmc=7606956 |pmid=32883054}}</ref>
''Rifampicin-resistant TB'' (RR-TB) is resistant to the drug rifampicin. ''Multi-drug resistant tuberculosis'' (MDR-TB) is defined as resistance to the two most effective first-line TB drugs: rifampicin and isoniazid.<ref>{{Cite web |date=20 May 2024 |title=Tuberculosis: Multidrug-resistant (MDR-TB) or rifampicin-resistant TB (RR-TB) |url=https://www.who.int/news-room/questions-and-answers/item/tuberculosis-multidrug-resistant-tuberculosis-(mdr-tb) |access-date=2025-06-11 |website=World Health Organization |language=en}}</ref> ''Extensively drug-resistant tuberculosis'' (XDR-TB) is resistant to rifampicin (and may also be resistant to isoniazid), and is also resistant to at least one fluoroquinolone (levofloxacin or moxifloxacin) and to at least one other Group A drug (bedaquiline or linezolid).<ref>{{Cite web |date=23 May 2024 |title=Tuberculosis: Extensively drug-resistant tuberculosis (XDR-TB) |url=https://www.who.int/news-room/questions-and-answers/item/tuberculosis-extensively-drug-resistant-tuberculosis-(XDR-TB) |access-date=2025-06-11 |website=World Health Organization |language=en}}</ref><ref name="CDC-DST-2024" /> A further categorization, totally drug resistant tuberculosis, has been used to describe strains with even greater drug resistance. {{As of|2025}}, it has no accepted definition, but it is most commonly described as 'resistance to all first- and second-line drugs used to treat TB'.<ref name="Cegielski-2012">{{Cite journal |last1=Cegielski |first1=Peter |last2=Nunn |first2=Paul |last3=Kurbatova |first3=Ekaterina V. |last4=Weyer |first4=Karin |last5=Dalton |first5=Tracy L. |last6=Wares |first6=Douglas F. |last7=Iademarco |first7=Michael F. |last8=Castro |first8=Kenneth G. |last9=Raviglione |first9=Mario |date=November 2012 |title=Challenges and controversies in defining totally drug-resistant tuberculosis |journal=Emerging Infectious Diseases |volume=18 |issue=11 |pages=e2 |doi=10.3201/eid1811.120526 |issn=1080-6059 |pmc=3559144 |pmid=23092736}}</ref> It was first observed in 2003 in Italy,<ref name="WHO-Global-2.4-2023">{{Cite web |date=21 July 2023 |title=Global tuberculosis report 2023 - 2.4 Drug-resistant TB treatment |url=https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2023/tb-diagnosis---treatment/drug-resistant-tb-treatment |access-date=2025-06-11 |website=World Health Organization |language=en}}</ref> but not widely reported until 2012,<ref name="Cegielski-2012" /><ref name="WHO-Global-1.3-2024">{{Cite web |title=Global Tuberculosis Report 2024 - 1.3 Drug-resistant TB |url=https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2024/tb-disease-burden/1-3-drug-resistant-tb |access-date=2025-06-12 |website=World Health Organization |language=en}}</ref> and has also been found in Iran, India, and South Africa.<ref name="Parida2015">{{cite journal |vauthors=Parida SK, Axelsson-Robertson R, Rao MV, Singh N, Master I, Lutckii A, Keshavjee S, Andersson J, Zumla A, Maeurer M |date=April 2015 |title=Totally drug-resistant tuberculosis and adjunct therapies |url= |journal=J Intern Med |volume=277 |issue=4 |pages=388–405 |doi=10.1111/joim.12264 |pmid=24809736}}</ref>
{{As of|2023}}, the WHO estimates that 3.2% of new TB infections globally are RR-TB or MDR-TB; this went down from 4.0% in 2015.<ref name="WHO-Global-1.3-2024" /> Among those who have been previously treated for TB, the proportion of people with RR-TB or MDR-TB has also decreased from 25% in 2015 to an estimated 16% in 2023.<ref name="WHO-Global-1.3-2024" />
Treatment of MDR-TB requires treatment with second-line drugs, which, in general, are less effective, more toxic, and more expensive than first-line drugs.<ref>{{Cite journal |last1=Millard |first1=James |last2=Ugarte-Gil |first2=Cesar |last3=Moore |first3=David A. J. |date=2015-02-26 |title=Multidrug resistant tuberculosis |url=http://www.bmj.com/content/350/bmj.h882 |journal=BMJ |volume=350 |pages=h882 |doi=10.1136/bmj.h882 |issn=1756-1833 |pmid=25721508 |s2cid=11683912}}</ref> Treatment regimens can run for up to two years, compared to the six months of first-line drug treatment.<ref name="WHO-Global-2.4-2023" /> Treatment of MDR-TB is significantly more costly than treating regular TB. As an example, in the UK in 2013 the cost of standard TB treatment was estimated at £5,000 while the cost of treating MDR-TB was estimated to be more than 10 times greater, ranging from £50,000 to £70,000 per case.<ref>{{Cite journal |last=Lancet |first=The |date=2013-04-27 |title=The ongoing problem of tuberculosis in the UK |url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60910-1/fulltext |journal=The Lancet |language=English |volume=381 |issue=9876 |page=1431 |doi=10.1016/S0140-6736(13)60910-1 |issn=0140-6736 |pmid=23622269 |url-access=subscription}}</ref>
In low-income countries, the impact of MDR-TB on the families of its victims is severe, affecting income, mental health, and social well-being. Families may become impoverished due to the financial strain of MDR-TB treatment, with studies reporting that a significant portion of household income can be spent on healthcare.<ref>{{Cite journal |last1=van den Hof |first1=Susan |last2=Collins |first2=David |last3=Hafidz |first3=Firdaus |last4=Beyene |first4=Demissew |last5=Tursynbayeva |first5=Aigul |last6=Tiemersma |first6=Edine |date=2016-09-05 |title=The socioeconomic impact of multidrug resistant tuberculosis on patients: results from Ethiopia, Indonesia and Kazakhstan |journal=BMC Infectious Diseases |volume=16 |issue=1 |page=470 |doi=10.1186/s12879-016-1802-x |issn=1471-2334 |pmc=5011357 |pmid=27595779 |doi-access=free}}</ref><ref>{{Cite journal |last1=Numpong |first1=Samorn |last2=Kengganpanich |first2=Mondha |last3=Kaewkungwal |first3=Jaranit |last4=Pan-ngum |first4=Wirichada |last5=Silachamroon |first5=Udomsak |last6=Kasetjaroen |first6=Yuthichai |last7=Lawpoolsri |first7=Saranath |date=2022-01-01 |title=Confronting and Coping with Multidrug-Resistant Tuberculosis: Life Experiences in Thailand |journal=Qualitative Health Research |language=EN |volume=32 |issue=1 |pages=159–167 |doi=10.1177/10497323211049777 |issn=1049-7323 |pmc=8739603 |pmid=34845946}}</ref>
== Signs and symptoms ==
thumb|upright=1.5|The main symptoms of variants and stages of tuberculosis are given,<ref>{{cite web|url=http://www.emedicinehealth.com/tuberculosis/page3_em.htm|title=Tuberculosis Symptoms|publisher=eMedicine Health| vauthors = Schiffman G |date=15 January 2009|url-status=live|archive-url=https://web.archive.org/web/20090516075020/http://www.emedicinehealth.com/tuberculosis/page3_em.htm|archive-date=16 May 2009}}</ref> with many symptoms overlapping with other variants, while others are more, but not entirely, specific for certain variants. thumb|Tuberculosis of the lip, secondary to open pulmonary TB There is a popular misconception that tuberculosis is purely a disease of the lungs that manifests as coughing.<ref>{{cite book |vauthors=Kamboj A, Lause M, Kamboj K |year=2023 |chapter=The Problem of Tuberculosis: Myths, Stigma, and Mimics |veditors=Rezaei N |title=Tuberculosis |series=Integrated Science |volume=11 |publisher=Springer |doi=10.1007/978-3-031-15955-8_50 |pages=1046–1062 |isbn=978-3-031-15954-1}}</ref> Tuberculosis may infect many organs, even though it most commonly occurs in the lungs (known as ''pulmonary tuberculosis'').<ref name="Adkinson-2010" /> Extrapulmonary TB occurs when tuberculosis develops in organs other than the lungs; it may coexist with pulmonary TB.<ref name="Adkinson-2010" />
General signs and symptoms include fever, chills, night sweats, loss of appetite, weight loss, and fatigue.<ref name="Adkinson-2010" />
=== Latent tuberculosis === {{Main|Latent tuberculosis}}
The majority of individuals with TB infection show no symptoms, a state known as inactive or latent tuberculosis.<ref name="CDC-About-TB-2025" /> This condition is not contagious, and can be detected by the tuberculin skin test (TST) and the interferon-gamma release assay (IGRA); other tests should be conducted to eliminate the possibility of active TB.<ref name="Price_2024">{{Citation |title=Latent Tuberculosis |vauthors=Price C, Nguyen AD |date=11 January 2024 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK599527/ |access-date=2025-03-17 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=38261712}}</ref> Without treatment, an estimated 5% to 15% of cases will progress into active TB during the person's lifetime.<ref name="Price_2024" />
===Pulmonary=== If a tuberculosis infection does become active, it most commonly involves the lungs (in about 90% of cases).<ref name="Lawn-2011" /><ref>{{cite book| vauthors = Behera D |title=Textbook of Pulmonary Medicine|year=2010|publisher=Jaypee Brothers Medical Publishers|location=New Delhi|isbn=978-81-8448-749-7|page=457|url=https://books.google.com/books?id=0TbJjd9eTp0C&pg=PA457|edition=2nd|url-status=live|archive-url=https://web.archive.org/web/20150906185549/https://books.google.com/books?id=0TbJjd9eTp0C&pg=PA457|archive-date=6 September 2015}}</ref> Symptoms may include chest pain, a prolonged cough producing sputum which may be bloody, tiredness, temperature, loss of appetite, wasting and general malaise.<ref name="Lawn-2011" /><ref>{{Cite web |date=20 April 2023 |title=Tuberculosis (TB) |url=https://www.nhs.uk/conditions/tuberculosis-tb/ |access-date=2025-03-17 |website=National Health Service |language=en}}</ref> In very rare cases, the infection may erode into the pulmonary artery or a Rasmussen aneurysm, resulting in massive bleeding.<ref name="Adkinson-2010" /><ref>{{cite journal | vauthors = Halezeroğlu S, Okur E | title = Thoracic surgery for haemoptysis in the context of tuberculosis: what is the best management approach? | journal = Journal of Thoracic Disease | volume = 6 | issue = 3 | pages = 182–85 | date = March 2014 | pmid = 24624281 | pmc = 3949181 | doi = 10.3978/j.issn.2072-1439.2013.12.25 }}</ref>
Tuberculosis may cause extensive scarring of the lungs, which persists after successful disease treatment. Survivors continue to experience chronic respiratory symptoms such as cough, sputum production, and shortness of breath.<ref>{{cite journal | vauthors = Gai X, Allwood B, Sun Y | title = Post-tuberculosis lung disease and chronic obstructive pulmonary disease | journal = Chinese Medical Journal | volume = 136 | issue = 16 | pages = 1923–1928 | date = August 2023 | pmid = 37455331 | pmc = 10431356 | doi = 10.1097/CM9.0000000000002771 }}</ref><ref>{{Cite web | vauthors = Basire D |date=2024-04-23 |title=Post-TB lung health: Lasting impact beyond treatment |url=https://www.breathingmatters.co.uk/our-findings/post-tb-lung-health-lasting-impact-beyond-treatment/ |access-date=2025-03-18 |website=Breathing Matters - UCL Respiratory |language=en}}</ref>
Pyopneumothorax is a rare and serious complication of pulmonary tuberculosis, with a high rate of morbidity and mortality.<ref>{{cite journal |last1=Bajpai |first1=Jyoti |last2=Tewari |first2=Jay |last3=Roy |first3=Shubhajeet |last4=Verma |first4=Ajay K |last5=Verma |first5=Shailendra P |last6=Kant |first6=Surya |title=Pyopneumothorax Secondary to Pulmonary Tuberculosis Superadded by Congenital Factor XIII Deficiency: A Case Report |journal=Cureus Journal of Medical Science |date=19 October 2023 |volume=15 |issue=10 |article-number=e47350 |doi=10.7759/cureus.47350 |pmid=38022233 |publisher=Springer Nature Limited |doi-access=free |issn=2168-8184 |pmc=10659563}}</ref> It is caused by both air and pus accumulating in the pleural space, simultaneously causing a pneumothorax and empyema, usually as the result of a rupture of a subpleural caseous necrosis (a collection of dead cells enclosed within a granuloma).<ref>{{cite journal |last1=Annareddy |first1=Srinivasulareddy |last2=Aurangabadkar |first2=Gaurang |last3=Choudhary |first3=Sumer S. |last4=Jadhav |first4=Ulhas |last5=Khan |first5=Shafee |last6=Ghewade |first6=Babaji |title=A case of tubercular empyema with pyopneumothorax |journal=Journal of Family Medicine and Primary Care |date=June 2023 |volume=12 |issue=6 |pages=1231–1233 |doi=10.4103/jfmpc.jfmpc_2239_22 |pmid=37636179 |publisher=Wolters Kluwer – Medknow |doi-access=free |issn=2278-7135 |pmc=10451592}}</ref> Initial symptoms include abrupt onset chest pain, high fever with chills, severe dyspnea, and less commonly pain & numbness in the extremities. In rare cases, a pyopneumothorax can cause peripheral blood clots resulting in an infarction, gangrene and tissue necrosis of one or more limbs, requiring amputation unless caught early; death can result if the gangrenous limb isn't amputated in time.<ref>{{cite journal |last1=Balasundaran |first1=Pournami |last2=Manoharan |first2=Heyma Krishna |last3=Bhargava |first3=Jitendra Kishore |last4=Arya |first4=Veerendra |last5=Natarajan |first5=Gowtham |title=A Curious Case of Black Limb in Tuberculosis |journal=Journal of Global Infectious Diseases |date=January 2024 |volume=16 |issue=1 |pages=36–38 |doi=10.4103/jgid.jgid_94_23 |pmid=38680756 |publisher=Wolters Kluwer – Medknow |doi-access=free |issn=0974-777X |pmc=11045157}}</ref>
=== Extrapulmonary === {{Main|Extrapulmonary tuberculosis}}
In 15–20% of active cases, the infection spreads outside the lungs, causing other kinds of TB.<ref>{{cite book| veditors = Jindal SK |title=Textbook of Pulmonary and Critical Care Medicine|publisher=Jaypee Brothers Medical Publishers|location=New Delhi|isbn=978-93-5025-073-0|page=549|url=https://books.google.com/books?id=EvGTw3wn-zEC&pg=PA549|year=2011|url-status=live|archive-url=https://web.archive.org/web/20150907185434/https://books.google.com/books?id=EvGTw3wn-zEC&pg=PA549|archive-date=7 September 2015}}</ref> These are collectively denoted as extrapulmonary tuberculosis.<ref name="Golden-2005">{{cite journal | vauthors = Golden MP, Vikram HR | title = Extrapulmonary tuberculosis: an overview | journal = American Family Physician | volume = 72 | issue = 9 | pages = 1761–68 | date = November 2005 | pmid = 16300038 }}</ref> Extrapulmonary TB occurs more commonly in people with a weakened immune system and young children. In those with HIV, this occurs in more than 50% of cases.<ref name="Golden-2005" /> Notable extrapulmonary infection sites include the pleura (in tuberculous pleurisy), the central nervous system (in tuberculous meningitis), the lymphatic system (in scrofula of the neck), the genitourinary system (in urogenital tuberculosis), and the bones and joints (in Pott disease of the spine), among others. A potentially more serious, widespread form of TB is called "disseminated tuberculosis"; it is also known as miliary tuberculosis.<ref name="Adkinson-2010" /> Miliary TB currently makes up about 10% of extrapulmonary cases.<ref name="Habermann-2008" />
Symptoms of extrapulmonary TB usually include the general signs and symptoms as above, with additional symptoms related to the part of the body which is affected.<ref>{{Cite web |date=2024-05-08 |title=Clinical Symptoms of Tuberculosis |url=https://www.cdc.gov/tb/hcp/clinical-signs-and-symptoms/index.html |access-date=2025-03-17 |website=Centers for Disease Control and Prevention |language=en-us}}</ref> Urogenital tuberculosis, however, typically presents differently, as this manifestation most commonly appears decades after the resolution of pulmonary symptoms. Most patients with chronic urogenital TB do not have pulmonary symptoms at the time of diagnosis. Urogenital tuberculosis most commonly presents with urinary 'storage symptoms' such as increased frequency and/or urgency of urination, flank pain, hematuria, and nonspecific symptoms such as fever and malaise.<ref name="Figueiredo-2017">{{Cite journal |last1=Figueiredo |first1=André A. |last2=Lucon |first2=Antônio M. |last3=Srougi |first3=Miguel |date=2017-02-24 |editor-last=Schlossberg |editor-first=David |title=Urogenital Tuberculosis |journal=Microbiology Spectrum |language=en |volume=5 |issue=1 |article-number=5.1.01 |doi=10.1128/microbiolspec.TNMI7-0015-2016 |issn=2165-0497 |pmc=11687435 |pmid=28087922}}</ref>
== Causes ==
=== Mycobacteria === {{Main|Mycobacterium tuberculosis}}
[[File:Mycobacterium tuberculosis.jpg|thumb|Scanning electron micrograph of ''M. tuberculosis'']] The principal microbial cause of TB is ''Mycobacterium tuberculosis'' (MTB), a small, aerobic, non-motile and rod-shaped bacillus.<ref name="Adkinson-2010" /> It divides every 16 to 20 hours, which is slow compared with other bacteria, which usually divide in less than an hour.<ref>{{cite book| vauthors = Jindal SK |title=Textbook of Pulmonary and Critical Care Medicine|publisher=Jaypee Brothers Medical Publishers|location=New Delhi|isbn=978-93-5025-073-0|page=525|url=https://books.google.com/books?id=rAT1bdnDakAC&pg=PA525|year=2011|url-status=live|archive-url=https://web.archive.org/web/20150906211342/https://books.google.com/books?id=rAT1bdnDakAC&pg=PA525|archive-date=6 September 2015}}</ref> Mycobacteria have a complex, lipid-rich cell envelope, with the high lipid content of the outer membrane acting as a robust barrier contributing to their drug resistance.<ref>{{cite book |title=Infectious Diseases: A Clinical Short Course, 2nd ed. |vauthors=Southwick F |publisher=McGraw-Hill Medical Publishing Division |year=2007 |isbn=978-0-07-147722-2 |pages=104, 313–14 |chapter=Chapter 4: Pulmonary Infections}}</ref><ref>{{cite journal | vauthors = Niederweis M, Danilchanka O, Huff J, Hoffmann C, Engelhardt H | title = Mycobacterial outer membranes: in search of proteins | journal = Trends in Microbiology | volume = 18 | issue = 3 | pages = 109–16 | date = March 2010 | pmid = 20060722 | pmc = 2931330 | doi = 10.1016/j.tim.2009.12.005 }}</ref> If a Gram stain is performed, MTB either stains very weakly "Gram-positive" or does not retain dye as a result of the high lipid and mycolic acid content of its cell wall.<ref name="Madison_2001">{{cite journal | vauthors = Madison BM | title = Application of stains in clinical microbiology | journal = Biotechnic & Histochemistry | volume = 76 | issue = 3 | pages = 119–25 | date = May 2001 | pmid = 11475314 | doi = 10.1080/714028138 }}</ref> MTB can withstand weak disinfectants and survive in a dry state for weeks.<ref>{{Cite web |last=Canada |first=Public Health Agency of |date=2012-09-13 |title=Pathogen Safety Data Sheets: Infectious Substances – Mycobacterium tuberculosis and Mycobacterium tuberculosis complex |url=https://www.canada.ca/en/public-health/services/laboratory-biosafety-biosecurity/pathogen-safety-data-sheets-risk-assessment/mycobacterium-tuberculosis-complex.html |access-date=2025-12-27 |website=www.canada.ca}}</ref> In nature, the bacterium can grow only within the cells of a host organism, but ''M. tuberculosis'' can be cultured in the laboratory.<ref>{{cite journal | vauthors = Parish T, Stoker NG | s2cid = 28960959 | title = Mycobacteria: bugs and bugbears (two steps forward and one step back) | journal = Molecular Biotechnology | volume = 13 | issue = 3 | pages = 191–200 | date = December 1999 | pmid = 10934532 | doi = 10.1385/MB:13:3:191 | doi-access = free }}</ref>
The term ''M. tuberculosis'' complex describes a genetically related group of ''Mycobacterium'' species that can cause tuberculosis in humans or other animals. Among its members are four other TB-causing mycobacteria: ''M. bovis'', ''M. africanum'', ''M. canettii'', and ''M. microti''.<ref>{{Cite journal |last1=Zhang |first1=Haobo |last2=Liu |first2=Mengda |last3=Fan |first3=Weixing |last4=Sun |first4=Shufang |last5=Fan |first5=Xiaoxu |date=2022-09-07 |title=The impact of Mycobacterium tuberculosis complex in the environment on one health approach |journal=Frontiers in Public Health |language=English |volume=10 |article-number=994745 |doi=10.3389/fpubh.2022.994745 |doi-access=free |issn=2296-2565 |pmc=9489838 |pmid=36159313 |bibcode=2022FrPH...1094745Z }}</ref> ''M. bovis'' causes bovine TB and was once a common cause of human TB, but the introduction of pasteurized milk has almost eliminated this as a public health problem in developed countries.<ref name="Kumar-2007">{{Cite book |title=Robbins Basic Pathology |vauthors=Kumar V, Robbins SL |date=2007 |publisher=Elsevier |isbn=978-1-4160-2973-1 |edition=8th |location=Philadelphia |oclc=69672074}}</ref><ref>{{cite journal |vauthors=Thoen C, Lobue P, de Kantor I |date=February 2006 |title=The importance of Mycobacterium bovis as a zoonosis |journal=Veterinary Microbiology |volume=112 |issue=2–4 |pages=339–45 |doi=10.1016/j.vetmic.2005.11.047 |pmid=16387455}}</ref> ''M. africanum'' is not widespread, but it is a significant cause of human TB in parts of Africa.<ref>{{cite journal | vauthors = Niemann S, Rüsch-Gerdes S, Joloba ML, Whalen CC, Guwatudde D, Ellner JJ, Eisenach K, Fumokong N, Johnson JL, Aisu T, Mugerwa RD, Okwera A, Schwander SK | title = Mycobacterium africanum subtype II is associated with two distinct genotypes and is a major cause of human tuberculosis in Kampala, Uganda | journal = Journal of Clinical Microbiology | volume = 40 | issue = 9 | pages = 3398–405 | date = September 2002 | pmid = 12202584 | pmc = 130701 | doi = 10.1128/JCM.40.9.3398-3405.2002 }}</ref><ref>{{cite journal | vauthors = Niobe-Eyangoh SN, Kuaban C, Sorlin P, Cunin P, Thonnon J, Sola C, Rastogi N, Vincent V, Gutierrez MC | title = Genetic biodiversity of Mycobacterium tuberculosis complex strains from patients with pulmonary tuberculosis in Cameroon | journal = Journal of Clinical Microbiology | volume = 41 | issue = 6 | pages = 2547–53 | date = June 2003 | pmid = 12791879 | pmc = 156567 | doi = 10.1128/JCM.41.6.2547-2553.2003 }}</ref> ''M. canettii'' is rare and seems to be limited to the Horn of Africa, although a few cases have been seen in African emigrants.<ref>{{cite book| vauthors = Acton QA |title=Mycobacterium Infections: New Insights for the Healthcare Professional|year=2011|publisher=ScholarlyEditions|isbn=978-1-4649-0122-5|page=1968|url=https://books.google.com/books?id=g2iFfV6uEuAC&pg=PA1968|url-status=live|archive-url=https://web.archive.org/web/20150906201531/https://books.google.com/books?id=g2iFfV6uEuAC&pg=PA1968|archive-date=6 September 2015}}</ref><ref>{{cite journal | vauthors = Pfyffer GE, Auckenthaler R, van Embden JD, van Soolingen D | title = Mycobacterium canettii, the smooth variant of M. tuberculosis, isolated from a Swiss patient exposed in Africa | journal = Emerging Infectious Diseases | volume = 4 | issue = 4 | pages = 631–4 | date = 1998 | pmid = 9866740 | pmc = 2640258 | doi = 10.3201/eid0404.980414 }}</ref> ''M. microti'' appears to have a natural reservoir in small rodents such as mice and voles, but can infect larger mammals. It is rare in humans and is seen almost only in immunodeficient people, although its prevalence may be significantly underestimated.<ref>{{cite journal | vauthors = Panteix G, Gutierrez MC, Boschiroli ML, Rouviere M, Plaidy A, Pressac D, Porcheret H, Chyderiotis G, Ponsada M, Van Oortegem K, Salloum S, Cabuzel S, Bañuls AL, Van de Perre P, Godreuil S | title = Pulmonary tuberculosis due to Mycobacterium microti: a study of six recent cases in France | journal = Journal of Medical Microbiology | volume = 59 | issue = Pt 8 | pages = 984–989 | date = August 2010 | pmid = 20488936 | doi = 10.1099/jmm.0.019372-0 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Smith NH, Crawshaw T, Parry J, Birtles RJ | title = Mycobacterium microti: More diverse than previously thought | journal = Journal of Clinical Microbiology | volume = 47 | issue = 8 | pages = 2551–2559 | date = August 2009 | pmid = 19535520 | pmc = 2725668 | doi = 10.1128/jcm.00638-09 }}</ref>
There are other known mycobacteria which cause lung disease resembling TB. ''M. avium complex'' is an environmental microorganism found in soil and water sources worldwide, which tends to present as an opportunistic infection in immunocompromised people.<ref>{{Cite web |title=MAC Lung Disease |url=https://www.lung.org/lung-health-diseases/lung-disease-lookup/mac-lung-disease |access-date=2025-03-18 |website=American Lung Association |language=en}}</ref><ref>{{cite journal | vauthors = Busatto C, Vianna JS, da Silva LV, Ramis IB, da Silva PE | title = Mycobacterium avium: an overview | journal = Tuberculosis | volume = 114 | pages = 127–134 | date = January 2019 | pmid = 30711152 | doi = 10.1016/j.tube.2018.12.004 }}</ref> The natural reservoir of ''M. kansasii'' is unknown, but it has been found in tap water; it is most likely to infect humans with lung disease or who smoke.<ref>{{cite journal | vauthors = Johnston JC, Chiang L, Elwood K | title = Mycobacterium kansasii | journal = Microbiology Spectrum | volume = 5 | issue = 1 | pages = 10.1128/microbiolspec.tnmi7–0011–2016 | date = January 2017 | article-number = 5.1.21 | pmid = 28185617 | pmc = 11687434 | doi = 10.1128/microbiolspec.tnmi7-0011-2016 }}</ref> These two species are classified as "nontuberculous mycobacteria".<ref>{{cite journal | title = Diagnosis and treatment of disease caused by nontuberculous mycobacteria | journal = American Journal of Respiratory and Critical Care Medicine | volume = 156 | issue = 2 Pt 2 | pages = S1–S25 | date = August 1997 | pmid = 9279284 | doi = 10.1164/ajrccm.156.2.atsstatement }}</ref> thumb|Public health campaigns in the 1920s tried to halt the spread of TB.
=== Transmission ===
Tuberculosis spreads through the air when people with active pulmonary TB cough, sneeze, speak, or sing, releasing tiny airborne droplets containing the bacteria. Anyone nearby can breathe in these droplets and become infected. The droplets can remain airborne and infective for several hours, and are more likely to persist in poorly ventilated areas.<ref name="CDC-Spread-2025">{{Cite web |date=2025-02-05 |title=Tuberculosis: Causes and How It Spreads |url=https://www.cdc.gov/tb/causes/index.html |access-date=2025-03-18 |website=Centers for Disease Control and Prevention |language=en-us}}</ref> TB is not spread by shaking hands, sharing food, drinks, or utensils, touching bed linens and toilet seats, sharing toothbrushes, or kissing.<ref name="CDC-Spread-2025"/>
=== Risk factors === {{Main|Risk factors for tuberculosis}}
Risk factors for TB include exposure to droplets from people with active TB, as well as environmental and health-condition-related factors that decrease a person's immune system response.<ref name="PHA_Canada_2024" />
==== Close contact ==== Prolonged, frequent, or close contact with people who have active TB is a high risk factor for becoming infected; this group includes health care workers and children where a family member is infected.<ref>{{Cite web |date=2024-12-10 |title=Clinical Overview of Latent Tuberculosis Infection |url=https://www.cdc.gov/tb/hcp/clinical-overview/latent-tuberculosis-infection.html |access-date=2025-03-19 |website=Centers for Disease Control and Prevention |language=en-us}}</ref><ref name="Ahmed-2011">{{cite journal |vauthors=Ahmed N, Hasnain SE |date=September 2011 |title=Molecular epidemiology of tuberculosis in India: moving forward with a systems biology approach |journal=Tuberculosis |volume=91 |issue=5 |pages=407–13 |doi=10.1016/j.tube.2011.03.006 |pmid=21514230}}</ref> Transmission is most likely to occur from only people with active TB – those with latent infection are not thought to be contagious.<ref name="Kumar-2007" /> Environmental risk factors that put a person in closer contact with infectious droplets from a person infected with TB are overcrowding, poor ventilation, or proximity to a potentially infective person.<ref name="Schmidt-2008">{{Cite journal |last=Schmidt |first=Charles W. |date=November 2008 |title=Linking TB and the Environment: An Overlooked Mitigation Strategy |journal=Environmental Health Perspectives |volume=116 |issue=11 |pages=A478–A485 |doi=10.1289/ehp.116-a478 |doi-broken-date=13 January 2026 |pmc=2592293 |pmid=19057686 |bibcode=2008EnvHP.116.a478S }}</ref><ref name="Narasimhan_2013">{{cite journal |vauthors=Narasimhan P, Wood J, Macintyre CR, Mathai D |date=2013 |title=Risk factors for tuberculosis |journal=Pulmonary Medicine |volume=2013 |article-number=828939 |doi=10.1155/2013/828939 |pmc=3583136 |pmid=23476764 |doi-access=free}}</ref>
==== Environmental factors ==== Environmental factors which weaken the body's protective mechanisms and may put a person at additional risk of contracting TB include air pollution, exposure to smoke (including tobacco smoke), and exposure (often occupational) to dust or particulates.<ref name="Schmidt-2008" /><ref name="CDC-Spread-2025" />
==== Immunodeficiencies ====
The most important risk factor globally for developing active TB is concurrent human immunodeficiency virus (HIV) infection; in 2023, 6.1% of those becoming infected with TB were also infected with HIV.<ref name="WHO-2024-incidence">{{Cite web |date=29 October 2024 |title=Global Tuberculosis Report 2024: 1.1 TB incidence |url=https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2024/tb-disease-burden/1-1-tb-incidence |access-date=2025-08-14 |website=World Health Organization |language=en}}</ref> Sub-Saharan Africa has a particularly high burden of HIV-associated TB.<ref name="WHO_Factsheet_2025" /> Of those without HIV infection who are infected with tuberculosis, about 5–15% develop active disease during their lifetimes;<ref name="Price_2024" /> in contrast, 30% of those co-infected with HIV develop the active disease.<ref name="Gibson_BMJ_2005">{{cite book |url=http://www.wiley.com/WileyCDA/WileyTitle/productCd-072791605X.html |title=Evidence-Based Respiratory Medicine |date=2005 |publisher=BMJ Books |isbn=978-0-7279-1605-1 |veditors=Gibson PG, Abramson M, Wood-Baker R, Volmink J, Hensley M, Costabel U |edition=1st |page=321 |archive-url=https://web.archive.org/web/20151208072842/http://www.wiley.com/WileyCDA/WileyTitle/productCd-072791605X.html |archive-date=8 December 2015 |url-status=live}}</ref> People living with HIV are estimated 16 times more likely to fall ill with TB than people without HIV; TB is the leading cause of death among people with HIV.<ref name="WHO_Factsheet_2025" />
Another important risk factor is the use of medications that suppress the immune system. These include (but are not limited to), chemotherapy; medication after an organ transplant; and medication for lupus or rheumatoid arthritis.<ref name="PHA_Canada_2024">{{Cite web |date=2024-02-21 |title=Tuberculosis (TB): Prevention and risks |url=https://www.canada.ca/en/public-health/services/diseases/tuberculosis/prevention-risks.html |access-date=2025-03-20 |website=Public Health Agency of Canada}}</ref><ref name="Maeda2024">{{cite journal |vauthors=Maeda T, Connolly M, Thevenet-Morrison K, Levy P, Utell M, Munsiff S, Croft D |title=Tuberculosis screening for patients on biologic Medications: A Single-Center experience and Society guideline Review, Monroe County, New York, 2018-2021 |journal=J Clin Tuberc Other Mycobact Dis |volume=36 |issue= |article-number=100460 |date=August 2024 |pmid=39021381 |doi=10.1016/j.jctube.2024.100460 |pmc=11254483 |url=}}</ref> Other risk factors include: heavy alcohol use, diabetes mellitus, silicosis, tobacco smoking, recreational drug use, severe kidney disease, head and neck cancer, and low body weight.<ref name="PHA_Canada_2024" /><ref name="CDC_Risk_2016">{{Cite web|date=March 18, 2016 |title=TB Risk Factors |url=https://www.cdc.gov/tb/topic/basics/risk.htm|access-date=25 August 2020|website=CDC |language=en-us|archive-date=30 August 2020|archive-url=https://web.archive.org/web/20200830234002/https://www.cdc.gov/tb/topic/basics/risk.htm|url-status=live}}</ref> Children, especially those under age five, have undeveloped immune systems and are at higher risk.<ref name="CDC_Risk_2016" />
== Pathogenesis == thumb|The spleen in a patient with miliary tuberculosis showing granulomas (tubercles) TB infection begins when a M. tuberculosis bacterium, inhaled from the air, penetrates the lungs and reaches the alveoli. Here it encounters an alveolar macrophage, a cell of the body's immune system, which attempts to destroy it.<ref name="Ahmad-2022">{{Cite journal |last1=Ahmad |first1=Faraz |last2=Rani |first2=Anshu |last3=Alam |first3=Anwar |last4=Zarin |first4=Sheeba |last5=Pandey |first5=Saurabh |last6=Singh |first6=Hina |last7=Hasnain |first7=Seyed Ehtesham |last8=Ehtesham |first8=Nasreen Zafar |date=2022-05-06 |title=Macrophage: A Cell With Many Faces and Functions in Tuberculosis |journal=Frontiers in Immunology |volume=13 |article-number=747799 |doi=10.3389/fimmu.2022.747799 |doi-access=free |issn=1664-3224 |pmc=9122124 |pmid=35603185}}</ref> However, M. tuberculosis can neutralise and colonise the macrophage, leading to persistent infection.<ref name="Ahmad-2022" />
The defence mechanism of the macrophage begins when a foreign body, such as a bacterial cell, binds to receptors on the surface of the macrophage. The macrophage then stretches itself around the bacterium and engulfs it.<ref>{{cite journal |vauthors=Hampton MB, Vissers MC, Winterbourn CC |date=February 1994 |title=A single assay for measuring the rates of phagocytosis and bacterial killing by neutrophils |url=http://www.jleukbio.org/cgi/pmidlookup?view=long&pmid=8301210 |journal=J. Leukoc. Biol. |volume=55 |issue=2 |pages=147–52 |doi=10.1002/jlb.55.2.147 |pmid=8301210 |s2cid=44911791 |archive-url=https://archive.today/20121228084302/http://www.jleukbio.org/cgi/pmidlookup?view=long&pmid=8301210 |archive-date=December 28, 2012 |access-date=December 19, 2014|url-access=subscription }}</ref> Once inside this macrophage, the bacterium is trapped in a compartment called a phagosome; the phagosome subsequently merges with a lysosome to form a phagolysosome.<ref name="Rohde-2007">{{Cite journal |last1=Rohde |first1=Kyle |last2=Yates |first2=Robin M. |last3=Purdy |first3=Georgiana E. |last4=Russell |first4=David G. |date=2007 |title=Mycobacterium tuberculosis and the environment within the phagosome |url=https://onlinelibrary.wiley.com/doi/10.1111/j.1600-065X.2007.00547.x |journal=Immunological Reviews |language=en |volume=219 |issue=1 |pages=37–54 |doi=10.1111/j.1600-065X.2007.00547.x |pmid=17850480 |issn=1600-065X}}</ref> The lysosome is an organelle which contains digestive enzymes; these are released into the phagolysosome and kill the invader.<ref>{{Cite book |last1=Delves |first1=P. J. |last2=Martin |first2=S. J. |last3=Burton |first3=D. R. |last4=Roit |first4=I. M. |title=Roitt's Essential Immunology |edition=11th |year=2006 |publisher=Blackwell Publishing |location=Malden, MA |isbn=978-1-4051-3603-7 |pages=6–7}}</ref>
The M. tuberculosis bacterium can subvert the normal process by inhibiting phagosome development and preventing fusion with the lysosome.<ref name="Rohde-2007" /> The bacterium can survive and replicate within the phagosome; it will eventually destroy its host macrophage, releasing progeny bacteria which spread the infection.<ref name="Ahmad-2022" />
In the next stage of infection, macrophages, epithelioid cells, lymphocytes and fibroblasts aggregate to form a granuloma, which surrounds and isolates the infected macrophages.<ref name="Ahmad-2022" /> This does not destroy the tuberculosis bacilli, but contains them, preventing spread of the infection to other parts of the body. They are nevertheless able to survive within the granuloma.<ref name="Ahmad-2022" /><ref name="Silva-Miranda-2012">{{Cite journal |last1=Silva Miranda |first1=Mayra |last2=Breiman |first2=Adrien |last3=Allain |first3=Sophie |last4=Deknuydt |first4=Florence |last5=Altare |first5=Frederic |date=2012 |title=The Tuberculous Granuloma: An Unsuccessful Host Defence Mechanism Providing a Safety Shelter for the Bacteria? |journal=Journal of Immunology Research |language=en |volume=2012 |issue=1 |article-number=139127 |doi=10.1155/2012/139127 |doi-access=free |issn=2314-7156 |pmc=3395138 |pmid=22811737}}</ref> In tuberculosis, the granuloma contains necrotic tissue at its centre, and appears as a small white nodule, also known as a ''tubercle'', from which the disease derives its name.<ref name="Alzayer-2025">{{Citation |last1=Alzayer |first1=Zainab |title=Primary Lung Tuberculosis |date=2025 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK567737/ |access-date=2025-03-26 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=33620814 |last2=Al Nasser |first2=Yasser}}</ref>
Granulomas are most common in the lung, but they can appear anywhere in the body. As long as the infection is contained within granulomas, there are no outward symptoms and the infection is latent.<ref name="Alzayer-2025" /> However, if the immune system is unable to control the infection, the disease can progress to active TB, which can cause significant damage to the lungs and other organs.<ref name="Silva-Miranda-2012" />
If TB bacteria gain entry to the blood stream from an area of damaged tissue, they can spread throughout the body and set up many foci of infection, all appearing as tiny, white tubercles in the tissues.<ref>{{cite book| vauthors = Crowley LV |title=An introduction to human disease: pathology and pathophysiology correlations|year=2010|publisher=Jones and Bartlett|location=Sudbury, MA|isbn=978-0-7637-6591-0|page=374|url=https://books.google.com/books?id=TEiuWP4z_QIC&pg=PA374|edition=8th|url-status=live|archive-url=https://web.archive.org/web/20150906193726/https://books.google.com/books?id=TEiuWP4z_QIC&pg=PA374|archive-date=6 September 2015}}</ref> This severe form of TB disease, most common in young children and those with HIV, is called miliary tuberculosis.<ref>{{cite book| vauthors = Harries AD, Maher D, Graham S |title=TB/HIV a Clinical Manual|year=2005|publisher=World Health Organization (WHO)|location=Geneva|isbn=978-92-4-154634-8|page=75|url=https://books.google.com/books?id=8dfhwKaCSxkC&pg=PA75|edition=2nd|url-status=live|archive-url=https://web.archive.org/web/20150906195514/https://books.google.com/books?id=8dfhwKaCSxkC&pg=PA75|archive-date=6 September 2015}}</ref> People with this disseminated TB have a high fatality rate even with treatment (about 30%).<ref name="Habermann-2008">{{cite book| vauthors = Habermann TM, Ghosh A |title=Mayo Clinic internal medicine: concise textbook|year=2008|publisher=Mayo Clinic Scientific Press|location=Rochester, MN|isbn=978-1-4200-6749-1|page=789|url=https://books.google.com/books?id=YJtodBwNxokC&pg=PA789|url-status=live|archive-url=https://web.archive.org/web/20150906190055/https://books.google.com/books?id=YJtodBwNxokC&pg=PA789|archive-date=6 September 2015}}</ref><ref>{{cite journal | vauthors = Jacob JT, Mehta AK, Leonard MK | title = Acute forms of tuberculosis in adults | journal = The American Journal of Medicine | volume = 122 | issue = 1 | pages = 12–17 | date = January 2009 | pmid = 19114163 | doi = 10.1016/j.amjmed.2008.09.018 }}</ref>
In many people, the infection waxes and wanes. Tissue destruction and necrosis are often balanced by healing and fibrosis.<ref name="Grosset-2003">{{cite journal |vauthors=Grosset J |date=March 2003 |title=Mycobacterium tuberculosis in the extracellular compartment: an underestimated adversary |journal=Antimicrobial Agents and Chemotherapy |volume=47 |issue=3 |pages=833–36 |doi=10.1128/AAC.47.3.833-836.2003 |pmc=149338 |pmid=12604509}}</ref> Affected tissue is replaced by scarring and cavities filled with caseous necrotic material. During active disease, some of these cavities connect to the air passages (bronchi), and this material can be coughed up. It contains living bacteria and thus can spread the infection. Treatment with appropriate antibiotics kills bacteria and allows healing to take place. Upon cure, affected areas are eventually replaced by scar tissue.<ref name="Grosset-2003" />
== Diagnosis == {{Main|Diagnosis of tuberculosis}}
[[File:TB in sputum.png|thumb|''M. tuberculosis'' (stained red) in sputum]]Diagnosis of tuberculosis is often difficult. Symptoms manifest slowly and are generally non-specific, e.g., cough, fatigue, fever, which have many possible causes.<ref name="Tobin-2024">{{Citation |last1=Tobin |first1=Ellis H. |title=Tuberculosis Overview |date=22 December 2024 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK441916/ |access-date=2025-03-27 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=28722945 |last2=Tristram |first2=Debbie}}</ref> The conclusive test for pulmonary TB is a bacterial culture taken from a sample of sputum, but this is slow to give a result, and does not detect latent TB. Extra-pulmonary TB infection can affect the kidneys, spine, brain, lymph nodes, or bones - a sample cannot easily be obtained for culture.<ref name="CDC-Overview-2025">{{Cite web |last=CDC |date=2025-01-30 |title=Clinical Overview of Tuberculosis Disease |url=https://www.cdc.gov/tb/hcp/clinical-overview/tuberculosis-disease.html |access-date=2025-03-29 |website=Tuberculosis (TB) |language=en-us}}</ref> Tests based on the immune response are sensitive but are likely to give false negatives in those with weak immune systems such as very young patients and those coinfected with HIV. Another issue affecting diagnosis in many parts of the world is that TB infection is most common in resource-poor settings where sophisticated laboratories are rarely available.<ref>{{Cite journal |last1=Datta |first1=Sumona |last2=Evans |first2=Carlton A. |date=2020-09-01 |title=The uncertainty of tuberculosis diagnosis |journal=The Lancet Infectious Diseases |language=English |volume=20 |issue=9 |pages=1002–1004 |doi=10.1016/S1473-3099(20)30400-X |issn=1473-3099 |pmid=32437698|pmc=7234790 }}</ref><ref>{{Cite web |last1=Hewison |first1=Cathy |last2=Gomez |first2=Diana |last3=Deborggraeve |first3=Stijn |date=2022-10-24 |title=The deadly gap in diagnosing children with tuberculosis |url=https://msf-access.medium.com/the-deadly-gap-in-diagnosing-children-with-tuberculosis-2f0673117940 |access-date=2025-03-29 |website=MSF Access Campaign |language=en}}</ref>
A diagnosis of TB should be considered in those with signs of lung disease or constitutional symptoms lasting longer than two weeks.<ref name="Escalante-2009">{{cite journal |vauthors=Escalante P |date=June 2009 |title=In the clinic. Tuberculosis |journal=Annals of Internal Medicine |volume=150 |issue=11 |pages=ITC61-614; quiz ITV616 |doi=10.7326/0003-4819-150-11-200906020-01006 |pmid=19487708 |s2cid=639982}}</ref> Diagnosis of TB, whether latent or active, starts with medical history and physical examination. Subsequently several tests can be performed to refine the diagnosis:<ref>{{Cite web |last=CDC |date=2025-01-30 |title=Clinical and Laboratory Diagnosis for Tuberculosis |url=https://www.cdc.gov/tb/hcp/testing-diagnosis/clinical-and-laboratory-diagnosis.html |access-date=2025-03-29 |website=Centers for Disease Control and Prevention |language=en-us}}</ref> A chest X-ray and multiple sputum cultures for acid-fast bacilli are typically part of the initial evaluation.<ref name="Escalante-2009" />
=== Mantoux test === [[File:Mantoux_tuberculin_skin_test.jpg|thumb|The Mantoux skin test consists of an injection of a small quantity of PPD tuberculin just below the skin on the forearm.]] The Mantoux tuberculin skin test is often used to screen people at high risk for TB, such as healthcare workers or close contacts of TB patients, who may not display symptoms of infection.<ref name="Escalante-2009" /> In the Mantoux test, a small quantity of tuberculin antigen is injected intradermally on the forearm.<ref>{{cite web |date=October 2011 |title=TB Elimination - Tuberculin Skin Testing |url=https://www.cdc.gov/tb/publications/factsheets/testing/skintesting.pdf |access-date=5 June 2017 |website=CDC.gov |publisher=CDC - National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention - Division of Tuberculosis Elimination}}</ref><ref>{{cite web |title=The Mantoux test: Administration, reading and interpretation |url=http://www.immunisation.nhs.uk/files/mantouxtest.pdf |archive-url=https://web.archive.org/web/20100215105953/http://www.immunisation.nhs.uk/files/mantouxtest.pdf |archive-date=15 February 2010 |access-date=5 June 2017 |website=NHS.uk}}</ref> The result of the test is read after 48 to 72 hours. A person who has been exposed to the bacteria would be expected to mount an immune response; the reaction is read by measuring the diameter of the raised area.<ref>{{Cite web |title=Mantoux Tuberculin Skin Test |url=https://www.cdc.gov/tb/education/mantoux/pdf/Mantoux_TB_Skin_Test.pdf |access-date=30 March 2025 |website=Centers for Disease Control and Prevention}}</ref> Vaccination with Bacille Calmette-Guerin (BCG) may result in a false-positive result. Several factors may lead to false negatives; these include HIV infection, some viral illnesses, and overwhelming TB disease.<ref>{{Cite web |date=2014 |title=Table A3.1, Causes of false-negative and false-positive tuberculin skin tests |url=https://www.ncbi.nlm.nih.gov/books/NBK214439/table/annex3.t1/?report=objectonly |access-date=2025-03-30 |website=www.ncbi.nlm.nih.gov |language=en}}</ref><ref>{{Cite journal |last1=Nayak |first1=Surajit |last2=Acharjya |first2=Basanti |date=April 2012 |title=Mantoux test and its interpretation |journal=Indian Dermatology Online Journal |language=en-US |volume=3 |issue=1 |pages=2–6 |doi=10.4103/2229-5178.93479 |doi-access=free |issn=2229-5178 |pmc=3481914 |pmid=23130251}}</ref>
=== Interferon-Gamma Release Assay === The Interferon Gamma Release Assay (IGRA) is recommended for those who are positive to the Mantoux test.<ref>{{NICE|117|Tuberculosis|2011}}</ref> This test mixes a blood sample with antigenic material derived from the TB bacterium. If the patient has developed an immune response to a TB infection, white blood cells in the sample will release interferon-gamma (IFN-γ), which can be measured.<ref name="CDC_Testing_2024">{{Cite web |date=2024-09-12 |title=Clinical Testing Guidance for Tuberculosis: Interferon Gamma Release Assay |url=https://www.cdc.gov/tb/hcp/testing-diagnosis/interferon-gamma-release-assay.html |access-date=2025-03-30 |website=Centers for Disease Control and Prevention |language=en-us}}</ref> This test is more reliable than the Mantoux test, and does not give a false positive after BCG vaccination;<ref name="CDC_Testing_2024" /> however it may give a positive result in case of infection by the related bacteria ''M. szulgai'', ''M. marinum'', and ''M. kansasii''.<ref>{{cite book |url=https://books.google.com/books?id=rAT1bdnDakAC&pg=PA544 |title=Textbook of Pulmonary and Critical Care Medicine |publisher=Jaypee Brothers Medical Publishers |year=2011 |isbn=978-93-5025-073-0 |veditors=Jindal SK |location=New Delhi |page=544 |archive-url=https://web.archive.org/web/20150906185238/https://books.google.com/books?id=rAT1bdnDakAC&pg=PA544 |archive-date=6 September 2015 |url-status=live}}</ref>
=== Chest radiograph === In active pulmonary TB, infiltrates (opaque areas) or scarring are visible in the lungs on a chest X-ray. Infiltrates are suggestive but not necessarily diagnostic of TB. Other lung diseases can mimic the appearance of TB, and this test will not detect extrapulmonary infection or a recent infection.<ref>{{Cite web |last=Sherrell |first=Zia |date=2023-12-20 |title=Chest X-ray for tuberculosis (TB): What to expect, results, and more |url=https://www.medicalnewstoday.com/articles/tuberculosis-x-ray |access-date=2025-03-30 |website=www.medicalnewstoday.com |language=en}}</ref>
=== Microbiological studies === [[File:TB_Culture.jpg|thumb|A close-up of ''Mycobacterium tuberculosis'' in a culture medium]] A definitive diagnosis of tuberculosis can be made by detecting ''Mycobacterium tuberculosis'' organisms in a specimen taken from the patient (most often sputum, but may also be pus, cerebrospinal fluid, biopsied tissue, etc.).<ref name="Tobin-2024" /> The specimen is examined by fluorescence microscopy.<ref>{{cite journal |vauthors=Steingart KR, Henry M, Ng V, Hopewell PC, Ramsay A, Cunningham J, Urbanczik R, Perkins M, Aziz MA, Pai M |date=September 2006 |title=Fluorescence versus conventional sputum smear microscopy for tuberculosis: a systematic review |journal=The Lancet. Infectious Diseases |volume=6 |issue=9 |pages=570–81 |doi=10.1016/S1473-3099(06)70578-3 |pmid=16931408}}</ref> The bacterium is slow growing, so a cell culture may take several weeks to yield a result.<ref>{{Cite web |title=Acid-Fast Bacillus (AFB) Tests |url=https://medlineplus.gov/lab-tests/acid-fast-bacillus-afb-tests/ |access-date=2025-03-31 |website=MedlinePlus |language=en}}</ref>
=== Other tests === Nucleic acid amplification tests (NAAT) and adenosine deaminase testing may allow rapid diagnosis of TB.<ref>{{cite journal |vauthors=Bento J, Silva AS, Rodrigues F, Duarte R |date=2011 |title=[Diagnostic tools in tuberculosis] |journal=Acta Médica Portuguesa |volume=24 |issue=1 |pages=145–54 |doi=10.20344/amp.333 |pmid=21672452 |s2cid=76156550 |doi-access=free}}</ref><ref name="CDC_Xpert_20242" /> In December 2010, the World Health Organization endorsed the Xpert MTB/RIF system (a NAAT) for diagnosis of tuberculosis in endemic countries.<ref name="WHO-Rapid test-2010">{{Cite web |title=WHO endorses new rapid tuberculosis test |url=http://www.who.int/mediacentre/news/releases/2010/tb_test_20101208/en/index.html |archive-url=https://web.archive.org/web/20101210115147/http://www.who.int/mediacentre/news/releases/2010/tb_test_20101208/en/index.html |archive-date=2010-12-10 |access-date=2026-05-17 |website=World Health Organization}}</ref>
Blood tests to detect antibodies are not specific or sensitive, so they are not recommended.<ref>{{cite journal |vauthors=Steingart KR, Flores LL, Dendukuri N, Schiller I, Laal S, Ramsay A, Hopewell PC, Pai M |date=August 2011 |title=Commercial serological tests for the diagnosis of active pulmonary and extrapulmonary tuberculosis: an updated systematic review and meta-analysis |journal=PLOS Medicine |volume=8 |issue=8 |article-number=e1001062 |doi=10.1371/journal.pmed.1001062 |pmc=3153457 |pmid=21857806 |doi-access=free |veditors=Evans C}}</ref>
Polymerase chain reaction testing of urine for ''Mycobacterium tuberculosis'' is often required for the diagnosis of urogenital tuberculosis and may also be used to diagnose tuberculosis in biopsy samples from tissues. It is highly sensitive and specific, with good turnaround time.<ref name="Figueiredo-2017" />
== Prevention == The main strategies to prevent infection with TB are treatment of both active and latent TB, as well as vaccination of children who are at risk.<ref name="Lawn-2011" />
Although latent TB is not infective, it should be treated to prevent its development into active pulmonary TB, which is infective.<ref>{{Cite web |date=2025-02-05 |title=Tuberculosis Vaccine |url=https://www.cdc.gov/tb/vaccines/index.html |access-date=2025-04-21 |website=Centers for Disease Control and Prevention |language=en-us}}</ref> The cascade of person-to-person spread can be circumvented by segregating those with active ("overt") TB and putting them on anti-TB drug regimens. After about two weeks of effective treatment, subjects with nonresistant active infections generally do not remain contagious to others; however, it is important to complete the full course of treatment, which is usually six months.<ref>{{Cite web |date=2025-03-31 |title=Tuberculosis (TB): migrant health guide |url=https://www.gov.uk/guidance/tuberculosis-tb-migrant-health-guide |access-date=2025-04-21 |website=GOV.UK |language=en}}</ref><ref name="Ahmed-2011" />
=== Vaccines === {{Main|Tuberculosis vaccines|BCG vaccine}}
The only available vaccine {{as of|2021|lc=yes}} is bacillus Calmette-Guérin (BCG).<ref>{{cite journal | vauthors = McShane H | title = Tuberculosis vaccines: beyond bacille Calmette-Guerin | journal = Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences | volume = 366 | issue = 1579 | pages = 2782–89 | date = October 2011 | pmid = 21893541 | pmc = 3146779 |doi-access=free | doi = 10.1098/rstb.2011.0097 }}</ref><ref>{{cite web |title=Vaccines |website=Centers for Disease Control |url=https://www.cdc.gov/tb/topic/basics/vaccines.htm |archive-url=https://web.archive.org/web/20211230115301/https://www.cdc.gov/tb/topic/basics/vaccines.htm |archive-date=2021-12-30 |url-status=deviated}}</ref> In areas where tuberculosis is not common, only children at high risk are typically immunized, while suspected cases of tuberculosis are individually tested for and treated.<ref name="WHO_BCG_2018">{{cite periodical |date=23 February 2018 |title=BCG vaccines: WHO position paper – February 2018 |periodical=Weekly Epidemiological Record |volume=93 |issue=8 |pages=73–96 |pmid=29474026 |hdl-access=free |hdl=10665/260307}}</ref> In countries where tuberculosis is common, one dose is recommended in healthy babies as soon after birth as possible.<ref name="WHO_BCG_2018" /> A single dose is given by intradermal injection. Administered to children under 5, it decreases the risk of getting the infection by 20% and the risk of infection turning into active disease by nearly 60%.<ref>{{cite journal | vauthors = Roy A, Eisenhut M, Harris RJ, Rodrigues LC, Sridhar S, Habermann S, Snell L, Mangtani P, Adetifa I, Lalvani A, Abubakar I | title = Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis |doi-access=free | journal = BMJ | volume = 349 | article-number= g4643 | date = August 2014 | issue = aug04 5 | pmid = 25097193 | pmc = 4122754 | doi = 10.1136/bmj.g4643 }}</ref><ref>{{cite journal | vauthors = Dias JV, Varandas L, Gonçalves L, Kagina B | title = Outcomes of childhood TB in countries with a universal BCG vaccination policy | journal = The International Journal of Tuberculosis and Lung Disease | volume = 28 | issue = 6 | pages = 273–277 | date = June 2024 | pmid = 38822485 | doi = 10.5588/ijtld.23.0321 }}</ref> It is not effective if administered to adults.<ref>{{Cite journal |last1=Martinez |first1=Leonardo |last2=Cords |first2=Olivia |last3=Liu |first3=Qiao |last4=Acuna-Villaorduna |first4=Carlos |last5=Bonnet |first5=Maryline |last6=Fox |first6=Greg J. |last7=Carvalho |first7=Anna Cristina C. |last8=Chan |first8=Pei-Chun |last9=Croda |first9=Julio |last10=Hill |first10=Philip C. |last11=Lopez-Varela |first11=Elisa |last12=Donkor |first12=Simon |last13=Fielding |first13=Katherine |last14=Graham |first14=Stephen M. |last15=Espinal |first15=Marcos A. |date=2022-09-01 |title=Infant BCG vaccination and risk of pulmonary and extrapulmonary tuberculosis throughout the life course: a systematic review and individual participant data meta-analysis |journal=The Lancet Global Health |language=English |volume=10 |issue=9 |pages=e1307–e1316 |doi=10.1016/S2214-109X(22)00283-2 |issn=2214-109X |pmid=35961354|pmc=10406427 }}</ref>
=== Airborne infection control === Airborne infection control (AIC) for tuberculosis is a set of administrative, environmental, and personal protective actions taken to reduce the spread of TB through infectious airborne respiratory particles. AIC is critical in prevention and treatment strategies for the disease globally.<ref name="WHO2023">{{cite book |title=WHO operational handbook on tuberculosis: Module 1 – Prevention, infection prevention and control|publisher=World Health Organization|year=2023|isbn=978-92-4-007815-4|url=https://www.who.int/publications/i/item/9789240078154|access-date=7 March 2026}}</ref>
==== Hierarchy of controls ==== The WHO outlines a three‑level hierarchy of TB infection prevention and control measures:<ref name="WHO2023" />
* Administrative controls – early identification of presumptive TB cases, triage, separation of infectious patients, and rapid initiation of treatment. * Environmental controls – ventilation systems (natural, mechanical, or mixed‑mode), use of negative‑pressure rooms, and germicidal ultraviolet (UV) light fixtures to reduce airborne particle concentration. * Respiratory protection – use of medical masks and particulate respirators (e.g., N95 or FFP2) by health care workers and surgical masks by TB patients in high‑risk settings.
==== Special situations ==== Airborne infection control measures are particularly important in high‑risk environments such as prisons, refugee camps, homeless shelters, and health care facilities with limited resources. WHO recommends tailored interventions, including upper‑room germicidal ultraviolet systems, air filtration, and strict respiratory hygiene practices in these settings.<ref name="WHO2023" />
==== India: National TB Elimination Programme ==== In India, airborne infection control is a key component of the National Tuberculosis Elimination Programme (NTEP). The programme emphasizes contact tracing in high‑risk populations, airborne infection control measures in health facilities, and a multi‑sectoral response to address social determinants of TB.<ref name="NTEP">{{cite web |title=National Tuberculosis Elimination Programme|url=https://dghs.mohfw.gov.in/national-tuberculosis-elimination-programme.php|website=Ministry of Health and Family Welfare, Government of India|access-date=7 March 2026}}</ref> Infrastructure scale‑up has included the establishment of over 6,400 molecular diagnostic laboratories and 81 culture and drug susceptibility testing centres, alongside infection control interventions in hospitals and medical colleges.<ref name="NTEP" />
==== End TB Transmission Initiative (ETTi) ==== The End TB Transmission Initiative (ETTi) – Powering Airborne IPC is a working group of the Stop TB Partnership focused on strengthening airborne infection prevention and control for tuberculosis and other airborne pathogens. It was established to highlight the importance of airborne IPC following recognition of airborne transmission of diseases such as TB, SARS‑CoV‑2, influenza, and measles.<ref name="ETTi">{{cite web |title=End TB Transmission Initiative (ETTi)|url=https://www.stoptb.org/who-we-are/stop-tb-working-groups/end-tb-transmission-initiative#:~:text=The%20End%20Tuberculosis%20(TB)%20Transmission%20Initiative%20(ETTi),fight%20against%20TB%20and%20other%20airborne%20infections.|publisher=Stop TB Partnership|access-date=7 March 2026}}</ref> The initiative advocates for airborne IPC as a global priority, supports research and evidence dissemination, and promotes capacity building to prevent transmission in health care, community, and congregate settings.<ref name="ETTi" />
==== Monitoring and evaluation ==== WHO recommends regular monitoring of airborne infection control implementation through facility risk assessments, data collection on ventilation and protective equipment, and evaluation of TB incidence trends. Annexes in the WHO handbook provide tools such as facility TB risk assessment forms, health worker screening registers, and checklists for programmatic review.<ref name="WHO2023" />
=== Public health === thumb|A tuberculosis public health campaign in Ireland, 1905The first International Congress on Tuberculosis was held at Berlin in 1899. It was known by this time that tuberculosis was caused by a bacillus, thought to be passed by phlegm coughed up by a sick person, dried into dust, and then inhaled by a healthy person.{{sfn|Maxwell|Pye-Smith|1899|p=5}} Milk was known to be an important means of infection.{{sfn|Maxwell|Pye-Smith|1899|p=5}} Means of prevention included free ventilation of houses and wholesome and abundant food. Milk should be boiled, and meat should be carefully inspected, or else the cattle should be tested for infection. Cures for the disease included abundant food, particularly fatty foods, and life in the open air.{{sfn|Maxwell|Pye-Smith|1899|p=8}}
TB was made a notifiable disease in Britain; there were campaigns to stop spitting in public places, and the infected poor were pressured to enter sanatoria that resembled prisons.<ref>McCarthy 2001:413-7</ref>{{Full citation needed|date=March 2026}} In the United States, concern about the spread of tuberculosis played a role in the movement to prohibit public spitting except into spittoons.
==== Worldwide campaigns ==== [[File:Tuberculosis screening, 1940, Royal Navy Barracks, Chatham (IWM A 2008).jpg|thumb|Royal Navy sailors being screened for tuberculosis (1940)]] {{Further information|Elimination of tuberculosis}}
The World Health Organization (WHO) declared TB a "global health emergency" in 1993,<ref name="Lawn-2011" /> and in 2006, the Stop TB Partnership developed a Global Plan to Stop Tuberculosis, which aimed to save 14 million lives between its launch and 2015.<ref>{{cite web|url=http://www.stoptb.org/global/plan/|title=The Global Plan to Stop TB|publisher=World Health Organization (WHO)|year=2011|access-date=13 June 2011|url-status=live|archive-url=https://web.archive.org/web/20110612030924/http://www.stoptb.org/global/plan/|archive-date=12 June 2011}}</ref> Several targets they set were not achieved by 2015, mostly due to the increase in HIV-associated tuberculosis and the emergence of multi-drug resistant tuberculosis.<ref name="Lawn-2011" />
In 2014, the WHO adopted the "End TB" strategy which aims to reduce TB incidence by 80% and TB deaths by 90% by 2030.<ref name="End-TB-2015" /> The strategy contains a milestone to reduce TB incidence by 20% and TB deaths by 35% by 2020.<ref name="WHO_Global_2020">{{Cite book |url=https://apps.who.int/iris/rest/bitstreams/1312164/retrieve |title=Global tuberculosis report 2020 |publisher=World Health Organization |year=2020 |isbn=978-92-4-001313-1 |access-date=22 July 2021 |archive-url=https://web.archive.org/web/20210722172009/https://apps.who.int/iris/rest/bitstreams/1312164/retrieve |archive-date=22 July 2021 |url-status=live}}</ref> However, by 2020 only a 9% reduction in incidence per population was achieved globally, with the European region achieving 19% and the African region achieving 16% reductions.<ref name="WHO_Global_2020" /> Similarly, the number of deaths only fell by 14%, missing the 2020 milestone of a 35% reduction, with some regions making better progress (31% reduction in Europe and 19% in Africa).<ref name="WHO_Global_2020" /> Correspondingly, also treatment, prevention, and funding milestones were missed in 2020, for example, only 6.3 million people were started on TB prevention short of the target of 30 million.<ref name="WHO_Global_2020" />
The goal of tuberculosis elimination is being hampered by the lack of rapid testing, short and effective treatment courses, and completely effective vaccines.<ref>{{cite journal | vauthors = Uplekar M, Weil D, Lonnroth K, Jaramillo E, Lienhardt C, Dias HM, Falzon D, Floyd K, Gargioni G, Getahun H, Gilpin C, Glaziou P, Grzemska M, Mirzayev F, Nakatani H, Raviglione M | title = WHO's new end TB strategy | journal = Lancet | volume = 385 | issue = 9979 | pages = 1799–1801 | date = May 2015 | pmid = 25814376 | doi = 10.1016/S0140-6736(15)60570-0 | s2cid = 39379915 }}</ref>
== Treatment == {{Main|Management of tuberculosis}}
[[File:Tubi - 1234,0186.jpg|thumb|Tuberculosis phototherapy treatment in Kuopio, Finland, 1934]] thumb|A monograph on the treatment of tuberculosis (dated 1891) The antibiotic drugs used for treating TB are generally classified as either first-line or second-line. Treatment with a combination of first-line drugs (Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol) is preferred; they are more effective, and have fewer side effects. Second-line drugs are used if a person's TB infection either develops resistance to one or more first-line drugs, or if the infection comprises a drug-resistant strain.<ref name="Immunopaedia-2014">{{Cite web |date=2014-12-15 |title=TB Drugs |url=https://www.immunopaedia.org.za/treatment-diagnostics/tb-drugs/ |access-date=2025-12-21 |website=Immunopaedia |language=en}}</ref> The second-line drugs are generally less effective, have more severe side effects, and must be taken over a longer period of time.<ref name="Immunopaedia-2014" />
=== Drug susceptible TB === An infection is drug-susceptible if it has no resistance to any of the first-line drugs. To prevent the tuberculosis bacterium from developing drug resistance, the recommended treatment regimens combine four drugs. These should be taken over a period of 4 or 6 months.<ref name="WHO-guidelines-2025-treatment(1)">{{Cite web |date=23 April 2025 |title=WHO consolidated operational handbook on tuberculosis: module 4: treatment and care |url=https://www.who.int/publications/i/item/9789240108141 |access-date=2025-12-21 |website=World Health Organization |language=en}}</ref> The 6 month regime, known by the acronym HRZE, comprises all four first-line drugs (Isoniazid (H), Rifapentine (R), Pyrazinamide (Z), and Ethambutol (E)) taken daily for two months, followed by just the H and R drugs for the remaining four months. Evidence indicates that it is highly effective if followed through properly. The four-month regime, known by the acronym HMPZ, has moderate evidence of effectiveness and several contra-indications. For the first 2 months, four drugs are taken (Isoniazid (H), Rifapentine (P), Moxifloxacin (M), and Pyrazinamide (Z)); followed by two more months with the H, P, and M components.<ref name="WHO-guidelines-2025-treatment(1)" />
=== Drug-resistant TB (DR-TB) === A particular issue with TB treatment arises when an infection is resistant to one or more of the treatment drugs. If first-line treatment does not work for a patient, then the infection should undergo drug susceptibility testing (DST) to develop a tailored second-line treatment regimen which will be more effective. Historically, treatment regimens for multi-drug resistant (MDR-TB) have required multiple drugs taken over long periods - between 18 and 24 months. The expense, duration, and adverse effects of these treatments mean many patients did not complete the course.<ref>{{Cite web |date=2015 |title=The Price of a Pandemic: Counting the Cost of MDR-TB |url=https://appg-tb.org.uk/wp-content/uploads/2023/09/309c93_f0731d24f4754cd4a0ac0d6f6e67a526.pdf |publisher=All Party Parliamentary Group on TB}}</ref>
{{As of|2025}}, WHO recommends two shorter 6-month regimens and two 9-month regimens for DR-TB and MDR-TB using a combination of second-line drugs taken orally; all have good evidence of effectiveness.<ref>{{Cite journal |last1=Davoli |first1=Caterina |last2=Rossi |first2=Chiara |last3=Ciccarone |first3=Andrea |last4=Bertoni |first4=Francesca |last5=Calamelli |first5=Marina |last6=Rossi |first6=Benedetta |last7=Matteelli |first7=Alberto |date=2025-11-01 |title=Can 6-month long regimens become the standardized treatment for MDR-TB globally? |journal=International Journal of Infectious Diseases |language=English |volume=160 |article-number=108065 |doi=10.1016/j.ijid.2025.108065 |issn=1201-9712 |pmid=40953688|doi-access=free }}</ref> The 6-month regimens are known by the acronyms BPaLM and BDLLfx:
* BPaLM (bedaquiline, pretomanid, linezolid, moxifloxacin).<ref name="WHO-guidelines-2025-treatment">{{Cite web |title=WHO consolidated guidelines on tuberculosis: module 4: treatment and care |url=https://www.who.int/publications/i/item/9789240107243 |access-date=2025-12-23 |website=World Health Organization |language=en}}</ref> * BDLLfxC (bedaquiline, delamanid , and linezolid in combination with either levofloxacin (Lfx) or clofazimine (C))<ref name="WHO-guidelines-2025-treatment" />
=== Adherence and support === It can be difficult for patients to adhere to their TB treatment regimen. Several drugs must be taken daily for a long period, often with unpleasant side effects. There is often a rapid improvement in symptoms, so that patients stop taking medication even though the infection is still active and likely to reassert symptoms after a period.<ref name="Munro-2007">{{Cite journal |last1=Munro |first1=Salla A. |last2=Lewin |first2=Simon A. |last3=Smith |first3=Helen J. |last4=Engel |first4=Mark E. |last5=Fretheim |first5=Atle |last6=Volmink |first6=Jimmy |date=2007-07-24 |title=Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research |journal=PLOS Medicine |language=en |volume=4 |issue=7 |article-number=e238 |doi=10.1371/journal.pmed.0040238 |doi-access=free |issn=1549-1676 |pmc=1925126 |pmid=17676945}}</ref> In areas without public health systems, prolonged treatment is expensive.<ref name="Munro-2007" /><ref>{{Cite web |last1=Lardizabal |first1=Alfred A |last2=Patrawalla |first2=Amee |date=14 April 2024 |title=Adherence to tuberculosis treatment |url=https://www.uptodate.com/contents/adherence-to-tuberculosis-treatment |access-date=2025-06-03 |website=www.uptodate.com}}</ref> Failure to complete a course of treatment can result in the emergence of drug-resistant tuberculosis.<ref name="Munro-2007" />
Public health bodies recommend supporting patients during the treatment period.<ref>{{Cite web |date=2016-01-13 |title=Tuberculosis |url=https://www.nice.org.uk/guidance/ng33/chapter/recommendations |access-date=2025-06-03 |website=National Institute for Health and Care Excellence |at=§1.7 Adherence, treatment completion and follow‑up.}}</ref><ref name="WHO-Care-TB">{{Cite web |title=1. Care and support interventions for all people with TB |url=https://tbksp-test.who.int/en/node/1905 |archive-url=https://web.archive.org/web/20250603210705/https://tbksp-test.who.int/en/node/1905 |archive-date=2025-06-03 |access-date=2025-06-03 |website=World Health Organization}}</ref> One form of support is directly observed therapy - a healthcare worker watches the TB patient swallow the drugs, either in person or online.<ref>{{Cite web |date=7 Feb 2024 |title=TB 101 for Health Care Workers - Directly Observed Therapy |url=https://www.cdc.gov/tb/webcourses/TB101/page16489.html |access-date=2025-06-03 |website=Centers for Disease Control and Prevention}}</ref> Other forms of support include having an assigned case manager, digital monitoring, health education, counseling, and community support.<ref name="WHO-Care-TB" /><ref name="WHO-Guidlines-4-2022">{{Cite book |title=WHO Consolidated Guidelines on Tuberculosis. Module 4: Treatment. Tuberculosis Care and Support |date=2022 |publisher=World Health Organization |isbn=978-92-4-004771-6 |edition=1st |location=Geneva |url=https://tbksp-test.who.int/en/node/1905}}</ref>
== Prognosis ==
[[File:Tuberculosis deaths who, PER.svg|thumb|upright=1.4|Age-standardized disability-adjusted life years caused by tuberculosis per 100,000 inhabitants, 2004:<ref>{{cite web |url=https://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |title=WHO Disease and injury country estimates |year=2004 |publisher=World Health Organization (WHO) |access-date=11 November 2009 |url-status=live |archive-url=https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |archive-date=11 November 2009 }}</ref> {{Col-begin}} {{Col-break}} {{legend|#b3b3b3|no data|size=60%}} {{legend|#ffff65|≤10|size=60%}} {{legend|#fff200|10–25|size=60%}} {{legend|#ffdc00|25–50|size=60%}} {{legend|#ffc600|50–75|size=60%}} {{legend|#ffb000|75–100|size=60%}} {{legend|#ff9a00|100–250|size=60%}} {{Col-break}} {{legend|#ff8400|250–500|size=60%}} {{legend|#ff6e00|500–750|size=60%}} {{legend|#ff5800|750–1000|size=60%}} {{legend|#ff4200|1000–2000|size=60%}} {{legend|#ff2c00|2000–3000|size=60%}} {{legend|#cb0000|≥ 3000|size=60%}} {{col-end}}]]Tuberculosis (TB) is generally curable with prompt and appropriate treatment, but can be fatal if left untreated. The prognosis depends on factors like disease stage, drug resistance, and a person's overall health. While treatment is effective, delays or inadequate treatment can lead to severe illness and death.<ref name="WHO-Global-TB-2023">{{Cite web |title=Global Tuberculosis Report 2023 - 1.2 TB mortality |url=https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2023/tb-disease-burden/1-2-tb-mortality |access-date=2025-06-18 |website=World Health Organization |language=en}}</ref>
Without treatment, about two-thirds of people with TB will die of the disease, on average, within three years of diagnosis.<ref>{{Cite journal |last1=Tiemersma |first1=Edine W. |last2=van der Werf |first2=Marieke J. |last3=Borgdorff |first3=Martien W. |last4=Williams |first4=Brian G. |last5=Nagelkerke |first5=Nico J. D. |date=2011-04-04 |title=Natural History of Tuberculosis: Duration and Fatality of Untreated Pulmonary Tuberculosis in HIV Negative Patients: A Systematic Review |journal=PLOS ONE |language=en |volume=6 |issue=4 |article-number=e17601 |doi=10.1371/journal.pone.0017601 |doi-access=free |issn=1932-6203 |pmc=3070694 |pmid=21483732 |bibcode=2011PLoSO...617601T }}</ref><ref name="WHO-Global-TB-2023" />
Progression from TB infection to overt TB disease occurs when the bacilli overcome the immune system defenses and begin to multiply. In some 1–5% of cases, this occurs soon after the initial infection.<ref name="Kumar-2007" /> However, in the majority of cases, a latent infection occurs with no obvious symptoms.<ref name="Kumar-2007" /> Over an individual's lifetime, these dormant bacilli produce active tuberculosis in 5–10% of these latent cases, often many years after infection.<ref name="CDC-Overview-2025" />
The risk of reactivation increases in those whose immune system becomes weakened, such as may be caused by certain drug treatments, or by infection with HIV.<ref>{{Cite journal |last1=Kiazyk |first1=S. |last2=Ball |first2=T. B. |date=2017-03-02 |title=Latent tuberculosis infection: An overview |journal=Canada Communicable Disease Report |volume=43 |issue=3–4 |pages=62–66 |doi=10.14745/ccdr.v43i34a01 |issn=1188-4169 |pmc=5764738 |pmid=29770066}}</ref> In people coinfected with ''M. tuberculosis'' and HIV, the risk of reactivation increases to 10% per year.<ref name="Kumar-2007" />
Tuberculosis (TB) prognosis is significantly worsened by HIV co-infection, leading to higher mortality rates and poorer treatment outcomes. People with HIV are much more susceptible to developing active TB, and even with treatment, they face increased risks of unsuccessful treatment and death compared to those without HIV.<ref>{{Cite web |title=Tuberculosis & HIV |url=https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/treatment/tuberculosis-hiv |access-date=2025-06-18 |website=www.who.int |language=en}}</ref><ref>{{Cite web |title=Tuberculosis Diagnosis in People with HIV Increases Risk of Death Within 10 Years |url=https://www.hiv.gov/blog/tuberculosis-diagnosis-people-hiv-increases-risk-death-within-10-years |access-date=2025-06-18 |website=HIV.gov |language=en-us}}</ref>
== Epidemiology == Reports of tuberculosis can be found throughout recorded history. In Europe, Hippocrates, writing around 400 BCE describes ''phthisis'';<ref>{{Cite web |website=The Internet Classics Archive |title=Of the Epidemics by |author=Hippocrates |url=https://classics.mit.edu/Hippocrates/epidemics.1.i.html |access-date=2025-08-08}}</ref> in India, the Vedas (composed 1500–1200 BCE) refer to ''yaksma'';<ref>{{Cite web |last=www.wisdomlib.org |date=2016-09-10 |title=Yakshma, Yakṣma: 16 definitions |url=https://www.wisdomlib.org/definition/yakshma |access-date=2025-08-08 |website=www.wisdomlib.org |language=en}}</ref> both of these are generally equated with tuberculosis. Earlier evidence of tuberculosis has been found in prehistoric human remains in Europe, Africa, Asia, and the Americas, with the earliest dating to the early Neolithic era (approximately 10,000-11,000 years ago).<ref name="Buzic-2020"/>
Phylogenetic analysis of DNA lineages indicates that the ancestors of the tuberculosis bacterium adapted to human hosts in Africa around 70,000 years ago, and spread across the globe with migrating humans.<ref name="Buzic-2020">{{Cite journal |last1=Buzic |first1=Ileana |last2=Giuffra |first2=Valentina |date=2020-04-30 |title=he paleopathological evidence on the origins of human tuberculosis: a review |url=https://www.jpmh.org/index.php/jpmh/article/view/1379 |journal=Journal of Preventive Medicine and Hygiene |language=en |volume=61 |issue=1 Suppl 1 |pages=E3–E8 |doi=10.15167/2421-4248/JPMH2020.61.1S1.1379 |pmc=7263064 |pmid=32529097}}</ref>
The World Health Organization estimates that roughly one-quarter of the world's population carry infection with ''M. tuberculosis'' (prevalence), with new infections occurring in about 11 million people each year (incidence).<ref name="WHO_Factsheet_2025" /> Most infections with ''M. tuberculosis'' do not cause disease,<ref>{{cite web |date=20 June 2011 |title=Fact Sheets: The Difference Between Latent TB Infection and Active TB Disease |url=https://www.cdc.gov/tb/publications/factsheets/general/LTBIandActiveTB.htm |url-status=live |archive-url=https://web.archive.org/web/20110804005502/http://www.cdc.gov/tb/publications/factsheets/general/LTBIandActiveTB.htm |archive-date=4 August 2011 |access-date=26 July 2011 |publisher=Centers for Disease Control and Prevention (CDC)}}</ref> and 90–95% of infections remain asymptomatic.<ref>{{cite book |url=https://archive.org/details/globalhealth1010000skol |title=Global health 101 |vauthors=Skolnik R |publisher=Jones & Bartlett Learning |year=2011 |isbn=978-0-7637-9751-5 |edition=2nd |location=Burlington, MA |page=[https://archive.org/details/globalhealth1010000skol/page/253 253] |url-access=registration}}</ref>
TB infection disproportionally affects low-income populations and countries. Factors like poverty, inadequate living conditions, and poor nutrition contribute to higher TB prevalence and incidence in these settings.<ref name="WHO_Factsheet_2025" /> Globally, the highest burden of TB is concentrated in low-income countries.<ref>{{Cite web |date=2003 |author1=Nhlema, B.| others=Kemp, J.; Steenbergen, G.; Theobald, S.; Tang, S.; Squire, S.B. |title=A systematic analysis of TB and poverty. | collaboration=WHO, Geneva, Switzerland|url=https://www.gov.uk/research-for-development-outputs/a-systematic-analysis-of-tb-and-poverty |access-date=2025-08-11 |website=GOV.UK |language=en}}</ref><ref>{{Cite web |title=Health Topics - Tuberculosis |url=https://www.who.int/health-topics/tuberculosis |access-date=2025-08-11 |website=World Health Organization |language=en}}</ref>
People living with HIV have a significantly higher risk of developing tuberculosis (TB) compared to those without HIV. HIV weakens the immune system, making individuals more susceptible to TB infection and increasing the likelihood of progression from latent to active TB. TB is also a leading cause of death among people with HIV.<ref>{{Cite journal |last1=Hamada |first1=Yohhei |last2=Getahun |first2=Haileyesus |last3=Tadesse |first3=Birkneh Tilahun |last4=Ford |first4=Nathan |date=2021-08-01 |title=HIV-associated tuberculosis |journal=International Journal of STD & AIDS |language=EN |volume=32 |issue=9 |pages=780–790 |doi=10.1177/0956462421992257 |issn=0956-4624 |pmc=8236666 |pmid=33612015}}</ref><ref name="WHO_Factsheet_2025" />
To a certain extent, newly diagnosed TB infections tend to cluster in spring and summer; this is attributed in part to lower vitamin D levels and indoor crowding during the colder seasons, combined with a lag between infection and diagnosis. The strength of seasonality varies with latitude, with stronger patterns observed in regions farther from the equator.<ref>{{Cite journal |last1=Tedijanto |first1=Christine |last2=Hermans |first2=Sabine |last3=Cobelens |first3=Frank |last4=Wood |first4=Robin |last5=Andrews |first5=Jason R. |date=November 2018 |title=Drivers of Seasonal Variation in Tuberculosis Incidence: Insights from a Systematic Review and Mathematical Model |journal=Epidemiology |language=en |volume=29 |issue=6 |pages=857–866 |doi=10.1097/EDE.0000000000000877 |pmid=29870427 |pmc=6167146 |issn=1044-3983}}</ref> <gallery widths="220" heights="210"> File:Tuberculosis incidence (per 100,000 people), OWID.svg|alt=Number of new cases of tuberculosis per 100,000 people in 2022.|Number of new cases of tuberculosis per 100,000 people, 2022<ref>{{cite web |title=Tuberculosis incidence (per 100,000 people) |url=https://ourworldindata.org/grapher/incidence-of-tuberculosis-sdgs |website=Our World in Data |access-date=7 March 2020 |archive-date=26 September 2019 |archive-url=https://web.archive.org/web/20190926041419/https://ourworldindata.org/grapher/incidence-of-tuberculosis-sdgs |url-status=live }}</ref> File:TB mortality rates in HIV-negative people 2023.webp|Map showing the rate of TB deaths worldwide in HIV-negative people, by country, 2023.<ref name="WHO-Global-1.3-2024"/> File:Tuberculosis deaths by region, OWID.svg|Tuberculosis deaths by region, 1990 to 2017<ref>{{cite web |title=Tuberculosis deaths by region |url=https://ourworldindata.org/grapher/tuberculosis-deaths-region |website=Our World in Data |access-date=7 March 2020 |archive-date=8 May 2020 |archive-url=https://web.archive.org/web/20200508204644/https://ourworldindata.org/grapher/tuberculosis-deaths-region |url-status=live }}</ref> File:Tuberculosis-deaths-by-age.svg|Deaths from tuberculosis, by age, World, 1990 to 2019<ref>{{cite web |title=Deaths from tuberculosis, by age |url=https://owidm.wmcloud.org/grapher/tuberculosis-deaths-by-age |website=Our World in Data |access-date=8 April 2025}}</ref> </gallery>
=== At-risk groups ===
People deemed to be at higher risk for exposure to or infection from M. tuberculosis include those who frequently travel to or live in countries where TB disease is common; residents and employees of densely-occupied settings such as homeless shelters, detention and correctional facilities, and nursing homes; health care workers; populations defined locally as having an increased incidence of TB disease; those who are malnourished; and residents of resource-poor communities.<ref name="CDC-Testing-2019">{{cite web |year=2019 |title=Targeted Testing and the Diagnosis of Latent Tuberculosis Infection and Tuberculosis Disease |url=https://www.cdc.gov/tb/media/pdfs/Self_Study_Module_3_Testing_and_Diagnosis_of_Latent_TB_Infection_and_TB_Disease.pdf |access-date=13 December 2025 |publisher=United States Centers for Disease Control and Prevention |location=Atlanta, Georgia}}</ref><ref name="Dryburgh-2024">{{cite report|url=https://www.who.int/europe/publications/tuberculosis-and-malnutrition-factsheet | last1=Dryburgh|first1=Laura | last2=Rippin | first2=Holly | last3 = Malykh | first3= Regina | publisher=World Health Organization |year = 2024 | access-date=13 December 2025 | title=Tuberculosis and Malnutrition}}</ref>
There is a strong correlation between the risk for TB and socioeconomic status (SES). Specifically, people of low SES are more likely to contract TB. They also have more risk factors for TB disease, including malnutrition, HIV co-infection, more exposure to crowded and poorly ventilated spaces, and limited access to healthcare. Moreover, inadequate healthcare translates to those living with TB disease not being diagnosed and treated promptly, resulting in continued spread of the disease to others.<ref name="Narasimhan_2013" />
TB is the leading cause of death among people with HIV. In fact, people living with HIV are 12 times more likely to develop TB disease than people without HIV because HIV weakens the immune system, making individuals more susceptible to TB infection and progression from latent to active TB.<ref name="WHO_Factsheet_2025" />
The incidence of TB varies with age. Globally, TB occurs mainly in adults 15 years and older. Men are more likely to be infected than women.<ref name="Yang-2024">{{Cite journal |last1=Yang |first1=Huafei |last2=Ruan |first2=Xinyi |last3=Li |first3=Wanyue |last4=Xiong |first4=Jun |last5=Zheng |first5=Yuxin |date=2024-11-11 |title=Global, regional, and national burden of tuberculosis and attributable risk factors for 204 countries and territories, 1990–2021: a systematic analysis for the Global Burden of Diseases 2021 study |journal=BMC Public Health |volume=24 |issue=1 |page=3111 |doi=10.1186/s12889-024-20664-w |doi-access=free |issn=1471-2458 |pmc=11552311 |pmid=39529028}}</ref><ref name="WHO-2024-incidence" /> There is some evidence that, in countries with a low burden of TB such as Britain, Canada and the US, incidence rates among those 65 and older are consistently higher than in other age groups. A large portion of active TB cases in this age group are thought to be due to the reactivation of previously dormant TB infections.<ref>{{Cite journal |last1=Wu |first1=Iris L. |last2=Chitnis |first2=Amit S. |last3=Jaganath |first3=Devan |date=2022-08-01 |title=A narrative review of tuberculosis in the United States among persons aged 65 years and older |journal=Journal of Clinical Tuberculosis and Other Mycobacterial Diseases |volume=28 |article-number=100321 |doi=10.1016/j.jctube.2022.100321 |issn=2405-5794 |pmc=9213239 |pmid=35757390}}</ref><ref>{{Cite web |date=29 May 2025 |title=Tuberculosis incidence and epidemiology, England, 2023 |url=https://www.gov.uk/government/publications/tuberculosis-in-england-2024-report/tuberculosis-incidence-and-epidemiology-england-2023 |access-date=2025-08-17 |website=UK Health Security Agency |language=en}}</ref><ref>{{Cite web |date=2023-10-18 |title=Tuberculosis surveillance in Canada summary report: 2012-2021 |url=https://www.canada.ca/en/public-health/services/publications/diseases-conditions/tuberculosis-surveillance-canada-summary-2012-2021.html |access-date=2025-08-17 |website=Public Health Agency of Canada}}</ref>
Globally, Indigenous peoples are disproportionately impacted by TB.<ref>{{Cite journal |last1=Mounchili |first1=Aboubakar |last2=Perera |first2=Reshel |last3=Lee |first3=Robyn S. |last4=Njoo |first4=Howard |last5=Brooks |first5=James |date=2022-03-24 |title=Chapter 1: Epidemiology of tuberculosis in Canada |journal=Canadian Journal of Respiratory, Critical Care, and Sleep Medicine |volume=6 |issue=sup1 |pages=8–21 |doi=10.1080/24745332.2022.2033062 |issn=2474-5332}}</ref><ref>{{Cite journal |last1=Meumann |first1=Ella M. |last2=Horan |first2=Kristy |last3=Ralph |first3=Anna P. |last4=Farmer |first4=Belinda |last5=Globan |first5=Maria |last6=Stephenson |first6=Elizabeth |last7=Popple |first7=Tracy |last8=Boyd |first8=Rowena |last9=Kaestli |first9=Mirjam |last10=Seemann |first10=Torsten |last11=Vandelannoote |first11=Koen |last12=Lowbridge |first12=Christopher |last13=Baird |first13=Robert W. |last14=Stinear |first14=Timothy P. |last15=Williamson |first15=Deborah A. |date=2021-10-01 |title=Tuberculosis in Australia's tropical north: a population-based genomic epidemiological study |journal=The Lancet Regional Health – Western Pacific |language=English |volume=15 |article-number=100229 |doi=10.1016/j.lanwpc.2021.100229 |issn=2666-6065 |pmc=8350059 |pmid=34528010}}</ref><ref name="Laird-2021">{{cite journal |vauthors=Laird P, Schultz A |title=Tuberculosis in Australia's Top End First Nations highlights health and life expectancy gaps: a call to arms |journal=Lancet Reg Health West Pac |volume=15 |issue= |article-number=100253 |date=October 2021 |pmid=34528019 |pmc=8379636 |doi=10.1016/j.lanwpc.2021.100253 |url=}}</ref> Australian Indigenous populations face disproportionately higher TB rates, more than four times those of non-Indigenous Australian-born.<ref name=Inauen2025>{{cite journal |vauthors=Inauen J, Storken A, Gill C, Brigham M, Kelly M, Barry S |title=Overcoming barriers in tuberculosis control: a case study from a remote community of South Australia |journal=Lancet Reg Health West Pac |volume=60 |issue= |article-number=101604 |date=July 2025 |pmid=40688172 |pmc=12271421 |doi=10.1016/j.lanwpc.2025.101604 |url=}}</ref> In 2023, the rate of TB disease among First Nations in Canada was over 3 times that of the overall Canadian population.<ref name="ISC-2025">{{cite web|title=Tuberculosis in Indigenous communities |url=https://sac-isc.gc.ca/eng/1570132922208/1570132959826 |access-date=13 December 2025 | publisher=Indigenous Services Canada | date=21 March 2025 }}</ref> Contributing factors are the result of ongoing inequities stemming from historical and ongoing impacts of colonization including isolation from health services, food insecurity, higher prevalence of health conditions such as diabetes, overcrowding, and poverty.<ref name="Clark-2002">{{cite journal|title=The association of housing density, isolation and tuberculosis in Canadian First Nations communities|journal=International Journal of Epidemiology | last1=Clark |first1=Michael | last2=Riben | first2=Peter | last3=Nowgesic | first3=Earl | volume=31 | issue=5 | date=1 October 2002 | pages=940–945 | doi=10.1093/ije/31.5.940 |pmid=12435764 }}</ref><ref>{{Cite journal |last1=Cormier |first1=Maxime |last2=Schwartzman |first2=Kevin |last3=N'Diaye |first3=Dieynaba S. |last4=Boone |first4=Claire E. |last5=Santos |first5=Alexandre M. dos |last6=Gaspar |first6=Júlia |last7=Cazabon |first7=Danielle |last8=Ghiasi |first8=Marzieh |last9=Kahn |first9=Rebecca |last10=Uppal |first10=Aashna |last11=Morris |first11=Martin |last12=Oxlade |first12=Olivia |date=2019-01-01 |title=Proximate determinants of tuberculosis in Indigenous peoples worldwide: a systematic review |journal=The Lancet Global Health |language=English |volume=7 |issue=1 |pages=e68–e80 |doi=10.1016/S2214-109X(18)30435-2 |issn=2214-109X |pmid=30554764|doi-access=free }}</ref><ref name="ISC-2025" />
=== Global trends === thumb|Global tuberculosis rates per 100,000 population, from 2010 to 2023. Shaded areas represent 95% uncertainty intervals.<ref name="WHO-2024-incidence" /> Since the late 19th century, a combination of improved living conditions and public health measures has resulted in declines in case and mortality rates in Western Europe and North America. This trend accelerated in the 1950s when effective drug treatments first became available.<ref>{{Cite journal |last1=Glaziou |first1=Philippe |last2=Floyd |first2=Katherine |last3=Raviglione |first3=Mario |date=June 2018 |title=Global Epidemiology of Tuberculosis |url=http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1651492 |journal=Seminars in Respiratory and Critical Care Medicine |language=en |volume=39 |issue=3 |pages=271–285 |doi=10.1055/s-0038-1651492 |pmid=30071543 |issn=1069-3424}}</ref> However progress stalled and even reversed in some regions after the 1990s due to factors like drug resistance and the HIV/AIDS pandemic.<ref name="Bloom-2017">{{cite book |last1=Bloom |first1=Barry R. |chapter=Tuberculosis |date=2017 |title=Major Infectious Diseases |via=NCBI Bookshelf |editor-last=Holmes |editor-first=King K. |url=https://www.ncbi.nlm.nih.gov/books/NBK525174/ |access-date=2025-08-19 |edition=3rd |location=Washington (DC) |publisher=The International Bank for Reconstruction and Development / The World Bank |isbn=978-1-4648-0524-0 |pmid=30212088 |last2=Atun |first2=Rifat |last3=Cohen |first3=Ted |last4=Dye |first4=Christopher |last5=Fraser |first5=Hamish |last6=Gomez |first6=Gabriela B. |last7=Knight |first7=Gwen |last8=Murray |first8=Megan |last9=Nardell |first9=Edward |doi=10.1596/978-1-4648-0524-0_ch11 |editor2-last=Bertozzi |editor2-first=Stefano |editor3-last=Bloom |editor3-first=Barry R. |editor4-last=Jha |editor4-first=Prabhat}}</ref>
Global monitoring of TB incidence is primarily done through annual reports by the World Health Organization (WHO), which has been collecting data and publishing comprehensive reports on the disease since 1997.<ref>{{Cite web |title=Global tuberculosis report - Data |url=https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/data |access-date=2025-08-21 |website=World Health Organization |language=en}}</ref>
=== Geographical epidemiology === The distribution of tuberculosis is not uniform across the globe; it is concentrated in low- and middle-income countries, with high-burden regions including the WHO South-East Asia, African, and Western Pacific regions.<ref name="WHO_Factsheet_2025" /> High incidence of TB is strongly correlated with poor literacy and sex (male).<ref>{{Cite journal |last1=Bai |first1=Wentao |last2=Ameyaw |first2=Edward Kwabena |date=2024-01-02 |title=Global, regional and national trends in tuberculosis incidence and main risk factors: a study using data from 2000 to 2021 |journal=BMC Public Health |volume=24 |issue=1 |page=12 |doi=10.1186/s12889-023-17495-6 |doi-access=free |issn=1471-2458 |pmc=10759569 |pmid=38166735}}</ref> Hopes of totally controlling the disease have been dramatically dampened because of many factors, including the difficulty of developing an effective vaccine, the expensive and time-consuming diagnostic process, the necessity of many months of treatment, the increase in HIV-associated tuberculosis, and the emergence of drug-resistant cases in the 1980s.<ref name="Lawn-2011" />
Approximately 87% of new TB cases occur in the 30 high TB burden countries, with more than two-thirds of the global burden occurring in Bangladesh, China, the Democratic Republic of the Congo, India, Indonesia, Nigeria, Pakistan, and the Philippines.<ref name="WHO_Factsheet_2025" />
==== India ==== {{Main|Tuberculosis in India}}
It is estimated that approximately 40% of the population of India carry tuberculosis infection.<ref>{{Cite journal |last1=Chauhan |first1=Arohi |last2=Parmar |first2=Malik |last3=Dash |first3=Girish Chandra |last4=Solanki |first4=Hardik |last5=Chauhan |first5=Sandeep |last6=Sharma |first6=Jessica |last7=Sahoo |first7=Krushna Chandra |last8=Mahapatra |first8=Pranab |last9=Rao |first9=Raghuram |last10=Kumar |first10=Ravinder |last11=Rade |first11=Kirankumar |last12=Pati |first12=Sanghamitra |date=2023-05-03 |title=The prevalence of tuberculosis infection in India: A systematic review and meta-analysis |journal=Indian Journal of Medical Research |language=en |volume=157 |issue=2–3 |pages=135–151 |doi=10.4103/ijmr.ijmr_382_23 |doi-access=free |issn=0971-5916 |pmc=10319385 |pmid=37202933}}</ref> This is attributed to widespread poverty, malnutrition, overcrowding, and poor hygiene, which facilitate transmission and disease development. Factors like stigma, lack of awareness, delayed diagnosis, and the high financial burden of treatment hinder progress. The emergence of multi-drug resistant TB, together with weak healthcare infrastructure contribute to the persistence of the disease, despite national control programs.<ref>{{Cite journal |last1=Bhargava |first1=Anurag |last2=Bhargava |first2=Madhavi |last3=Juneja |first3=Anika |date=2021-07-03 |title=Social determinants of tuberculosis: context, framework, and the way forward to ending TB in India |url=https://www.tandfonline.com/doi/full/10.1080/17476348.2021.1832469 |journal=Expert Review of Respiratory Medicine |volume=15 |issue=7 |pages=867–883 |doi=10.1080/17476348.2021.1832469 |pmid=33016808 |issn=1747-6348|url-access=subscription }}</ref> Overall, the rate of TB incidence (the annual total of new infections) in India has decreased from nearly 300 per 100,000 population in 2010 to 200 in 2023.<ref name="WHO-2024-incidence" />
==== Indonesia ==== TB is a major health challenge in Indonesia, with an estimated one million cases annually and around 134,000 deaths each year.<ref>{{Cite web |date=17 March 2025 |title=Tuberculosis Care and Treatment in the Republic of Indonesia |url=https://www.cepheid.com/en-DK/insights/insight-hub/community-and-global-health/2025/03/tuberculosis-care-and-treatment-in-the-republic-of-indonesia.html |access-date=2025-08-23 |website=Cepheid |language=en-DK}}</ref> Factors contributing to this include a family history of TB, malnutrition, inappropriate ventilation, diabetes mellitus, smoking behavior, and low income level.<ref>{{Cite journal |last1=Dana |first1=NINDREA Ricvan |last2=Rika |first2=Susanti |last3=M |first3=INDIKA Pudia |last4=Alexander |first4=MAISA Benny |last5=Muthia |first5=Sukma |last6=Linda |first6=Rosalina |last7=Astri |first7=Widya |last8=Zuhrah |first8=Taufiqa |last9=Rahman |first9=AGUSTIAN Dede |last10=Rahmi |first10=Fithria |last11=Nomira |first11=Putri |last12=Setia |first12=NINGSIH Dianni Arma Wahyu |last13=Arif |first13=LUBIS Bella LucintaRillova |last14=Ainil |first14=Mardiah |last15=Octarini |first15=EZEDDIN Maudy |date=2024-03-08 |title=Modifiable and Non-Modifiable Risk Factors for Tuberculosis Among Adults in Indonesia: A Systematic Review and Meta-Analysis |url=https://journals.athmsi.org/index.php/AJID/article/view/6051 |journal=African Journal of Infectious Diseases |language=en |volume=18 |issue=2 |pages=19–28 |doi=10.21010/Ajidv18i2.3 |pmid=38606192 |issn=2505-0419|pmc=11004781 }}</ref> Incidence of TB infection increased in 2020 and subsequent years; this has been attributed to strain on health systems caused by the COVID-19 pandemic.<ref>{{Cite journal |last1=Surendra |first1=Henry |last2=Elyazar |first2=Iqbal R. F. |last3=Puspaningrum |first3=Evelyn |last4=Darmawan |first4=Deddy |last5=Pakasi |first5=Tiffany T. |last6=Lukitosari |first6=Endang |last7=Sulistyo |first7=Sulistyo |last8=Deviernur |first8=Shena M. |last9=Fuady |first9=Ahmad |last10=Thwaites |first10=Guy |last11=Crevel |first11=Reinout van |last12=Shankar |first12=Anuraj H. |last13=Baird |first13=J. Kevin |last14=Hamers |first14=Raph L. |date=2023-09-01 |title=Impact of the COVID-19 pandemic on tuberculosis control in Indonesia: a nationwide longitudinal analysis of programme data |journal=The Lancet Global Health |language=English |volume=11 |issue=9 |pages=e1412–e1421 |doi=10.1016/S2214-109X(23)00312-1 |issn=2214-109X |pmid=37591587|doi-access=free |hdl=2066/296849 |hdl-access=free }}</ref>
==== China ==== {{Main|Tuberculosis in China}}
The incidence of TB in China has decreased over time, from 67 new cases per 100,000 of population in 2010 to 40 in 2023.<ref name="WHO-2024-incidence" /> TB risk is not uniform across the country, with higher relative risks observed in the poorer western and southwestern regions, such as Xinjiang and Tibet.<ref>{{Cite journal |last1=Guo |first1=C. |last2=Du |first2=Y. |last3=Shen |first3=S. Q. |last4=Lao |first4=X. Q. |last5=Qian |first5=J. |last6=Ou |first6=C. Q. |date=September 2017 |title=Spatiotemporal analysis of tuberculosis incidence and its associated factors in mainland China |journal=Epidemiology & Infection |language=en |volume=145 |issue=12 |pages=2510–2519 |doi=10.1017/S0950268817001133 |pmid=28595668 |pmc=9148796 |issn=0950-2688}}</ref> Quality of care is inconsistent, despite efforts by the Chinese Center for Disease Control and Prevention to improve diagnosis, referral and treatment nationwide.<ref>{{Cite journal |last1=Long |first1=Qian |last2=Guo |first2=Lei |last3=Jiang |first3=Weixi |last4=Huan |first4=Shitong |last5=Tang |first5=Shenglan |date=2021-12-01 |title=Ending tuberculosis in China: health system challenges |journal=The Lancet Public Health |language=English |volume=6 |issue=12 |pages=e948–e953 |doi=10.1016/S2468-2667(21)00203-6 |issn=2468-2667 |pmid=34838198|doi-access=free }}</ref>
==== Philippines ==== As of 2023, the Philippines accounts for 6.8% of global TB cases, the 4th worldwide.<ref name="WHO-2024-incidence" /> Cases have increased from 520 per 100,000 people in 2007 to 625 cases per 100,000 in 2024, following a spike in numbers during the Covid-19 pandemic.<ref name="WHO-2024-incidence" /> TB in the Philippines has been linked with poverty, overcrowded living conditions, malnutrition, and health inequities; in addition institutional discrimination and stigma may lead to delayed diagnosis and ongoing transmission.<ref>{{Cite journal |last1=Galvez |first1=Gene Khyle Francis Uy |last2=Interior |first2=Jasmine Soco |date=2025-11-30 |title=Stigma and Inequity in Tuberculosis Transmission and Control in the Philippines |journal=Pathogens |language=en |volume=14 |issue=12 |page=1226 |doi=10.3390/pathogens14121226 |doi-access=free |issn=2076-0817 |pmc=12735505 |pmid=41471182}}</ref><ref>{{Cite journal |last1=Cahyani |first1=Faridha |last2=Dewi |first2=Arlina |date=2025-06-30 |title=Stigma among tuberculosis patients: A bibliometric analysis and scoping review |url=https://www.romj.org/2025-0209 |journal=Russian Open Medical Journal |volume=14 |issue=2 |article-number=e0209 |doi=10.15275/rusomj.2025.0209|doi-access=free }}</ref>
==== Lesotho ==== Lesotho has an estimated 664 new infections per 100,000 population in 2023.<ref name="World Bank Open Data-2024">{{Cite web |date=2024 |title=Incidence of tuberculosis (per 100,000 people) |url=https://data.worldbank.org/indicator/SH.TBS.INCD |access-date=2025-08-24 |website=World Bank Open Data |quote=Data sourced from Global Tuberculosis Report, World Health Organization, 2024}}</ref> This compares favourably with the figure of 1,184 in 2010. It is still one of the highest TB incidence rates globally.<ref name="WHO-2024-incidence" /> A major factor is the extremely high prevalence of HIV in the adult population (around 23%), with many TB patients being co-infected.<ref>{{Cite journal |last1=Matji |first1=R. |last2=Maama |first2=L. |last3=Roscigno |first3=G. |last4=Lerotholi |first4=M. |last5=Agonafir |first5=M. |last6=Sekibira |first6=R. |last7=Law |first7=I. |last8=Tadolini |first8=M. |last9=Kak |first9=N. |date=2023-03-09 |title=Policy and programmatic directions for the Lesotho tuberculosis programme: Findings of the national tuberculosis prevalence survey, 2019 |journal=PLOS ONE |language=en |volume=18 |issue=3 |article-number=e0273245 |doi=10.1371/journal.pone.0273245 |doi-access=free |issn=1932-6203 |pmc=9997977 |pmid=36893175 |bibcode=2023PLoSO..1873245M }}</ref> Other factors include lack of funding, mountainous territory making access to care difficult, and poor adherence to therapy regimens.<ref>{{Cite web |date=11 February 2025 |title=1,500 Lesotho health workers sent home after US aid suspended |url=https://www.eatg.org/hiv-news/1500-lesotho-health-workers-sent-home-after-us-aid-suspended/ |access-date=2025-08-27 |website=European AIDS treatment group |language=en-US}}</ref><ref>{{Cite journal |last1=Hirsch-Moverman |first1=Yael |last2=Mantell |first2=Joanne E. |last3=Lebelo |first3=Limakatso |last4=Howard |first4=Andrea A. |last5=Hesseling |first5=Anneke C. |last6=Nachman |first6=Sharon |last7=Frederix |first7=Koen |last8=Maama |first8=Llang Bridget |last9=El-Sadr |first9=Wafaa M. |date=2020-05-25 |title=Provider attitudes about childhood tuberculosis prevention in Lesotho: a qualitative study |journal=BMC Health Services Research |volume=20 |issue=1 |page=461 |doi=10.1186/s12913-020-05324-0 |doi-access=free |issn=1472-6963 |pmc=7249694 |pmid=32450858}}</ref><ref>{{Cite journal |last1=Mostafa |first1=Mariam A. |last2=Ogunmuyiwa |first2=Joy Oluwaseun |last3=Appleby Tenney |first3=Kathryne |last4=Tip |first4=Sai Lone |last5=Zamalloa |first5=CarlosO. Zegarra |last6=Blossom |first6=Jeffrey C. |last7=Mpo |first7=Tlebere |date=2024-01-01 |title=Health for all: Primary care facility localization in Lesotho using qualitative research and GIS |journal=Global Transitions |volume=6 |pages=123–135 |doi=10.1016/j.glt.2024.05.002 |bibcode=2024GloT....6..123M |issn=2589-7918|doi-access=free }}</ref>
== Society and culture ==
=== Names === In different ages and cultures, tuberculosis went by many names. {{Lang|grc-latn|Phthisis}} ({{Lang|grc|φθίσις}}) in ancient Greek translates to ''decay'' or ''wasting disease'', presumed to refer to pulmonary tuberculosis; around 460 BCE, Hippocrates described phthisis as a disease of dry seasons.<ref>{{cite web |title=Hippocrates 3.16 Classics, MIT |url=https://classics.mit.edu/Hippocrates/aphorisms.mb.txt |access-date=15 December 2015 |archive-url=https://web.archive.org/web/20050211173218/http://classics.mit.edu/Hippocrates/aphorisms.mb.txt |archive-date=11 February 2005}}</ref><ref>{{Citation |title=φθίσις |date=2025-02-26 |work=Wiktionary, the free dictionary |url=https://en.m.wiktionary.org/wiki/%CF%86%CE%B8%CE%AF%CF%83%CE%B9%CF%82 |access-date=2025-04-16 |language=en}}</ref> Tabes in ancient Latin has a similar meaning.<ref name="CDC-History-2025" /> ''Consumption'', derived from Latin root {{Lang|la|con}} meaning 'completely' with {{Lang|la|sumere}} 'to take up from under', was the most common nineteenth-century English word for the disease, and was also in use well into the twentieth century.<ref name="Chambers-1998" /><ref>{{cite book| vauthors = Caldwell M |title=The Last Crusade|date=1988|publisher=Macmillan|location=New York|isbn=978-0-689-11810-4|page=[https://archive.org/details/isbn_9780689118104/page/21 21]|url-access=registration|url=https://archive.org/details/isbn_9780689118104/page/21}}</ref> In ''The Life and Death of Mr Badman'' by John Bunyan, the author calls consumption "the captain of all these men of death."<ref>{{cite book| vauthors = Bunyan J |date=1808 |title=The Life and Death of Mr. Badman|url=https://archive.org/details/lifeanddeathmrb01bunygoog |quote=captain. |page=[https://archive.org/details/lifeanddeathmrb01bunygoog/page/n238 244] |location=London |publisher=W. Nicholson |via=Internet Archive |access-date=28 September 2016}}</ref> "Great white plague" has also been used.<ref name="CDC-History-2025" />
=== Art and literature === [[File:Munch Det Syke Barn 1885-86.jpg|thumb|Painting ''The Sick Child'' by Edvard Munch, 1885–1886, depicts the illness of his sister Sophie, who died of tuberculosis when Edvard was 14; his mother also died of the disease.]] {{main|Cultural depictions of tuberculosis}}
Tuberculosis was for centuries associated with poetic and artistic qualities among those infected, and was also known as "the romantic disease".<ref name="Lawlor-2011">{{cite web| vauthors = Lawlor C |title=Katherine Byrne, Tuberculosis and the Victorian Literary Imagination|url=http://www.bsls.ac.uk/reviews/romantic-and-victorian/katherine-byrne-tuberculosis-and-the-victorian-literary-imagination/|publisher=British Society for Literature and Science|access-date=11 June 2017|archive-date=6 November 2020|archive-url=https://web.archive.org/web/20201106070752/http://www.bsls.ac.uk/reviews/romantic-and-victorian/katherine-byrne-tuberculosis-and-the-victorian-literary-imagination/|url-status=live}}</ref><ref>{{cite book | vauthors = Byrne K | title=Tuberculosis and the Victorian Literary Imagination |publisher=Cambridge University Press |year=2011 |isbn=978-1-107-67280-2}}</ref> Major artistic figures such as the poets John Keats, Percy Bysshe Shelley, and Edgar Allan Poe, the composer Frédéric Chopin,<ref>{{cite web|title=About Chopin's illness|url=http://www.iconsofeurope.com/chopin.tuberculosis.htm|publisher=Icons of Europe|access-date=11 June 2017|archive-date=28 September 2017|archive-url=https://web.archive.org/web/20170928150213/http://www.iconsofeurope.com/chopin.tuberculosis.htm|url-status=live}}</ref> the playwright Anton Chekhov, the novelists Franz Kafka, Katherine Mansfield,<ref>{{cite journal | vauthors = Vilaplana C | title = A literary approach to tuberculosis: lessons learned from Anton Chekhov, Franz Kafka, and Katherine Mansfield | journal = International Journal of Infectious Diseases | volume = 56 | pages = 283–85 | date = March 2017 | pmid = 27993687 | doi = 10.1016/j.ijid.2016.12.012 | doi-access = free }}</ref> Charlotte Brontë, Fyodor Dostoevsky, Thomas Mann, W. Somerset Maugham,<ref>{{cite book |vauthors=Rogal SJ |title=A William Somerset Maugham Encyclopedia |url=https://books.google.com/books?id=H0MqigagKTkC&pg=PA245 |year=1997 |publisher=Greenwood Publishing |isbn=978-0-313-29916-2 |page=245 |access-date=4 October 2017 |archive-date=2 June 2021 |archive-url=https://web.archive.org/web/20210602212607/https://books.google.com/books?id=H0MqigagKTkC&pg=PA245 |url-status=live }}</ref> George Orwell,<ref>{{cite web | vauthors = Eschner K |title=George Orwell Wrote '1984' While Dying of Tuberculosis |url=https://www.smithsonianmag.com/smart-news/george-orwell-wrote-1984-while-dying-tuberculosis-180962608/ |website=Smithsonian |access-date=25 March 2019 |archive-date=24 March 2019 |archive-url=https://web.archive.org/web/20190324161820/https://www.smithsonianmag.com/smart-news/george-orwell-wrote-1984-while-dying-tuberculosis-180962608/ |url-status=live }}</ref> and Robert Louis Stevenson, and the artists Alice Neel,<ref>{{cite journal |journal=Journal of the American Medical Association |url=http://jamanetwork.com/journals/jama/issue/293/22 |page=cover |date=8 June 2005 |volume=293 |issue=22 |title=Tuberculosis (whole issue) |access-date=4 October 2017 |archive-date=24 August 2020 |archive-url=https://web.archive.org/web/20200824105736/https://jamanetwork.com/journals/jama/issue/293/22 |url-status=live }}</ref> Jean-Antoine Watteau, Elizabeth Siddal, Marie Bashkirtseff, Edvard Munch, Aubrey Beardsley and Amedeo Modigliani either had the disease or were surrounded by people who did. A widespread belief was that tuberculosis assisted artistic talent. Physical mechanisms proposed for this effect included the slight fever and toxaemia it caused, allegedly helping them to see life more clearly and to act decisively.<ref>{{cite journal |vauthors=Lemlein RF |s2cid=191371443 |title=Influence of Tuberculosis on the Work of Visual Artists: Several Prominent Examples |journal=Leonardo |date=1981 |volume=14 |issue=2 |pages=114–11 |jstor=1574402 |doi=10.2307/1574402 }}</ref><ref>{{cite thesis | vauthors = Wilsey AM | title = 'Half in Love with Easeful Death:' Tuberculosis in Literature | date = May 2012 | work = Humanities Capstone Projects | degree = PhD Thesis | publisher = Pacific University | ref = Paper 11 | url = http://commons.pacificu.edu/cgi/viewcontent.cgi?article=1010&context=cashu | access-date = 28 September 2017 | archive-url = https://web.archive.org/web/20171011220904/http://commons.pacificu.edu/cgi/viewcontent.cgi?article=1010&context=cashu | archive-date = 11 October 2017 }}</ref><ref name="Morens-2002">{{cite journal | vauthors = Morens DM | title = At the deathbed of consumptive art | journal = Emerging Infectious Diseases | volume = 8 | issue = 11 | pages = 1353–8 | date = November 2002 | pmid = 12463180 | pmc = 2738548 | doi = 10.3201/eid0811.020549 }}</ref>
Tuberculosis formed an often-reused theme in literature, as in Thomas Mann's ''The Magic Mountain'', set in a sanatorium;<ref>{{cite web |url=http://hsl.mcmaster.libguides.com/c.php?g=306775&p=2045587 |title=Pulmonary Tuberculosis/In Literature and Art| publisher=McMaster University History of Diseases |access-date=9 June 2017}}</ref> in music, as in Van Morrison's song "T.B. Sheets";<ref>{{cite news| vauthors = Thomson G |title=Van Morrison – 10 of the best|url=https://www.theguardian.com/music/musicblog/2016/jun/01/van-morrison-10-of-the-best|work=The Guardian|date=1 June 2016|access-date=28 September 2017|archive-date=14 August 2020|archive-url=https://web.archive.org/web/20200814152313/https://www.theguardian.com/music/musicblog/2016/jun/01/van-morrison-10-of-the-best|url-status=live}}</ref> in opera, as in Puccini's ''La bohème'' and Verdi's ''La Traviata'';<ref name="Morens-2002" /> in art, as in Munch's painting of his ill sister;<ref>{{cite web|title=Tuberculosis Throughout History: The Arts|url=https://www.usaid.gov/sites/default/files/documents/1864/art_poster.pdf|publisher=United States Agency for International Development (USAID)|access-date=12 June 2017|archive-date=30 June 2017|archive-url=https://web.archive.org/web/20170630123411/https://www.usaid.gov/sites/default/files/documents/1864/art_poster.pdf}}</ref> and in film, such as the 1945 ''The Bells of St. Mary's'' starring Ingrid Bergman as a nun with tuberculosis.<ref>{{Cite magazine | vauthors = Corliss R |title=Top 10 Worst Christmas Movies |magazine=Time |url=https://entertainment.time.com/2011/12/20/top-10-worst-christmas-movies/ |date=22 December 2008 |quote='If you don't cry when Bing Crosby tells Ingrid Bergman she has tuberculosis', Joseph McBride wrote in 1973, 'I never want to meet you, and that's that.' |access-date=28 September 2017 |archive-date=22 September 2020 |archive-url=https://web.archive.org/web/20200922042323/https://entertainment.time.com/2011/12/20/top-10-worst-christmas-movies/ |url-status=live }}</ref>
=== Folklore === In 19th-century New England, tuberculosis deaths were associated with vampires. When one member of a family died from the disease, the other infected members would lose their health slowly. People believed this was caused by the original person with TB draining the life from the other family members.<ref>{{cite journal |vauthors=Sledzik PS, Bellantoni N |date=June 1994 |title=Brief communication: bioarcheological and biocultural evidence for the New England vampire folk belief |url=http://www.yorku.ca/kdenning/+++2150%202007-8/sledzik%20vampire.pdf |url-status=live |journal=American Journal of Physical Anthropology |volume=94 |issue=2 |pages=269–74 |doi=10.1002/ajpa.1330940210 |pmid=8085617 |bibcode=1994AJPA...94..269S |archive-url=https://web.archive.org/web/20170218082115/http://www.yorku.ca/kdenning/+++2150%202007-8/sledzik%20vampire.pdf |archive-date=18 February 2017}}</ref>
=== Law === Historically, some countries, including Czech Republic, England, Estonia, Germany, Israel, Norway, Russia and Switzerland had legislation to involuntarily detain or examine those suspected to have tuberculosis, or involuntarily treat them if infected.<ref>{{cite journal |last1=Coker |first1=R.J. |last2=Mounier-Jack |first2=S. |last3=Martin |first3=R. |title=Public health law and tuberculosis control in Europe |journal=Public Health |date=April 2007 |volume=121 |issue=4 |pages=266–273 |doi=10.1016/j.puhe.2006.11.003 |pmid=17280692 }}</ref><ref>{{cite journal |vauthors=Coker R, Thomas M, Lock K, Martin R |date=2007 |title=Detention and the evolving threat of tuberculosis: evidence, ethics, and law |journal=The Journal of Law, Medicine & Ethics |volume=35 |issue=4 |pages=609–15, 512 |doi=10.1111/j.1748-720X.2007.00184.x |pmid=18076512 |s2cid=19924571}}</ref> As of 2025, many countries require TB cases to be notified to a national surveillance organisation (UK,<ref>{{Cite web |title=Notifying suspected or confirmed active tuberculosis (TB) |url=https://www.gov.uk/government/publications/tuberculosis-notifying-cases/notifying-suspected-or-confirmed-active-tuberculosis-tb |access-date=2025-09-01 |website=GOV.UK |language=en}}</ref> US,<ref>{{Cite web |last=CDC |date=2025-04-17 |title=Clinical Overview of Tuberculosis Disease |url=https://www.cdc.gov/tb/hcp/clinical-overview/tuberculosis-disease.html |access-date=2025-09-01 |website=Tuberculosis (TB) |language=en-us}}</ref> European Union.<ref>{{Cite web |date=2024-07-18 |title=Tuberculosis - Annual Epidemiological Report for 2022 |url=https://www.ecdc.europa.eu/en/publications-data/tuberculosis-annual-epidemiological-report-2022 |access-date=2025-09-01 |website=www.ecdc.europa.eu |language=en}}</ref>). Many countries make either short term or long term entry visas for potential migrants conditional on a negative TB test.<ref>{{Cite journal |last1=Kavanagh |first1=Matthew M. |last2=Gostin |first2=Lawrence O. |last3=Stephens |first3=John |date=2020-10-23 |title=Tuberculosis, human rights, and law reform: Addressing the lack of progress in the global tuberculosis response |journal=PLOS Medicine |language=en |volume=17 |issue=10 |article-number=e1003324 |doi=10.1371/journal.pmed.1003324 |doi-access=free |issn=1549-1676 |pmc=7584189 |pmid=33095764}}</ref>
=== Stigma === Tuberculosis stigma is discrimination experienced by many people with TB, which acts as a major barrier to health-seeking, treatment adherence, and overall disease control.<ref>{{Cite web |date=2025-09-15 |title=4.1 Stigma |url=https://tbksp.who.int/en/node/2656 |access-date=2025-09-15 |website=World Health Organization}}</ref><ref name="Yadav-2024">{{Cite journal |last=Yadav |first=Sankalp |date=June 2024 |title=Stigma in Tuberculosis: Time to Act on an Important and Largely Unaddressed Issue |journal=Cureus |volume=16 |issue=6 |article-number=e61964 |doi=10.7759/cureus.61964 |doi-access=free |issn=2168-8184 |pmc=11229827 |pmid=38978939}}</ref> Depending on the setting, between 42% and 82% of people with TB report experience of stigma.<ref name="Yadav-2024" /> This prejudice leads to social exclusion, delayed diagnosis, poor adherence to treatment regimens, and thus poor treatment outcomes.<ref>{{Cite web |date=2012-09-20 |title=Stigma and myths |url=https://www.tbalert.org/about-tb/global-tb-challenges/stigma-myths/ |access-date=2025-09-15 |website=TB Alert |language=en-GB}}</ref>
Slow progress in preventing the disease may in part be due to stigma associated with TB.<ref name="Kielstra-20142">{{cite news |date=30 June 2014 |title=Ancient enemy, modern imperative – A time for greater action against tuberculosis |url=http://www.economistinsights.com/sites/default/files/Ancient%20enemy%20modern%20imperative.pdf |archive-url=https://web.archive.org/web/20140810101716/http://www.economistinsights.com/sites/default/files/Ancient%20enemy%20modern%20imperative.pdf |archive-date=10 August 2014 |access-date=22 January 2022 |newspaper=The Economist |publisher=Economist Intelligence Unit |vauthors=Kielstra P |veditors=Tabary Z}}</ref> Stigma may result in delays in seeking treatment,<ref name="Kielstra-20142" /> lower treatment compliance, and family members keeping diagnosis and cause of death secret<ref name="Courtwright-2010">{{cite journal |vauthors=Courtwright A, Turner AN |date=Jul–Aug 2010 |title=Tuberculosis and stigmatization: pathways and interventions |journal=Public Health Reports |volume=125 |issue=4_suppl |pages=34–42 |doi=10.1177/00333549101250S407 |pmc=2882973 |pmid=20626191}}</ref> – allowing the disease to spread further.<ref name="Kielstra-20142" /> Stigma may be due to misconceptions about the disease's transmissibility, cultural myths, association with poverty or (in Africa) HIV/AIDS.<ref name="Kielstra-20142" /> Studies in Ghana have found that individuals with TB may be banned from attending public gatherings,<ref>{{Cite journal |last1=Dodor |first1=Emmanuel Atsu |last2=Kelly |first2=Shona |date=2009-03-01 |title='We are afraid of them': Attitudes and behaviours of community members towards tuberculosis in Ghana and implications for TB control efforts |journal=Psychology, Health & Medicine |volume=14 |issue=2 |pages=170–179 |doi=10.1080/13548500802199753 |issn=1354-8506 |pmid=19235076}}</ref> and may be assigned junior staff in health facilities.<ref>{{Cite journal |last1=van der Westhuizen |first1=Helene-Mari |last2=Ehrlich |first2=Rodney |last3=Somdyala |first3=Ncumisa |last4=Greenhalgh |first4=Trisha |last5=Tonkin-Crine |first5=Sarah |last6=Butler |first6=Chris C. |date=2024-10-03 |title=Stigma relating to tuberculosis infection prevention and control implementation in rural health facilities in South Africa — a qualitative study outlining opportunities for mitigation |journal=BMC Global and Public Health |language=en |volume=2 |issue=1 |article-number=66 |doi=10.1186/s44263-024-00097-8 |doi-access=free |issn=2731-913X |pmc=11622938 |pmid=39681968}}</ref> In India, people with TB may lose their job or be unable to marry.<ref>{{Cite journal |last1=Kamble |first1=BhushanDattatray |last2=Singh |first2=SunilKumar |last3=Jethani |first3=Sumit |last4=Chellaiyan D |first4=VinothGnana |last5=Acharya |first5=BhabaniPrasad |date=2020 |title=Social stigma among tuberculosis patients attending DOTS centers in Delhi |journal=Journal of Family Medicine and Primary Care |language=en |volume=9 |issue=8 |pages=4223–4228 |doi=10.4103/jfmpc.jfmpc_709_20 |doi-access=free |issn=2249-4863 |pmc=7586534 |pmid=33110836}}</ref>
== Global programs == thumb|Between 1995 and 2015, the World Health Organization formulated 3 strategies for the control and ultimately the elimination of tuberculosis, with a target date of 2035. This diagram charts how these are linked and build on each other.<ref name="Matteelli-2018">{{Cite journal |last1=Matteelli |first1=Alberto |last2=Rendon |first2=Adrian |last3=Tiberi |first3=Simon |last4=Al-Abri |first4=Seif |last5=Voniatis |first5=Constantia |last6=Carvalho |first6=Anna Cristina C. |last7=Centis |first7=Rosella |last8=D'Ambrosio |first8=Lia |last9=Visca |first9=Dina |last10=Spanevello |first10=Antonio |last11=Migliori |first11=Giovanni Battista |date=2018-06-13 |title=Tuberculosis elimination: where are we now? |url=https://publications.ersnet.org/content/errev/27/148/180035 |journal=European Respiratory Review |language=en |volume=27 |issue=148 |doi=10.1183/16000617.0035-2018 |issn=0905-9180 |pmc=9488456 |pmid=29898905}}</ref> The World Health Organization has formulated and promoted several strategies to combat TB globally. The first of these, launched in 1995, was DOTS (Directly Observed Treatment, Short-course), which promoted a standard course of treatment together with the appropriate resources and state support.<ref name="Matteelli-2018" /> The DOTS program, implemented by the member nations of the World Health Organization, led to significant reductions in TB incidence and mortality by improving case detection and treatment success rates.<ref>{{Cite journal |last1=Dye |first1=Christopher |last2=Watt |first2=Catherine J. |last3=Bleed |first3=Daniel M. |last4=Hosseini |first4=S. Mehran |last5=Raviglione |first5=Mario C. |date=2005-06-08 |title=Evolution of Tuberculosis Control and Prospects for Reducing Tuberculosis Incidence, Prevalence, and Deaths Globally |journal=JAMA |volume=293 |issue=22 |pages=2767–2775 |doi=10.1001/jama.293.22.2767 |pmid=15941807 |issn=0098-7484}}</ref>
In 2006, WHO adopted the '''Stop TB Strategy''' which implemented millennium development goal 6c (by 2015, to halt and reverse the incidence major diseases).<ref>{{Cite web |date=19 February 2018 |title=Millennium Development Goals (MDGs) |url=https://www.who.int/news-room/fact-sheets/detail/millennium-development-goals-(mdgs) |access-date=2025-09-01 |website=World Health Organization |language=en}}</ref> This included and continued the DOTS program, with additional emphasis on sustainable financing, improved technology, and improved emphasis on drug resistance and HIV co-infection.<ref name="Matteelli-2018" /> This program ran from 2006 (when TB incidence was estimated at 8.8 million new cases)<ref>{{Cite book |title=Global Tuberculosis Control 2006 |date=2006 |publisher=World Health Organization |isbn=978-92-4-156314-7 |location=Geneva}}</ref> to 2014, when TB incidence was estimated at 9.6 million new cases.<ref>{{Cite book |url=https://iris.who.int/handle/10665/191102 |title=Global tuberculosis report 2015 |vauthors= |date=2015 |publisher=World Health Organization |isbn=978-92-4-156505-9 |edition=20th |location=Geneva |language=en}}</ref>
The Stop TB Strategy was followed in 2014 by the '''End TB Strategy'''. This sets targets of a 90% reduction in TB deaths and 80% reduction in TB incidence by 2030, followed by reductions of 95% and 90%, respectively, by 2035. A third target is that no TB-affected households experience catastrophic costs due to the disease by 2020.<ref>{{Cite journal |last1=Floyd |first1=K. |last2=Glaziou |first2=P. |last3=Houben |first3=R. M. G. J. |last4=Sumner |first4=T. |last5=White |first5=R. G. |last6=Raviglione |first6=M. |date=2018-07-01 |title=Global tuberculosis targets and milestones set for 2016–2035: definition and rationale |journal=The International Journal of Tuberculosis and Lung Disease |language=en |volume=22 |issue=7 |pages=723–730 |doi=10.5588/ijtld.17.0835 |issn=1027-3719 |pmc=6005124 |pmid=29914597}}</ref> This incorporated the principles of the previous strategies, while introducing objectives for prevention based on the identification and treatment of individuals with latent TB infection.<ref name="Matteelli-2018" />
In 2012, The World Health Organization (WHO), the Bill and Melinda Gates Foundation, and the U.S. government subsided a fast-acting diagnostic tuberculosis test, Xpert MTB/RIF, for use in low- and middle-income countries.<ref>{{cite web |date=6 August 2012 |title=Public–Private Partnership Announces Immediate 40 Percent Cost Reduction for Rapid TB Test |url=https://www.who.int/tb/features_archive/GeneXpert_press_release_final.pdf |url-status=live |archive-url=https://web.archive.org/web/20131029234310/http://www.who.int/tb/features_archive/GeneXpert_press_release_final.pdf |archive-date=29 October 2013 |publisher=World Health Organization (WHO)}}</ref><ref name="Reuters-2010" /> This is a rapid molecular test used to diagnose TB and simultaneously detect rifampicin resistance. It provides results in about 2 hours, which is much faster than traditional TB culture methods. The test is designed for use with the GeneXpert System.<ref name="CDC_Xpert_20242"/>
== Research directions == <!--Please do not add specific research studies here. For more information, see - https://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style/Medicine-related_articles#Trivia-->As part of the ''End TB'' strategy, the WHO has identified four areas where research-based innovations are needed. These are 1) diagnostics, 2) treatment of active TB, 3) treatment of latent TB, and 4) vaccines.<ref name="End-TB-2015">{{Cite web |date=18 March 2015 |title=The End TB Strategy: Brochure |url=https://www.who.int/publications/m/item/the-end-tb-strategy-brochure |access-date=2025-09-20 |website=Global Programme on Tuberculosis and Lung Health |language=en}}</ref>
=== Diagnostics === Diagnosis of TB infection is difficult, slow, and expensive. This is particularly true of latent TB infection, or infection outside the lungs. Diagnostics can be improved by developing faster, more sensitive tests, preferably based on molecular testing of a blood sample rather than traditional cultivation of a sputum smear; as well as creating ultra-portable diagnostic devices for point-of-care use.<ref>{{Cite journal |last1=Pai |first1=Madhukar |last2=Dewan |first2=Puneet K. |last3=Swaminathan |first3=Soumya |date=1 May 2023 |title=Transforming tuberculosis diagnosis |url=https://www.nature.com/articles/s41564-023-01365-3 |journal=Nature Microbiology |language=en |volume=8 |issue=5 |pages=756–759 |doi=10.1038/s41564-023-01365-3 |pmid=37127703 |issn=2058-5276}}</ref>
=== Treatment === Treatment for TB generally involves taking a cocktail of (sometimes expensive) drugs daily over a period of months. It is not surprising that people forget to take their medication or drop out entirely before completing a course of treatment. Shorter and simpler treatment regimens, as well as the introduction of new drugs, have the potential to improve adherence and thus improve outcomes.<ref name="End-TB-2015" />
There are two specific areas where research can lead to improvements in treatment. The first is the treatment of active tuberculosis, both drug-susceptible and drug-resistant strains. The introduction of safer, easier, and shorter treatment regimens would improve availability and adherence, giving better outcomes. The second area is the treatment and elimination of latent TB infection to prevent it from developing into the active form; again, improved treatment regimens would lead to better outcomes.<ref name="End-TB-2015" />
However, there is limited evidence that improved treatment regimens would improve outcomes. It will also be necessary to improve health literacy and support structures for persons with TB.<ref>{{Cite journal |last1=Dretzke |first1=Janine |last2=Hobart |first2=Carla |last3=Basu |first3=Anamika |last4=Ahyow |first4=Lauren |last5=Nagasivam |first5=Ahimza |last6=Moore |first6=David J |last7=Gajraj |first7=Roger |last8=Roy |first8=Anjana |date=11 March 2024 |title=Interventions to improve latent and active tuberculosis treatment completion rates in underserved groups in low incidence countries: a scoping review |journal=BMJ Open |language=en |volume=14 |issue=3 |article-number=e080827 |doi=10.1136/bmjopen-2023-080827 |doi-access=free|issn=2044-6055 |pmc=10936502 |pmid=38471682}}</ref>
=== Vaccines === Although it was originally developed over a century ago,{{Efn|The Bacillus Calmette-Guérin (BCG) vaccine was first administered to humans in 1921}} {{As of|2025|lc=y}}, BCG remains the only vaccine that is licensed for use; this is despite it having highly variable effectiveness.<ref>{{Cite journal |last1=Zhuang |first1=Li |last2=Ye |first2=Zhaoyang |last3=Li |first3=Linsheng |last4=Yang |first4=Ling |last5=Gong |first5=Wenping |date=2023-07-31 |title=Next-Generation TB Vaccines: Progress, Challenges, and Prospects |journal=Vaccines |language=en |volume=11 |issue=8 |page=1304 |doi=10.3390/vaccines11081304 |doi-access=free |issn=2076-393X |pmc=10457792 |pmid=37631874}}</ref> A promising vaccine candidate, MVA85A, failed in 2019 to demonstrate effectiveness in clinical trials.<ref>{{Cite journal |last1=Kashangura |first1=Rufaro |last2=Jullien |first2=Sophie |last3=Garner |first3=Paul |last4=Johnson |first4=Samuel |date=2019-04-30 |editor-last=Cochrane Infectious Diseases Group |title=MVA85A vaccine to enhance BCG for preventing tuberculosis |journal=Cochrane Database of Systematic Reviews |language=en |volume=2019 |issue=4 |article-number=CD012915 |doi=10.1002/14651858.CD012915.pub2 |pmc=6488980 |pmid=31038197}}</ref> There is an urgent need for improved vaccines, which could be effective both before exposure to TB and also post exposure.<ref name="End-TB-2015" />
=== Other areas of research === Fundamental research needs to continue into topics such as the interaction between the bacterium and its human host,<ref>{{Cite journal |last=Hunter |first=Robert L. |date=19 September 2018 |title=The Pathogenesis of Tuberculosis: The Early Infiltrate of Post-primary (Adult Pulmonary) Tuberculosis: A Distinct Disease Entity |journal=Frontiers in Immunology |language=English |volume=9 |article-number=2108 |doi=10.3389/fimmu.2018.02108 |doi-access=free |issn=1664-3224 |pmc=6156532 |pmid=30283448}}</ref> details of the chain of steps which culminate in TB transmission,<ref>{{Cite journal |last1=Churchyard |first1=Gavin |last2=Kim |first2=Peter |last3=Shah |first3=N Sarita |last4=Rustomjee |first4=Roxana |last5=Gandhi |first5=Neel |last6=Mathema |first6=Barun |last7=Dowdy |first7=David |last8=Kasmar |first8=Anne |last9=Cardenas |first9=Vicky |date=2017-11-03 |title=What We Know About Tuberculosis Transmission: An Overview |url=https://academic.oup.com/jid/article/216/suppl_6/S629/4589582 |journal=The Journal of Infectious Diseases |language=en |volume=216 |issue=suppl_6 |pages=S629–S635 |doi=10.1093/infdis/jix362 |issn=0022-1899 |pmc=5791742 |pmid=29112747}}</ref> and the social and political obstacles to effective implementation of the elimination strategy.<ref>{{Cite journal |last1=Appiah |first1=Maxwell Afranie |last2=Arthur |first2=Joshua Appiah |last3=Gborgblorvor |first3=Delphine |last4=Asampong |first4=Emmanuel |last5=Kye-Duodu |first5=Gideon |last6=Kamau |first6=Edward Mberu |last7=Dako-Gyeke |first7=Phyllis |date=10 July 2023 |title=Barriers to tuberculosis treatment adherence in high-burden tuberculosis settings in Ashanti region, Ghana: a qualitative study from patient's perspective |journal=BMC Public Health |volume=23 |issue=1 |page=1317 |doi=10.1186/s12889-023-16259-6 |doi-access=free |issn=1471-2458 |pmc=10332032 |pmid=37430295}}</ref>
== Other animals ==
Members of the genus ''Mycobacterium'' infect many different animals, including birds,<ref>{{cite journal | vauthors = Shivaprasad HL, Palmieri C | title = Pathology of mycobacteriosis in birds | journal = The Veterinary Clinics of North America. Exotic Animal Practice | volume = 15 | issue = 1 | pages = 41–55, v–vi | date = January 2012 | pmid = 22244112 | doi = 10.1016/j.cvex.2011.11.004 }}</ref> fish, rodents,<ref>{{cite journal | vauthors = Reavill DR, Schmidt RE | title = Mycobacterial lesions in fish, amphibians, reptiles, rodents, lagomorphs, and ferrets with reference to animal models | journal = The Veterinary Clinics of North America. Exotic Animal Practice | volume = 15 | issue = 1 | pages = 25–40, v | date = January 2012 | pmid = 22244111 | doi = 10.1016/j.cvex.2011.10.001 }}</ref> and reptiles.<ref>{{cite journal | vauthors = Mitchell MA | title = Mycobacterial infections in reptiles | journal = The Veterinary Clinics of North America. Exotic Animal Practice | volume = 15 | issue = 1 | pages = 101–11, vii | date = January 2012 | pmid = 22244116 | doi = 10.1016/j.cvex.2011.10.002 }}</ref> The species ''Mycobacterium tuberculosis'', though, is rarely present in wild animals.<ref>{{cite book| vauthors = Wobeser GA |title=Essentials of disease in wild animals|year=2006|publisher=Blackwell Publishing|location=Ames, IO [u.a.]|isbn=978-0-8138-0589-4|page=170|url=https://books.google.com/books?id=JgyS6fxVasYC&pg=PA170|edition=1st|url-status=live|archive-url=https://web.archive.org/web/20150906172856/https://books.google.com/books?id=JgyS6fxVasYC&pg=PA170|archive-date=6 September 2015}}</ref> An effort to eradicate bovine tuberculosis caused by ''Mycobacterium bovis'' from the cattle and deer herds of New Zealand has been relatively successful.<ref>{{cite journal | vauthors = Ryan TJ, Livingstone PG, Ramsey DS, de Lisle GW, Nugent G, Collins DM, Buddle BM | title = Advances in understanding disease epidemiology and implications for control and eradication of tuberculosis in livestock: the experience from New Zealand | journal = Veterinary Microbiology | volume = 112 | issue = 2–4 | pages = 211–19 | date = February 2006 | pmid = 16330161 | doi = 10.1016/j.vetmic.2005.11.025 }}</ref> Efforts in Great Britain have been less successful.<ref>{{cite journal | vauthors = White PC, Böhm M, Marion G, Hutchings MR | title = Control of bovine tuberculosis in British livestock: there is no 'silver bullet' | journal = Trends in Microbiology | volume = 16 | issue = 9 | pages = 420–7 | date = September 2008 | pmid = 18706814 | doi = 10.1016/j.tim.2008.06.005 | citeseerx = 10.1.1.566.5547 }}</ref><ref>{{cite journal | vauthors = Ward AI, Judge J, Delahay RJ | title = Farm husbandry and badger behaviour: opportunities to manage badger to cattle transmission of Mycobacterium bovis? | journal = Preventive Veterinary Medicine | volume = 93 | issue = 1 | pages = 2–10 | date = January 2010 | pmid = 19846226 | doi = 10.1016/j.prevetmed.2009.09.014 }}</ref>
{{As of|2015}}, tuberculosis appears to be widespread among captive elephants in the US. It is believed that the animals originally acquired the disease from humans, a process called reverse zoonosis. Because the disease can spread through the air to infect both humans and other animals, it is a public health concern affecting circuses and zoos.<ref>{{cite web | vauthors = Holt N |title=The Infected Elephant in the Room |url= http://www.slate.com/blogs/wild_things/2015/03/24/elephant_tuberculosis_epidemic_zoo_and_circus_animals_passing_tb_to_humans.html|website=Slate|access-date=5 April 2016|date=24 March 2015|url-status=live|archive-url=https://web.archive.org/web/20160414151050/http://www.slate.com/blogs/wild_things/2015/03/24/elephant_tuberculosis_epidemic_zoo_and_circus_animals_passing_tb_to_humans.html|archive-date=14 April 2016}}</ref><ref>{{cite web| vauthors = Mikota SK |title=A Brief History of TB in Elephants |url= https://www.aphis.usda.gov/animal_welfare/downloads/elephant/A%20Brief%20History%20of%20TB%20in%20Elephants.pdf|publisher=Animal and Plant Health Inspection Service (APHIS)|access-date=5 April 2016|archive-url=https://web.archive.org/web/20161006125349/https://www.aphis.usda.gov/animal_welfare/downloads/elephant/A%20Brief%20History%20of%20TB%20in%20Elephants.pdf|archive-date=6 October 2016}}</ref>
Transmission of both ''Mycobacterium bovis'' and ''Mycobacterium tuberculosis'' between humans and cattle has been documented, underscoring the importance of zooanthroponosis (human‑to‑animal transmission) and zoonotic tuberculosis (animal‑to‑human transmission). This highlights the need for a One Health approach that targets all four recognized reservoirs of tuberculosis—active TB disease and latent TB infection in humans, and active TB disease and latent TB infection in animals—if elimination is to be achieved. Diagnostic challenges further complicate control efforts, as commonly used nucleic acid amplification tests cannot reliably distinguish between members of the ''M. tuberculosis'' complex, and infections with ''M. bovis'' are naturally resistant to the first‑line drug pyrazinamide, making species‑specific diagnostic tools essential for effective treatment and surveillance.<ref>{{cite journal | vauthors = Mishra GP, Mulani JD | title = Zooanthroponosis and zoonotic TB: a call for a One Health approach | journal = Int J Tuberc Lung Dis | volume = 29 | issue = 8 | pages = 384–385 | date = August 2025 | doi = 10.5588/ijtld.25.0194 | pmid = 40751210 }}</ref>
== See also == {{Portal|Medicine}} * Post-tuberculosis lung disease * List of deaths due to tuberculosis * Bibliography of tuberculosis * International Congress on Tuberculosis
== Notes == {{notelist}}
== References == {{Reflist}}
==Sources==
{{refbegin}} * {{citation |url=https://curiosity.lib.harvard.edu/contagion/catalog/36-990062747650203941 |access-date=2020-07-12 |last1=Maxwell |first1=Sir Herbert |last2=Pye-Smith |first2=P. H. |year=1899 |publisher=Printed for H.M.S.O. by Wyman and Sons |title=Copy of report of the delegates of Her Majesty's Government at the International Congress on Tuberculosis, held at Berlin on the 24th to the 27th May 1899}} {{refend}}
==Further reading==
* {{cite book | last=Green | first=John | title=Everything Is Tuberculosis | publisher=Penguin Group | date=March 2025 | isbn=978-0-525-55657-2}}
== External links == <!-- Please DO ''not'' add new external links! Instead, please submit them on the Talk page for discussion about their proposed inclusion. Thank you. --> {{Sister project links|d=Q12204|wikt=tuberculosis|q=Tuberculosis|c=Category:Tuberculosis|n=no|b=no|v=no|voy=no|m=no|mw=no|s=no|species=Mycobacterium tuberculosis}} {{Offline|med}} * {{cite web |url=https://www.cdc.gov/tb/default.htm |publisher=Centers for Disease Control and Prevention (CDC) |title=Tuberculosis (TB)|date=24 October 2018 }} * {{cite web |url=http://www.hpa.org.uk/infections/topics_az/tb/menu.htm |publisher=Health Protection Agency |location=London |title=Tuberculosis (TB) |archive-url=https://web.archive.org/web/20070705100742/http://www.hpa.org.uk/infections/topics_az/tb/menu.htm |archive-date=5 July 2007 }} * [https://www.who.int/tb/global-tb-report-infographic.pdf?ua=1 WHO global 2016 TB report (infographic)] * [https://www.who.int/tb/country/data/profiles/en/ WHO tuberculosis country profiles] * [https://americanarchive.org/catalog/cpb-aacip_529-1c1td9p67s "Tuberculosis Among African Americans"], 1990-11-01, ''In Black America''; KUT Radio, American Archive of Public Broadcasting (WGBH and the Library of Congress) * [https://www.newtbdrugs.org/ Working Group on New TB drugs], tracking clinical trials and drug candidates
{{Medical condition classification and resources | DiseasesDB = 8515 | ICD11 = {{ICD11|1B10}}-{{ICD11|1B1Z}} | ICD10 = {{ICD10|A15-A19}} | ICD9 = {{ICD9|010}}–{{ICD9|018}} | OMIM = 607948 | MedlinePlus = 000077 | MedlinePlus_mult = {{MedlinePlus2|000624}} | eMedicineSubj = med | eMedicineTopic = 2324 | eMedicine_mult = {{eMedicine2|emerg|618}} {{eMedicine2|radio|411}} | MeshID = D014376 | Orphanet=3389 | Scholia=Q12204 }} {{Gram-positive actinobacteria diseases}} {{Tuberculosis}} {{Diseases of Poverty}} {{Authority control}}
Category:Tuberculosis Category:Airborne diseases Category:Articles containing video clips Category:Health in Africa Category:Health care-associated infections Category:Infectious causes of cancer Category:Mycobacterium-related cutaneous conditions Category:Vaccine-preventable diseases Category:Wikipedia infectious disease articles ready to translate Category:Wikipedia medicine articles ready to translate (full)