Tuberculosis#Folklore

{{Main|History of tuberculosis}}

File:Mummy at British Museum.jpg in the British Museum – tubercular decay has been found in the spine.]]

Tuberculosis has existed since antiquity. The oldest unambiguously detected M. tuberculosis gives evidence of the disease in the remains of bison in Wyoming dated to around 17,000 years ago.{{cite journal | vauthors = Rothschild BM, Martin LD, Lev G, Bercovier H, Bar-Gal GK, Greenblatt C, Donoghue H, Spigelman M, Brittain D | title = Mycobacterium tuberculosis complex DNA from an extinct bison dated 17,000 years before the present | journal = Clinical Infectious Diseases | volume = 33 | issue = 3 | pages = 305–11 | date = August 2001 | pmid = 11438894 | doi = 10.1086/321886 | doi-access = free }} However, whether tuberculosis originated in bovines, then transferred to humans, or whether both bovine and human tuberculosis diverged from a common ancestor, remains unclear.{{cite journal | vauthors = Pearce-Duvet JM | title = The origin of human pathogens: evaluating the role of agriculture and domestic animals in the evolution of human disease | journal = Biological Reviews of the Cambridge Philosophical Society | volume = 81 | issue = 3 | pages = 369–82 | date = August 2006 | pmid = 16672105 | doi = 10.1017/S1464793106007020 | s2cid = 6577678 }} A comparison of the genes of M. tuberculosis complex (MTBC) in humans to MTBC in animals suggests humans did not acquire MTBC from animals during animal domestication, as researchers previously believed. Both strains of the tuberculosis bacteria share a common ancestor, which could have infected humans even before the Neolithic Revolution.{{cite journal | vauthors = Comas I, Gagneux S | title = The past and future of tuberculosis research | journal = PLOS Pathogens | volume = 5 | issue = 10 | page = e1000600 | date = October 2009 | pmid = 19855821 | pmc = 2745564 | doi = 10.1371/journal.ppat.1000600 | veditors = Manchester M | doi-access = free }} 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.{{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 }} Genetic studies suggest the presence of TB in the Americas from about AD 100.{{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 }}

Although Richard Morton established the pulmonary form associated with tubercles as a pathology in 1689,{{WhoNamedIt|doctor|2413|Léon Charles Albert Calmette}}{{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 }} due to the variety of its symptoms, TB was not identified as a single disease until the 1820s. Benjamin Marten conjectured in 1720 that consumptions were caused by microbes which were spread by people living close to each other.{{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; ... " In 1819, René Laennec claimed that tubercles were the cause of pulmonary tuberculosis.{{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.) J. L. Schönlein first published the name "tuberculosis" (German: Tuberkulose) in 1832.{{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 }}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.

Between 1838 and 1845, John Croghan, the owner of Mammoth Cave in Kentucky from 1839 onwards, brought a number of 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.{{cite web | url = http://edition.cnn.com/2004/TRAVEL/DESTINATIONS/02/26/mammoth.cave.ap/index.html | title = Kentucky: Mammoth Cave long on history. | 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| work = CNN | date = 27 February 2004 | access-date = 8 October 2006 }} Hermann Brehmer opened the first TB sanatorium in 1859 in Görbersdorf (now Sokołowsko) in Silesia.{{cite journal | vauthors = McCarthy OR | title = The key to the sanatoria | journal = Journal of the Royal Society of Medicine | volume = 94 | issue = 8 | pages = 413–17 | date = August 2001 | pmid = 11461990 | pmc = 1281640 | url = http://www.jrsm.org/cgi/pmidlookup?view=long&pmid=11461990 | doi = 10.1177/014107680109400813 | access-date = 28 September 2011 | archive-date = 3 August 2012 | archive-url = https://archive.today/20120803180504/http://www.jrsm.org/cgi/pmidlookup?view=long&pmid=11461990 | url-status = live }} In 1865, Jean Antoine Villemin demonstrated that tuberculosis could be transmitted, via inoculation, from humans to animals and among animals.{{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=Etudes 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 }} (Villemin's findings were confirmed in 1867 and 1868 by John Burdon-Sanderson.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.)

File:RobertKoch.jpg discovered the tuberculosis bacillus.]]

Robert Koch identified and described the bacillus causing tuberculosis, M. tuberculosis, on 24 March 1882.{{cite book | vauthors = Koch R | title = Robert Koch: Zentrale Texte | chapter = Die Ätiologie der Tuberkulose (1882) |series=Klassische Texte der Wissenschaft |date=24 March 1882|trans-title=The Etiology of Tuberculosis| chapter-url = http://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}}{{cite web|url=https://www.cdc.gov/tb/worldtbday/history.htm|title=History: World TB Day|publisher=Centers for Disease Control and Prevention (CDC)|url-status=live|access-date=23 March 2019|date=12 December 2016|archive-date=7 December 2018|archive-url=https://web.archive.org/web/20181207112253/https://www.cdc.gov/tb/worldtbday/history.htm}} In 1905, he was awarded the Nobel Prize in Physiology or Medicine for this discovery.{{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}}

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.{{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}} In the 18th and 19th century, tuberculosis had become epidemic in Europe, showing a seasonal pattern.{{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/}}{{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 | pages = e0162575 | date = 5 October 2016 | pmid = 27706149 | pmc = 5051959 | doi = 10.1371/journal.pone.0162575 | doi-access = free | bibcode = 2016PLoSO..1162575Z }} 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.{{Citation needed|date=August 2020}}

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. What later became known as the Alexandra Hospital for Children with Hip Disease (tuberculous arthritis) was opened in London in 1867.{{Cite web |title=Lost Hospitals of London |url=https://ezitis.myzen.co.uk/alexandra.html |access-date=2024-06-27 |website=ezitis.myzen.co.uk}} 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).

Robert Koch did not believe the cattle and human tuberculosis diseases 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.{{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 }} World Tuberculosis Day is marked on 24 March each year, the anniversary of Koch's original scientific announcement. When the Medical Research Council formed in Britain in 1913, it initially focused on tuberculosis research.{{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}}

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,{{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 }} but achieved widespread acceptance in the US, Great Britain, and Germany only after World War II.{{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 }}

In 1946, the development of the antibiotic streptomycin made effective treatment and cure of TB a reality. Prior to 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.{{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}}

By the 1950s mortality in Europe had decreased 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.{{Cn|date=March 2025}}

However, 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).{{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}} 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). 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.{{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}}{{Cite journal |date=July–August 1993 |title=Tuberculosis : a global emergency |url=https://iris.who.int/handle/10665/52639 |journal=World Health |volume=46 |issue=4 |pages=3–31}}

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.{{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}} Treatment regimes can run for two years, compared to the six months of first-line drug treatment.Kaplan, Jeffrey. 2017. "Tuberculosis" American University. Lecture.{{cite book |last1=Adams and Woelke |url=http://accessmedicine.mhmedical.com/content.aspx?bookid=710&Sectionid=46796911 |title=Understanding Global Health. Chapter 10: TB and HIV/AIDS |date=2014 |publisher=McGraw Hill |edition=12th |access-date=9 May 2015}}

File:Tuberculosis symptoms.svg

File:Tuberculosis lip (1).jpg

There is a popular misconception that tuberculosis is purely a disease of the lungs that manifests as coughing.{{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}} Tuberculosis may infect many organs, even though it most commonly occurs in the lungs (known as pulmonary tuberculosis). Extrapulmonary TB occurs when tuberculosis develops outside of the lungs, although extrapulmonary TB may coexist with pulmonary TB.

General signs and symptoms include fever, chills, night sweats, loss of appetite, weight loss, and fatigue. In severe cases, nail clubbing may also occur.{{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}}

The majority of individuals with TB infection show no symptoms, a state known as inactive or latent tuberculosis. 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.{{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}} Without treatment, an estimated 5% to 15% of cases will progress into active TB during the person's lifetime.

If a tuberculosis infection does become active, it most commonly involves the lungs (in about 90% of cases).{{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}} Symptoms may include chest pain, a prolonged cough producing sputum which may be bloody, tiredness, temperature, loss of appetite, wasting and general malaise.{{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}} In very rare cases, the infection may erode into the pulmonary artery or a Rasmussen aneurysm, resulting in massive bleeding.{{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 }}

Tuberculosis may cause extensive scarring of the lungs, which persists after successful treatment of the disease. Survivors continue to experience chronic respiratory symptoms such as cough, sputum production, and shortness of breath.{{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 }}{{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}}

{{Main|Extrapulmonary tuberculosis}}

In 15–20% of active cases, the infection spreads outside the lungs, causing other kinds of TB.{{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}} These are collectively denoted as extrapulmonary tuberculosis.{{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 }} 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. 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. Miliary TB currently makes up about 10% of extrapulmonary cases.

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.{{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}} 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.{{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 |doi=10.1128/microbiolspec.TNMI7-0015-2016 |issn=2165-0497 |pmc=11687435 |pmid=28087922}}

{{Main| Mycobacterium tuberculosis}}

File:Mycobacterium tuberculosis.jpg of M. tuberculosis]]

The main cause of TB is Mycobacterium tuberculosis (MTB), a small, aerobic, nonmotile bacillus. It divides every 16 to 20 hours, which is slow compared with other bacteria, which usually divide in less than an hour.{{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}} 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.{{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}}{{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 }} 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.{{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 }} MTB can withstand weak disinfectants and survive in a dry state for weeks. In nature, the bacterium can grow only within the cells of a host organism, but M. tuberculosis can be cultured in the laboratory.{{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 }}

The term M. tuberculosis complex describes a genetically related group of Mycobacterium species that can cause tuberculosis in humans or other animals. It includes four other TB-causing mycobacteria: M. bovis, M. africanum, M. canettii, and M. microti.{{cite journal |vauthors=van Soolingen D, Hoogenboezem T, de Haas PE, Hermans PW, Koedam MA, Teppema KS, Brennan PJ, Besra GS, Portaels F, Top J, Schouls LM, van Embden JD |title=A novel pathogenic taxon of the Mycobacterium tuberculosis complex, Canetti: characterization of an exceptional isolate from Africa |journal=International Journal of Systematic Bacteriology |volume=47 |issue=4 |pages=1236–45 |date=October 1997 |pmid=9336935 |doi=10.1099/00207713-47-4-1236 |doi-access=free}} 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.{{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}}{{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}} M. africanum is not widespread, but it is a significant cause of human TB in parts of Africa.{{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 }}{{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 }} M. canettii is rare and seems to be limited to the Horn of Africa, although a few cases have been seen in African emigrants.{{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}}{{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 }} 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.{{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 }}{{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 }}

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.{{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}}{{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 }} 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.{{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 | pmid = 28185617 | pmc = 11687434 | doi = 10.1128/microbiolspec.tnmi7-0011-2016 }} These two species are classified as "nontuberculous mycobacteria".{{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 }} File:TB poster.jpg

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.{{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}}

{{Main|Risk factors for tuberculosis}}

Risk factors for TB include exposure to droplets from people with active TB and environmental-related and health-condition related factors that decrease a person's immune system response such as HIV or taking immunosuppressant medications.

Prolonged, frequent, or close contact with people who have active TB is a high high risk factor for becoming infected; this group includes health care workers and children where a family member is infected.{{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}}{{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}} Transmission is most likely to occur from only people with active TB – those with latent infection are not thought to be contagious. Environmental risk factors which put a person at closer contact with infective droplets from a person infected with TB are overcrowding, poor ventilation, or close proximity to a potentially infective person.{{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 |pmc=2592293 |pmid=19057686}}{{cite journal |vauthors=Narasimhan P, Wood J, Macintyre CR, Mathai D |date=2013 |title=Risk factors for tuberculosis |journal=Pulmonary Medicine |volume=2013 |page=828939 |doi=10.1155/2013/828939 |pmc=3583136 |pmid=23476764 |doi-access=free}}

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. Sub-Saharan Africa has a particularly high burden of HIV-associated TB. Of those without HIV infection who are infected with tuberculosis, about 5–15% develop active disease during their lifetimes; in contrast, 30% of those co-infected with HIV develop the active disease. 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.

Another important risk factor is use of medications which suppress the immune system; these include, chemotherapy, medication for lupus or rheumatoid arthritis, and medication after an organ transplant.{{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}} Other risk factors include: alcoholism, diabetes mellitus, silicosis, tobacco smoking, recreational drug use, severe kidney disease, head and neck cancer, low body weight.{{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}} Children, especially those under age five, have undeveloped immune systems and are at higher risk.

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.

File:Miliary_TB_of_the_spleen.jpg

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 which is part of the body's immune system, which attempts to destroy it.{{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 |doi=10.3389/fimmu.2022.747799 |doi-access=free |issn=1664-3224 |pmc=9122124 |pmid=35603185}} However, M. tuberculosis is able to neutralise and colonise the macrophage, leading to persistent infection.

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. {{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 }} 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.{{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}} The lysosome is an organelle which contains digestive enzymes; these are released into the phagolysosome and kill the invader.{{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}}

The M. tuberculosis bacterium is able to subvert the normal process by inhibiting the development of the phagosome and preventing it from fusing with the lysosome. The bacterium is able to survive and replicate within the phagosome; it will eventually destroy its host macrophage, releasing progeny bacteria which spread the infection.

In the next stage of infection, macrophages, epithelioid cells, lymphocytes and fibroblasts aggregate to form a granuloma, which surrounds and isolates the infected macrophages. 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.{{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 |pages=139127 |doi=10.1155/2012/139127 |doi-access=free |issn=2314-7156 |pmc=3395138 |pmid=22811737}} 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.{{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}}

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. 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.

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.{{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}} This severe form of TB disease, most common in young children and those with HIV, is called miliary tuberculosis.{{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}} People with this disseminated TB have a high fatality rate even with treatment (about 30%).{{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}}{{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 }}

In many people, the infection waxes and wanes. Tissue destruction and necrosis are often balanced by healing and fibrosis.{{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}} Affected tissue is replaced by scarring and cavities filled with caseous necrotic material. During active disease, some of these cavities are joined 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.

{{Main|Diagnosis of tuberculosis}}File:TB in sputum.png) in sputum]]Diagnosis of tuberculosis is often difficult. Symptoms manifest slowly, and are generally non-specific, e.g. cough, fatigue, fever which could be caused by a number of other factors.{{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}} 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.{{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}} 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.{{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 }}{{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}}

A diagnosis of TB should be considered in those with signs of lung disease or constitutional symptoms lasting longer than two weeks.{{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}} Diagnosis of TB, whether latent or active, starts with medical history and physical examination. Subsequently a number of tests can be performed to refine the diagnosis:{{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}} A chest X-ray and multiple sputum cultures for acid-fast bacilli are typically part of the initial evaluation.

File:Mantoux_tuberculin_skin_test.jpg 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 health workers or close contacts of TB patients, who may not display symptoms of infection. In the Mantoux test, a small quantity of tuberculin antigen is injected intradermally on the forearm.{{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}}{{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}} 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.{{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}} 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.{{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}}{{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}}

The Interferon-Gamma Release Assay (IGRA) is recommended in those who are positive to the Mantoux test.{{NICE|117|Tuberculosis|2011}} 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.{{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}} This test is more reliable than the Mantoux test, and does not give a false positive after BCG vaccination; however it may give a positive result in case of infection by the related bacteria M. szulgai, M. marinum, and M. kansasii.{{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}}

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.{{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}}

File:TB_Culture.jpg 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.).{{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}} The specimen is examined by fluorescence microscopy.{{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}} The bacterium is slow growing so a cell culture may take several weeks to yield a result.{{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}}

Nucleic acid amplification tests (NAAT) and adenosine deaminase testing may allow rapid diagnosis of TB.{{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}} In December 2010, the World Health Organization endorsed the Xpert MTB/RIF system (a NAAT) for diagnosis of tuberculosis in endemic countries.[https://web.archive.org/web/20101210115147/http://www.who.int/mediacentre/news/releases/2010/tb_test_20101208/en/index.html "WHO endorses new rapid tuberculosis test"] 8 December 2010. Retrieved on 12 June 2012

Blood tests to detect antibodies are not specific or sensitive, so they are not recommended.{{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 |page=e1001062 |doi=10.1371/journal.pmed.1001062 |pmc=3153457 |pmid=21857806 |doi-access=free |veditors=Evans C}}

PCR testing for Mycobacterium tuberculosis is often required for the diagnosis of urogenital tuberculosis and may also be used to diagnose tuberculosis in other tissues. It is highly sensitive and specific with good turnaround time.

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.

Although latent TB is not infective, it should be treated in order to prevent its development into active pulmonary TB, which is infective.{{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}} 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.{{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}}

{{Main|Tuberculosis vaccines|BCG vaccine}}

The only available vaccine {{as of|2021|lc=yes}} is bacillus Calmette-Guérin (BCG).{{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 }}{{cite web |title=Vaccines {{!}} Basic TB Facts |url=https://www.cdc.gov/tb/topic/basics/vaccines.htm |date=16 June 2021 |publisher=CDC |access-date=30 December 2021 |archive-date=30 December 2021 |archive-url=https://web.archive.org/web/20211230115301/https://www.cdc.gov/tb/topic/basics/vaccines.htm |url-status=live }} 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.{{cite journal |vauthors=((World Health Organization)) |date=February 2018 |title=BCG vaccines: WHO position paper – February 2018 |journal=Weekly Epidemiological Record |volume=93 |issue=8 |pages=73–96 |pmid=29474026 |hdl-access=free |hdl=10665/260307}} In countries where tuberculosis is common, one dose is recommended in healthy babies as soon after birth as possible. 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%.{{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 | page= g4643 | date = August 2014 | issue = aug04 5 | pmid = 25097193 | pmc = 4122754 | doi = 10.1136/bmj.g4643 }}{{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 }} It is not effective if administered to adults.{{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 }}

File:Notice Do not spit - National Association for the Prevention of Tuberculosis Dublin Branch.jpgThe 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 tested for infection. Cures for the disease included abundant food, particularly of a fatty nature, 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.McCarthy 2001:413-7 In the United States, concern about the spread of tuberculosis played a role in the movement to prohibit public spitting except into spittoons.  

File:Tuberculosis screening, 1940, Royal Navy Barracks, Chatham (IWM A 2008).jpg sailors being screened for tuberculosis (1940)]]

{{Further information|Elimination of tuberculosis}}

The World Health Organization (WHO) declared TB a "global health emergency" in 1993, and in 2006, the Stop TB Partnership developed a Global Plan to Stop Tuberculosis that aimed to save 14 million lives between its launch and 2015.{{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}} A number of 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.

In 2014, the WHO adopted the "End TB" strategy which aims to reduce TB incidence by 80% and TB deaths by 90% by 2030.{{Cite web |title=The End TB Strategy |url=https://www.who.int/teams/global-tuberculosis-programme/the-end-tb-strategy |url-status=live |archive-url=https://web.archive.org/web/20210722170507/https://www.who.int/teams/global-tuberculosis-programme/the-end-tb-strategy |archive-date=22 July 2021 |access-date=22 July 2021 |website=who.int}} The strategy contains a milestone to reduce TB incidence by 20% and TB deaths by 35% by 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}} 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. 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). 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.

The goal of tuberculosis elimination is being hampered by the lack of rapid testing, short and effective treatment courses, and completely effective vaccines.{{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 }}

{{Main|Management of tuberculosis}}

File:Tubi - 1234,0186.jpg in Kuopio, Finland, 1934]]

Treatment of TB uses antibiotics to kill the bacteria. Effective TB treatment is difficult, due to the unusual structure and chemical composition of the mycobacterial cell wall, which hinders the entry of drugs and makes many antibiotics ineffective.{{cite journal | vauthors = Brennan PJ, Nikaido H | title = The envelope of mycobacteria | journal = Annual Review of Biochemistry | volume = 64 | pages = 29–63 | year = 1995 | issue = 1 | pmid = 7574484 | doi = 10.1146/annurev.bi.64.070195.000333 }}

People with latent infections are treated to prevent them from progressing to active TB disease later in life.{{cite journal |vauthors=Menzies D, Al Jahdali H, Al Otaibi B |date=March 2011 |title=Recent developments in treatment of latent tuberculosis infection |journal=The Indian Journal of Medical Research |volume=133 |issue=3 |pages=257–66 |pmc=3103149 |pmid=21441678}} Treatment comprises a course of one or more of isoniazid, rifampin (also known as rifampicin) and rifapentine; the treatment regimen may last for between 3 and 9 months.{{Cite web |date=2025-04-17 |title=Treatment for Latent Tuberculosis Infection |url=https://www.cdc.gov/tb/hcp/treatment/latent-tuberculosis-infection.html |access-date=2025-05-21 |website=Centers for Disease Control and Prevention |language=en-us}}{{Cite web |date=2016-01-13 |title=Recommendations {{!}} Tuberculosis {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/ng33/chapter/recommendations |access-date=2025-05-21 |website=National Institute for Health and Care Excellence}} Completing treatment is crucial to eliminate the bacteria completely, prevent recurrence, and avoid the development of drug resistance.{{Cite web |title=Tuberculosis-Tuberculosis - Diagnosis & treatment |url=https://www.mayoclinic.org/diseases-conditions/tuberculosis/diagnosis-treatment/drc-20351256 |access-date=2025-05-21 |website=Mayo Clinic |language=en}}{{Cite web |date=20 April 2023 |title=Tuberculosis (TB) |url=https://www.nhs.uk/conditions/tuberculosis-tb/ |access-date=2025-05-21 |website=National Health Service |language=en}}

Active TB is best treated with combinations of several antibiotics to reduce the risk of the bacteria developing antibiotic resistance. The recommended treatment of new-onset pulmonary tuberculosis is a combination of antibiotics comprising rifampicin, isoniazid, pyrazinamide, and ethambutol for the first two months, followed by four months of only rifampicin and isoniazid; a total of six months.{{Citation |last1=Jilani |first1=Talha N. |title=Active Tuberculosis |date=26 January 2023 |work=StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK513246/ |access-date=2025-05-26 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30020618 |last2=Avula |first2=Akshay |last3=Zafar Gondal |first3=Anoosh |last4=Siddiqui |first4=Abdul H.}} If the symptoms do not improve, further testing is necessary to establish if the infection is drug-resistant, and the treatment regime should be adjusted if necessary.{{Cite web |title=3.2 Composition and duration of the regimen 2HRZE/4HR {{!}} TB Knowledge Sharing |url=https://tbksp.who.int/en/node/1935 |access-date=2025-05-29 |website=Global Programme on Tuberculosis & Lung Health - World Health Organization}}

If tuberculosis recurs, testing to determine which antibiotics it is sensitive to is important before determining treatment. If multi-drug resistant TB (MDR-TB) is detected, treatment with at least four effective antibiotics for 18 to 24 months is recommended. A treatment regimen for MDR-TB must take into account the patient's drug-resistance profile as well as individual factors such as age and localization of the disease.{{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=2025-05-29 |website=World Health Organization |language=en}} The duration of treatment can vary from 6 months to 18 months or longer.

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.{{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 |pages=e238 |doi=10.1371/journal.pmed.0040238 |doi-access=free |issn=1549-1676 |pmc=1925126 |pmid=17676945}} In areas without public health systems, prolonged treatment is expensive.{{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}} Failure to complete a course of treatment can result in the emergence of drug-resistant tuberculosis.

Public health bodies recommend that patients be given support during the period of treatment.{{Cite web |date=2016-01-13 |title=Recommendations {{!}} Tuberculosis {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/ng33/chapter/recommendations |access-date=2025-06-03 |website=National Institute for Health and Care Excellence |quote=1.7 Adherence, treatment completion and follow‑up.}}{{Cite web |title=1. Care and support interventions for all people with TB {{!}} TB Knowledge Sharing |url=https://tbksp-test.who.int/en/node/1905 |access-date=2025-06-03 |website=World Health Organization}} One form of support is directly observed therapy - a healthcare worker watches the TB patient swallow the drugs, either in person or online.{{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}} Other forms of support include having an assigned case manager, digital monitoring, health education, counseling, and community support.{{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}}

{{Update|part=section|date=June 2025}}

File:Multidrug-resistant-tuberculosis-without-extensive-drug-resistance1.png (total cases) and incidence (annual new cases) of MDR-TB from 1990 to 2021]]

Primary resistance occurs when a person becomes infected with a resistant strain of TB. A person infected with fully susceptible strain of M. tuberculosis may develop secondary (acquired) resistance during therapy because of inadequate treatment, not taking the prescribed regimen appropriately (lack of compliance), or using low-quality medication.{{cite journal | vauthors = O'Brien RJ | title = Drug-resistant tuberculosis: etiology, management and prevention | journal = Seminars in Respiratory Infections | volume = 9 | issue = 2 | pages = 104–12 | date = June 1994 | pmid = 7973169 }} Multi-drug resistant TB is defined as resistance to the two most effective first-line TB drugs: rifampicin and isoniazid. MDR-TB is a serious public health issue in many developing countries, as its treatment is longer and requires more expensive drugs.{{Cn|date=May 2025}} Extensively drug-resistant TB (XDR-TB) is resistant to three or more of the six classes of second-line drugs.{{cite journal | author = Centers for Disease Control and Prevention (CDC) | title = Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs—worldwide, 2000–2004 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 55 | issue = 11 | pages = 301–5 | date = March 2006 | pmid = 16557213 | url = https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5511a2.htm | url-status = live | archive-url = https://web.archive.org/web/20170522030229/https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5511a2.htm | archive-date = 22 May 2017 }} Totally drug-resistant TB is resistant to all currently used drugs.{{Cite magazine|title=Totally Resistant TB: Earliest Cases in Italy|magazine=Wired|url=https://www.wired.com/wiredscience/2012/01/tdr-first-Italy/| vauthors = McKenna M |date=12 January 2012|access-date=12 January 2012|url-status=live|archive-url=https://web.archive.org/web/20120114214156/http://www.wired.com/wiredscience/2012/01/tdr-first-Italy/|archive-date=14 January 2012}} It was first observed in 2003 in Italy,{{cite journal | vauthors = Migliori GB, De Iaco G, Besozzi G, Centis R, Cirillo DM | title = First tuberculosis cases in Italy resistant to all tested drugs | journal = Euro Surveillance | volume = 12 | issue = 5 | pages = E070517.1 | date = May 2007 | pmid = 17868596 | doi = 10.2807/esw.12.20.03194-en | doi-access = free }} but not widely reported until 2012,{{cite web|title=Totally Drug-Resistant TB: a WHO consultation on the diagnostic definition and treatment options|url=https://www.who.int/tb/challenges/xdr/Report_Meeting_totallydrugresistantTB_032012.pdf?ua=1|publisher=World Health Organization (WHO)|access-date=25 March 2016|url-status=live|archive-url=https://web.archive.org/web/20161021151601/http://www.who.int/tb/challenges/xdr/Report_Meeting_totallydrugresistantTB_032012.pdf?ua=1|archive-date=21 October 2016}} and has also been found in Iran and India.{{cite news | title = Ancient enemy, modern imperative – A time for greater action against tuberculosis | newspaper = The Economist |url=http://www.economistinsights.com/sites/default/files/Ancient%20enemy%20modern%20imperative.pdf |publisher=Economist Intelligence Unit|access-date=22 January 2022|date=30 June 2014| vauthors = Kielstra P | veditors = Tabary Z |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}} There is some efficacy for linezolid to treat those with XDR-TB but side effects and discontinuation of medications were common.{{cite journal | vauthors = Singh B, Cocker D, Ryan H, Sloan DJ | title = Linezolid for drug-resistant pulmonary tuberculosis | journal = The Cochrane Database of Systematic Reviews | volume = 3 | pages = CD012836 | date = March 2019 | issue = 3 | pmid = 30893466 | pmc = 6426281 | doi = 10.1002/14651858.CD012836.pub2 | collaboration = Cochrane Infectious Diseases Group }}{{cite journal | vauthors = Velayati AA, Masjedi MR, Farnia P, Tabarsi P, Ghanavi J, ZiaZarifi AH, Hoffner SE | title = Emergence of new forms of totally drug-resistant tuberculosis bacilli: super extensively drug-resistant tuberculosis or totally drug-resistant strains in Iran | journal = Chest | volume = 136 | issue = 2 | pages = 420–425 | date = August 2009 | pmid = 19349380 | doi = 10.1378/chest.08-2427 }} Bedaquiline is tentatively supported for use in multi-drug resistant TB.{{cite web|title=Provisional CDC Guidelines for the Use and Safety Monitoring of Bedaquiline Fumarate (Sirturo) for the Treatment of Multidrug-Resistant Tuberculosis|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6209a1.htm?s_cid=rr6209a1_x|url-status=live|archive-url=https://web.archive.org/web/20140104204359/http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6209a1.htm?s_cid=rr6209a1_x|archive-date=4 January 2014}}

XDR-TB is a term sometimes used to define extensively resistant TB, and constitutes one in ten cases of MDR-TB. Cases of XDR TB have been identified in more than 90% of countries.

For those with known rifampicin or MDR-TB, molecular tests such as the Genotype MTBDRsl Assay (performed on culture isolates or smear positive specimens) may be useful to detect second-line anti-tubercular drug resistance.{{cite journal | vauthors = Theron G, Peter J, Richardson M, Warren R, Dheda K, Steingart KR | title = ® MTBDRsl assay for resistance to second-line anti-tuberculosis drugs | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD010705 | date = September 2016 | issue = 9 | pmid = 27605387 | pmc = 5034505 | doi = 10.1002/14651858.CD010705.pub3 | collaboration = Cochrane Infectious Diseases Group }}{{cite web |url=https://www.who.int/tb/WHOPolicyStatementSLLPA.pdf |title=The use of molecular line probe assays for the detection of resistance to second-line anti-tuberculosis drugs |website=World Health Organization |access-date=18 June 2021 |archive-date=22 September 2021 |archive-url=https://web.archive.org/web/20210922003541/https://www.who.int/tb/WHOPolicyStatementSLLPA.pdf |url-status=live }}

Xpert MTB/XDR can be used to detect resistance of isoniazid, fluoroquinolones, and amikacin and can be helpful in selection of optimal medication.{{Cite journal |last1=Pillay |first1=Samantha |last2=Steingart |first2=Karen R |last3=Davies |first3=Geraint R |last4=Chaplin |first4=Marty |last5=De Vos |first5=Margaretha |last6=Schumacher |first6=Samuel G |last7=Warren |first7=Rob |last8=Theron |first8=Grant |date=2022-05-18 |editor-last=Cochrane Infectious Diseases Group |title=Xpert MTB/XDR for detection of pulmonary tuberculosis and resistance to isoniazid, fluoroquinolones, ethionamide, and amikacin |journal=Cochrane Database of Systematic Reviews |language=en |volume=2022 |issue=5 |pages=CD014841 |doi=10.1002/14651858.CD014841.pub2 |pmc=9115865 |pmid=35583175}}

File:Tuberculosis world map - DALY - WHO2004.svg disability-adjusted life years caused by tuberculosis per 100,000 inhabitants, 2004:{{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 }}

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Progression from TB infection to overt TB disease occurs when the bacilli overcome the immune system defenses and begin to multiply. In primary TB disease (some 1–5% of cases), this occurs soon after the initial infection. However, in the majority of cases, a latent infection occurs with no obvious symptoms. These dormant bacilli produce active tuberculosis in 5–10% of these latent cases, often many years after infection.

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. In people coinfected with M. tuberculosis and HIV, the risk of reactivation increases to 10% per year. Studies using DNA fingerprinting of M. tuberculosis strains have shown reinfection contributes more substantially to recurrent TB than previously thought,{{cite journal | vauthors = Lambert ML, Hasker E, Van Deun A, Roberfroid D, Boelaert M, Van der Stuyft P | title = Recurrence in tuberculosis: relapse or reinfection? | journal = The Lancet. Infectious Diseases | volume = 3 | issue = 5 | pages = 282–7 | date = May 2003 | pmid = 12726976 | doi = 10.1016/S1473-3099(03)00607-8 }} with estimates that it might account for more than 50% of reactivated cases in areas where TB is common.{{cite journal | vauthors = Wang JY, Lee LN, Lai HC, Hsu HL, Liaw YS, Hsueh PR, Yang PC | title = Prediction of the tuberculosis reinfection proportion from the local incidence | journal = The Journal of Infectious Diseases | volume = 196 | issue = 2 | pages = 281–8 | date = July 2007 | pmid = 17570116 | doi = 10.1086/518898 | doi-access = free }} The chance of death from a case of tuberculosis is about 4% {{as of|2008|lc=yes}}, down from 8% in 1995.

In people with smear-positive pulmonary TB (without HIV co-infection), after 5 years without treatment, 50–60% die while 20–25% achieve spontaneous resolution (cure). TB is almost always fatal in those with untreated HIV co-infection and death rates are increased even with antiretroviral treatment of HIV.{{Cite web|title=1.4 Prognosis – Tuberculosis|url=https://medicalguidelines.msf.org/viewport/TUB/latest/1-4-prognosis-20320185.html|access-date=25 August 2020|website=medicalguidelines.msf.org|archive-date=2 June 2021|archive-url=https://web.archive.org/web/20210602215007/https://medicalguidelines.msf.org/viewport/TUB/latest/1-4-prognosis-20320185.html|url-status=live}}

Roughly one-quarter of the world's population has been infected with M. tuberculosis,{{cite web |date=16 February 2018 |title=Tuberculosis (TB) |url=https://www.who.int/en/news-room/fact-sheets/detail/tuberculosis |url-status=live |archive-url=https://web.archive.org/web/20131230232509/http://www.who.int/mediacentre/factsheets/fs104/en/index.html |archive-date=30 December 2013 |access-date=15 September 2018 |publisher=World Health Organization (WHO)}} with new infections occurring in about 1% of the population each year.{{cite web |year=2002 |title=Tuberculosis |url=https://www.who.int/mediacentre/factsheets/who104/en/print.html |archive-url=https://web.archive.org/web/20130617193438/http://www.who.int/mediacentre/factsheets/who104/en/print.html |archive-date=17 June 2013 |publisher=World Health Organization (WHO)}} However, most infections with M. tuberculosis do not cause disease,{{cite web|publisher=Centers for Disease Control and Prevention (CDC)|url=https://www.cdc.gov/tb/publications/factsheets/general/LTBIandActiveTB.htm|title=Fact Sheets: The Difference Between Latent TB Infection and Active TB Disease|date=20 June 2011|access-date=26 July 2011|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}} and 90–95% of infections remain asymptomatic.{{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}} In 2012, an estimated 8.6 million chronic cases were active.{{cite web|title=Global tuberculosis report 2013|url=https://www.who.int/tb/publications/global_report/en/index.html|publisher=World Health Organization (WHO)|year=2013|url-status=live|archive-url=https://web.archive.org/web/20061212123736/http://www.who.int/tb/publications/global_report/en/index.html|archive-date=12 December 2006}} In 2010, 8.8 million new cases of tuberculosis were diagnosed, and 1.20–1.45 million deaths occurred (most of these occurring in developing countries).{{cite web |year=2011 |title=The sixteenth global report on tuberculosis |url=https://www.who.int/tb/publications/global_report/2011/gtbr11_executive_summary.pdf |archive-url=https://web.archive.org/web/20120906223650/http://www.who.int/tb/publications/global_report/2011/gtbr11_executive_summary.pdf |archive-date=6 September 2012 |publisher=World Health Organization (WHO)}}{{cite journal | vauthors = Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, etal | s2cid = 1541253 | title = Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2095–128 | date = December 2012 | pmid = 23245604 | doi = 10.1016/S0140-6736(12)61728-0 | pmc = 10790329 | hdl = 10536/DRO/DU:30050819 | url = https://zenodo.org/record/2557786 | hdl-access = free | access-date = 18 March 2020 | archive-date = 19 May 2020 | archive-url = https://web.archive.org/web/20200519152712/https://zenodo.org/record/2557786 | url-status = live }} Of these, about 0.35 million occur in those also infected with HIV.{{cite web|title=Global Tuberculosis Control 2011 |url=https://www.who.int/tb/publications/global_report/2011/gtbr11_full.pdf |publisher=World Health Organization (WHO) |access-date=15 April 2012 |archive-url=https://web.archive.org/web/20120617064025/http://www.who.int/tb/publications/global_report/2011/gtbr11_full.pdf |archive-date=17 June 2012 }} In 2018, tuberculosis was the leading cause of death worldwide from a single infectious agent. The total number of tuberculosis cases has been decreasing since 2005, while new cases have decreased since 2002.

Tuberculosis{{Clarify|reason=Which one? Pulmonary?|date=December 2022}} incidence is seasonal, with peaks occurring every spring and summer.{{cite journal | vauthors = Douglas AS, Strachan DP, Maxwell JD | title = Seasonality of tuberculosis: the reverse of other respiratory diseases in the UK | journal = Thorax | volume = 51 | issue = 9 | pages = 944–946 | date = September 1996 | pmid = 8984709 | pmc = 472621 | doi = 10.1136/thx.51.9.944 }}{{cite journal | vauthors = Martineau AR, Nhamoyebonde S, Oni T, Rangaka MX, Marais S, Bangani N, Tsekela R, Bashe L, de Azevedo V, Caldwell J, Venton TR, Timms PM, Wilkinson KA, Wilkinson RJ | title = Reciprocal seasonal variation in vitamin D status and tuberculosis notifications in Cape Town, South Africa | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 108 | issue = 47 | pages = 19013–19017 | date = November 2011 | pmid = 22025704 | pmc = 3223428 | doi = 10.1073/pnas.1111825108 | doi-access = free }}{{cite journal | vauthors = Parrinello CM, Crossa A, Harris TG | title = Seasonality of tuberculosis in New York City, 1990-2007 | journal = The International Journal of Tuberculosis and Lung Disease | volume = 16 | issue = 1 | pages = 32–37 | date = January 2012 | pmid = 22236842 | doi = 10.5588/ijtld.11.0145 }}{{cite journal | vauthors = Korthals Altes H, Kremer K, Erkens C, van Soolingen D, Wallinga J | title = Tuberculosis seasonality in the Netherlands differs between natives and non-natives: a role for vitamin D deficiency? | journal = The International Journal of Tuberculosis and Lung Disease | volume = 16 | issue = 5 | pages = 639–644 | date = May 2012 | pmid = 22410705 | doi = 10.5588/ijtld.11.0680 }} The reasons for this are unclear, but may be related to vitamin D deficiency during the winter.{{cite journal | vauthors = Koh GC, Hawthorne G, Turner AM, Kunst H, Dedicoat M | title = Tuberculosis incidence correlates with sunshine: an ecological 28-year time series study | journal = PLOS ONE | volume = 8 | issue = 3 | pages = e57752 | year = 2013 | pmid = 23483924 | pmc = 3590299 | doi = 10.1371/journal.pone.0057752 | doi-access = free | bibcode = 2013PLoSO...857752K }} There are also studies linking tuberculosis to different weather conditions like low temperature, low humidity and low rainfall. It has been suggested that tuberculosis incidence rates may be connected to climate change.{{cite journal | vauthors = Kuddus MA, McBryde ES, Adegboye OA | title = Delay effect and burden of weather-related tuberculosis cases in Rajshahi province, Bangladesh, 2007–2012 | journal = Scientific Reports | volume = 9 | issue = 1 | page = 12720 | date = September 2019 | pmid = 31481739 | pmc = 6722246 | doi = 10.1038/s41598-019-49135-8 | bibcode = 2019NatSR...912720K }}

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{{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 }}

File:Tuberculosis world map-Deaths per million persons-WHO2012.svg|Tuberculosis deaths per million persons, 2012

File:Tuberculosis deaths by region, OWID.svg|Tuberculosis deaths by region, 1990 to 2017{{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 }}

File:Tuberculosis-deaths-by-age.svg|Deaths from tuberculosis, by age, World{{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}}

Tuberculosis is closely linked to both overcrowding and malnutrition, making it one of the principal diseases of poverty. Those at high risk thus include: people who inject illicit drugs, inhabitants and employees of locales where vulnerable people gather (e.g., prisons and homeless shelters), medically underprivileged and resource-poor communities, high-risk ethnic minorities, children in close contact with high-risk category patients, and health-care providers serving these patients.{{cite journal|vauthors=Griffith DE, Kerr CM|date=August 1996|title=Tuberculosis: disease of the past, disease of the present|journal=Journal of PeriAnesthesia Nursing|volume=11|issue=4|pages=240–45|doi=10.1016/S1089-9472(96)80023-2|pmid=8964016}}

The rate of tuberculosis varies with age. In Africa, it primarily affects adolescents and young adults.{{cite web|title=Global Tuberculosis Control Report, 2006 – Annex 1 Profiles of high-burden countries|url=https://www.who.int/tb/publications/global_report/2006/pdf/full_report_correctedversion.pdf|archive-url=https://web.archive.org/web/20090726124358/http://www.who.int/tb/publications/global_report/2006/pdf/full_report_correctedversion.pdf|archive-date=26 July 2009|access-date=13 October 2006|publisher=World Health Organization (WHO)}} However, in countries where incidence rates have declined dramatically (such as the United States), tuberculosis is mainly a disease of the elderly and immunocompromised (risk factors are listed above).{{cite web|date=12 September 2006|title=2005 Surveillance Slide Set|url=https://www.cdc.gov/nchstp/tb/pubs/slidesets/surv/surv2005/default.htm|url-status=live|archive-url=https://web.archive.org/web/20061123122326/http://www.cdc.gov/nchstp/tb/pubs/slidesets/surv/surv2005/default.htm|archive-date=23 November 2006|access-date=13 October 2006|publisher=Centers for Disease Control and Prevention}} Worldwide, 22 "high-burden" states or countries together experience 80% of cases as well as 83% of deaths.

In Canada and Australia, tuberculosis is many times more common among the Indigenous peoples, especially in remote areas.{{cite journal|vauthors=FitzGerald JM, Wang L, Elwood RK|date=February 2000|title=Tuberculosis: 13. Control of the disease among aboriginal people in Canada|journal=Canadian Medical Association Journal|volume=162|issue=3|pages=351–55|pmc=1231016|pmid=10693593}}{{cite book| vauthors = Quah SR, Carrin G, Buse K, Heggenhougen K |url=https://books.google.com/books?id=IEXUrc0tr1wC&pg=PA424|title=Health Systems Policy, Finance, and Organization|publisher=Academic Press|year=2009|isbn=978-0-12-375087-7|location=Boston|page=424 |archive-url=https://web.archive.org/web/20150906220918/https://books.google.com/books?id=IEXUrc0tr1wC&pg=PA424|archive-date=6 September 2015|url-status=live}} Factors contributing to this include higher prevalence of predisposing health conditions and behaviours, and overcrowding and poverty. In some Canadian Indigenous groups, genetic susceptibility may play a role.

Socioeconomic status (SES) strongly affects TB risk. People of low SES are both more likely to contract TB and to be more severely affected by the disease. Those with low SES are more likely to be affected by risk factors for developing TB (e.g., malnutrition, indoor air pollution, HIV co-infection, etc.), and are additionally more likely to be exposed to crowded and poorly ventilated spaces. Inadequate healthcare also means that people with active disease who facilitate spread are not diagnosed and treated promptly; sick people thus remain in the infectious state and (continue to) spread the infection.

The distribution of tuberculosis is not uniform across the globe; about 80% of the population in many African, Caribbean, South Asian, and eastern European countries test positive in tuberculin tests, while only 5–10% of the U.S. population test positive. 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.

In developed countries, tuberculosis is less common and is found mainly in urban areas. In Europe, deaths from TB fell from 500 out of 100,000 in 1850 to 50 out of 100,000 by 1950. Improvements in public health were reducing tuberculosis even before the arrival of antibiotics, although the disease remained a significant threat to public health, such that when the Medical Research Council was formed in Britain in 1913 its initial focus was tuberculosis research.{{cite web | work = Medical Research Council | url = http://www.mrc.ac.uk/index/about/about-history/about-history-2.htm | title = Origins of the MRC. | archive-url = https://web.archive.org/web/20080411164838/http://www.mrc.ac.uk/index/about/about-history/about-history-2.htm | archive-date=11 April 2008 | access-date = 7 October 2006 }}

In 2010, rates per 100,000 people in different areas of the world were: globally 178, Africa 332, the Americas 36, Eastern Mediterranean 173, Europe 63, Southeast Asia 278, and Western Pacific 139.

In 2023, tuberculosis overtook COVID-19 as the leading cause of infectious disease-related deaths globally, according to a World Health Organization.{{Cite book |year=2024 |title=Global Tuberculosis Report 2024 |url=https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2024 |access-date=2024-10-31 |website=World Health Organization |language=en |publication-place=Geneva |isbn=978-92-4-010153-1 | vauthors = Organization WH }} Around 8.2 million people were newly diagnosed with TB last year, allowing them access to treatment—a record high since WHO's tracking began in 1995 and an increase from 7.5 million cases in 2022.{{Cite web |date=2024-10-29 |title=WHO report shows global tuberculosis cases are rising {{!}} CIDRAP |url=https://www.cidrap.umn.edu/tuberculosis/who-report-shows-global-tuberculosis-cases-are-rising |access-date=2024-10-31 |website=www.cidrap.umn.edu |language=en}} The report highlights ongoing obstacles in combating TB, including severe funding shortages that hinder efforts toward eradication. Although TB-related deaths decreased slightly to 1.25 million in 2023 from 1.32 million in 2022, the overall number of new cases rose marginally to an estimated 10.8 million.

Russia has achieved particularly dramatic progress with a decline in its TB mortality rate—from 61.9 per 100,000 in 1965 to 2.7 per 100,000 in 1993;{{Cite book |vauthors=Shkolnikov VM, Meslé F |chapter=The Russian Epidemiological Crisis as Mirrored by Mortality Trends |page=142 |year=1996 |url=https://www.rand.org/pubs/conf_proceedings/CF124.html |language=en |veditors=DaVanzo J, Farnsworth G |title=Russia's Demographic "Crisis" |publisher=RAND Corporation |isbn=0-8330-2446-9 |access-date=20 February 2023 |archive-date=20 February 2023 |archive-url=https://web.archive.org/web/20230220171629/https://www.rand.org/pubs/conf_proceedings/CF124.html |url-status=live }}{{cite web | url = https://www.who.int/tb/publications/global_report/en/index.html | title = Global Tuberculosis Control | archive-url = https://web.archive.org/web/20061212123736/http://www.who.int/tb/publications/global_report/en/index.html | archive-date=12 December 2006 | publisher = World Health Organization | date = 2011 }} however, mortality rate increased to 24 per 100,000 in 2005 and then recoiled to 11 per 100,000 by 2015.{{Cite web|url=https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=RU&LAN=EN&outtype=html|title=WHO global tuberculosis report 2016. Annex 2. Country profiles: Russian Federation|access-date=22 August 2020|archive-date=14 July 2017|archive-url=https://web.archive.org/web/20170714043942/https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=RU&LAN=EN&outtype=html}}

China has achieved particularly dramatic progress, with about an 80% reduction in its TB mortality rate between 1990 and 2010. The number of new cases has declined by 17% between 2004 and 2014.

In 2007, the country with the highest estimated incidence rate of TB was Eswatini, with 1,200 cases per 100,000 people. In 2017, the country with the highest estimated incidence rate as a % of the population was Lesotho, with 665 cases per 100,000 people.{{cite web|title=Global Tuberculosis Report 2018|url=http://apps.who.int/iris/bitstream/handle/10665/274453/9789241565646-eng.pdf?ua=1|access-date=27 September 2019|archive-date=7 August 2020|archive-url=https://web.archive.org/web/20200807121356/https://apps.who.int/iris/bitstream/handle/10665/274453/9789241565646-eng.pdf?ua=1|url-status=live}}

In South Africa, 54,200 people died in 2022 from TB. The incidence rate was 468 per 100,000 people; in 2015, this was 988 per 100,000. The total incidence was 280,000 in 2022; in 2015, this was 552,000.{{Cite web | vauthors = Tomlinson C |date=2023-11-10 |title=In-depth: What new WHO TB numbers mean for South Africa |url=https://www.spotlightnsp.co.za/2023/11/10/in-depth-what-new-who-tb-numbers-mean-for-sa/ |access-date=2024-03-27 |website=Spotlight |language=en-US}}

India had the highest total number of TB cases worldwide in 2010, in part due to poor disease management within the private and public health care sector.{{Cite journal |vauthors=Sandhu GK |date=2011 |title=Tuberculosis: Current Situation, Challenges and Overview of its Control Programs in India |journal=Journal of Global Infectious Diseases |volume=3 |issue=2 |pages=143–150 |doi=10.4103/0974-777X.81691 |issn=0974-777X |pmc=3125027 |pmid=21731301 |doi-access=free}}

As of 2017, India continued to have the largest total incidence, with an estimated 2,740,000 cases. According to the World Health Organization (WHO), in 2000–2015, India's estimated mortality rate dropped from 55 to 36 per 100,000 population per year with estimated 480 thousand people dying of TB in 2015.{{Cite web|url=https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=IN&LAN=EN&outtype=html|title=WHO Global tuberculosis report 2016: India|access-date=22 August 2020|archive-date=6 February 2018|archive-url=https://web.archive.org/web/20180206193815/https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=IN&LAN=EN&outtype=html}}{{cite web|url=http://www.dnaindia.com/health/report-govt-revisits-strategy-to-combat-tuberculosis-nadda-2388967|title=Govt revisits strategy to combat tuberculosis|work=Daily News and Analysis|date=8 April 2017|access-date=22 August 2020|archive-date=3 June 2021|archive-url=https://web.archive.org/web/20210603072417/https://www.dnaindia.com/health/report-govt-revisits-strategy-to-combat-tuberculosis-nadda-2388967|url-status=live}} In India a major proportion of tuberculosis patients are being treated by private partners and private hospitals. Evidence indicates that the tuberculosis national survey does not represent the number of cases that are diagnosed and recorded by private clinics and hospitals in India.{{cite journal | vauthors = Mahla RS | title = Prevalence of drug-resistant tuberculosis in South Africa | journal = The Lancet. Infectious Diseases | volume = 18 | issue = 8 | page = 836 | date = August 2018 | pmid = 30064674 | doi = 10.1016/S1473-3099(18)30401-8 | doi-access = free }}

Programs such as the Revised National Tuberculosis Control Program are working to reduce TB levels among people receiving public health care.{{cite journal |vauthors=Bhargava A, Pinto L, Pai M |year=2011 |title=Mismanagement of tuberculosis in India: Causes, consequences, and the way forward |url=https://www.paitbgroup.org/wp-content/uploads/Papers/2011/2011-XX-BhargavaA-Hyp.pdf |journal=Hypothesis |volume=9 |issue=1 |page=e7 |archive-url=https://web.archive.org/web/20221024060219/https://www.paitbgroup.org/wp-content/uploads/Papers/2011/2011-XX-BhargavaA-Hyp.pdf |archive-date=24 October 2022}}{{cite journal |vauthors=Amdekar Y |date=July 2009 |title=Changes in the management of tuberculosis |journal=Indian Journal of Pediatrics |volume=76 |issue=7 |pages=739–42 |doi=10.1007/s12098-009-0164-4 |pmid=19693453 |s2cid=41788291}}

In Canada, tuberculosis was endemic in some rural areas as of 1998.{{cite journal|url=http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102188560.html|title=Rural outbreaks of Mycobacterium tuberculosis in a Canadian province|journal=Abstr Intersci Conf Antimicrob Agents Chemother|year=1998|volume=38|page=555 |id=abstract no. L-27|vauthors=Al-Azem A, Kaushal Sharma M, Turenne C, Hoban D, Hershfield E, MacMorran J, Kabani A|archive-url=https://web.archive.org/web/20111118161808/http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102188560.html |archive-date=18 November 2011 }} The tuberculosis case rate in Canada in 2021 was 4.8 per 100,000 persons. The rates were highest among Inuit (135.1 per 100,000), First Nations (16.1 per 100,000) and people born outside of Canada (12.3 per 100,000).{{cite web |url=https://www.canada.ca/en/public-health/services/diseases/tuberculosis/surveillance.html|title=Tuberculosis (TB): Monitoring|publisher=Government of Canada|access-date=30 October 2024|date=4 March 2024|archive-url=https://web.archive.org/web/20240326030538/https://www.canada.ca/en/public-health/services/diseases/tuberculosis/surveillance.html|url-status=live|archive-date=26 March 2024}}

In the United States, Native Americans have a fivefold greater mortality from TB,{{cite book | vauthors = Birn AE |title= Textbook of International Health: Global Health in a Dynamic World |year= 2009 |page= 261 |publisher= Oxford University Press |isbn= 978-0-19-988521-3 |url= https://books.google.com/books?id=2XBB4-eYGZIC&pg=PT261 |url-status=live |archive-url= https://web.archive.org/web/20150906213750/https://books.google.com/books?id=2XBB4-eYGZIC&pg=PT261 |archive-date= 6 September 2015 }} and racial and ethnic minorities accounted for 88% of all reported TB cases.{{cite journal|vauthors=Williams PM, Pratt RH, Walker WL, Price SF, Stewart RJ, Feng PI| title= Tuberculosis — United States, 2023 | journal= MMWR. Morbidity and Mortality Weekly Report | date= 2024 |volume=73 |issue=12|pages=265–270|doi=10.15585/mmwr.mm7312a4| pmid= 38547024 |url=https://www.cdc.gov/mmwr/volumes/73/wr/mm7312a4.htm|pmc=10986816}} The overall tuberculosis case rate in the United States was 2.9 per 100,000 persons in

2023, representing a 16% increase in cases compared to 2022.

In 2024, Long Beach, California authorized a public health emergency in response to a local outbreak of TB.{{cite news | vauthors = Bendix A |title=California city declares a public health emergency after tuberculosis sickens 14 |url=https://www.nbcnews.com/health/health-news/tuberculosis-outbreak-california-city-health-emergency-rcna150881 |publisher=NBC News |date=7 May 2024}}

In 2017, in the United Kingdom, the national average was 9 per 100,000 and the highest incidence rates in Western Europe were 20 per 100,000 in Portugal.

Tuberculosis has been known by many names from the technical to the familiar. {{Lang|grc-latn|Phthisis}} ({{Lang|grc|φθίσις}}) in ancient Greek translates to decay or wasting disease, presumed to refer to pulmonary tuberculosis;{{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}} around 460 BCE, Hippocrates described phthisis as a disease of dry seasons.{{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}} The abbreviation TB is short for tubercle bacillus. Consumption was the most common nineteenth century English word for the disease, and was also in use well into the twentieth century. The Latin root {{Lang|la|con}} meaning 'completely' is linked to {{Lang|la|sumere}} meaning 'to take up from under'.{{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}} In The Life and Death of Mr Badman by John Bunyan, the author calls consumption "the captain of all these men of death."{{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}} "Great white plague" has also been used.

File:Munch Det Syke Barn 1885-86.jpg 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".{{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}}{{cite book | vauthors = Byrne K | title=Tuberculosis and the Victorian Literary Imagination |publisher=Cambridge University Press |year=2011 |isbn=978-1-107-67280-2}} Major artistic figures such as the poets John Keats, Percy Bysshe Shelley, and Edgar Allan Poe, the composer Frédéric Chopin,{{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}} the playwright Anton Chekhov, the novelists Franz Kafka, Katherine Mansfield,{{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 }} Charlotte Brontë, Fyodor Dostoevsky, Thomas Mann, W. Somerset Maugham,{{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 }} George Orwell,{{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 }} and Robert Louis Stevenson, and the artists Alice Neel,{{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 }} 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 that it caused, allegedly helping them to see life more clearly and to act decisively.{{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 }}{{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 }}{{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 }}

Tuberculosis formed an often-reused theme in literature, as in Thomas Mann's The Magic Mountain, set in a sanatorium;{{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}} in music, as in Van Morrison's song "T.B. Sheets";{{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}} in opera, as in Puccini's La bohème and Verdi's La Traviata; in art, as in Munch's painting of his ill sister;{{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}} and in film, such as the 1945 The Bells of St. Mary's starring Ingrid Bergman as a nun with tuberculosis.{{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 }}

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.{{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 |archive-url=https://web.archive.org/web/20170218082115/http://www.yorku.ca/kdenning/+++2150%202007-8/sledzik%20vampire.pdf |archive-date=18 February 2017}}

Some countries{{Which|date=May 2025}} have legislation to involuntarily detain or examine those suspected to have tuberculosis, or involuntarily treat them if infected.{{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}}

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.{{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)}}{{cite journal | vauthors = Lawn SD, Nicol MP | title = Xpert® MTB/RIF assay: development, evaluation and implementation of a new rapid molecular diagnostic for tuberculosis and rifampicin resistance | journal = Future Microbiology | volume = 6 | issue = 9 | pages = 1067–82 | date = September 2011 | pmid = 21958145 | pmc = 3252681 | doi = 10.2217/fmb.11.84 }}{{cite news |url=https://www.reuters.com/article/idUSTRE6B71RF20101208 |title=WHO says Cepheid rapid test will transform TB care |work=Reuters |date=8 December 2010 |url-status=live |archive-url=https://web.archive.org/web/20101211140847/http://www.reuters.com/article/idUSTRE6B71RF20101208 |archive-date=11 December 2010 }} This is a rapid molecular test used to diagnose TB and simultaneously detect rifampicin resistance. It provides results in about two hours, which is much faster than traditional TB culture methods. The test is designed for use with the GeneXpert System.{{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}}

A 2014 EIU-healthcare report finds there is a need to address apathy and urges for increased funding. The report cites among others Lucica Ditui "[TB] is like an orphan. It has been neglected even in countries with a high burden and often forgotten by donors and those investing in health interventions."

Slow progress has led to frustration, expressed by the executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria – Mark Dybul: "we have the tools to end TB as a pandemic and public health threat on the planet, but we are not doing it." Several international organizations are pushing for more transparency in treatment, and more countries are implementing mandatory reporting of cases to the government as of 2014, although adherence is often variable. Commercial treatment providers may at times overprescribe second-line drugs as well as supplementary treatment, promoting demands for further regulations.

The government of Brazil provides universal TB care, which reduces this problem. Conversely, falling rates of TB infection may not relate to the number of programs directed at reducing infection rates but may be tied to an increased level of education, income, and health of the population. Costs of the disease, as calculated by the World Bank in 2009 may exceed US$150 billion per year in "high burden" countries. Lack of progress eradicating the disease may also be due to lack of patient follow-up – as among the 250 million rural migrants in China.

There is insufficient data to show that active contact tracing helps to improve case detection rates for tuberculosis.{{cite journal | vauthors = Fox GJ, Dobler CC, Marks GB | title = Active case finding in contacts of people with tuberculosis | journal = The Cochrane Database of Systematic Reviews | issue = 9 | pages = CD008477 | date = September 2011 | volume = 2011 | pmid = 21901723 | pmc = 6532613 | doi = 10.1002/14651858.CD008477.pub2 }} Interventions such as house-to-house visits, educational leaflets, mass media strategies, educational sessions may increase tuberculosis detection rates in short-term.{{cite journal | vauthors = Mhimbira FA, Cuevas LE, Dacombe R, Mkopi A, Sinclair D | title = Interventions to increase tuberculosis case detection at primary healthcare or community-level services | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | pages = CD011432 | date = November 2017 | issue = 11 | pmid = 29182800 | pmc = 5721626 | doi = 10.1002/14651858.CD011432.pub2 | collaboration = Cochrane Infectious Diseases Group }} There is no study that compares new methods of contact tracing such as social network analysis with existing contact tracing methods.{{cite journal | vauthors = Braganza Menezes D, Menezes B, Dedicoat M | title = Contact tracing strategies in household and congregate environments to identify cases of tuberculosis in low- and moderate-incidence populations | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | pages = CD013077 | date = August 2019 | issue = 8 | pmid = 31461540 | pmc = 6713498 | doi = 10.1002/14651858.CD013077.pub2 | collaboration = Cochrane Infectious Diseases Group }}

Slow progress in preventing the disease may in part be due to stigma associated with TB. Stigma may be due to the fear of transmission from affected individuals. This stigma may additionally arise due to links between TB and poverty, and in Africa, AIDS. Such stigmatization may be both real and perceived; for example, in Ghana, individuals with TB are banned from attending public gatherings.{{cite journal | vauthors = Courtwright A, Turner AN | title = Tuberculosis and stigmatization: pathways and interventions | journal = Public Health Reports | volume = 125 | issue = 4_suppl | pages = 34–42 | date = Jul–Aug 2010 | pmid = 20626191 | pmc = 2882973 | doi = 10.1177/00333549101250S407 }}

Stigma towards TB may result in delays in seeking treatment, lower treatment compliance, and family members keeping cause of death secret – allowing the disease to spread further. In contrast, in Russia stigma was associated with increased treatment compliance. TB stigma also affects socially marginalized individuals to a greater degree and varies between regions.

One way to decrease stigma may be through the promotion of "TB clubs", where those infected may share experiences and offer support, or through counseling. Some studies have shown TB education programs to be effective in decreasing stigma, and may thus be effective in increasing treatment adherence. Despite this, studies on the relationship between reduced stigma and mortality are lacking {{as of|2010|lc=yes}}, and similar efforts to decrease stigma surrounding AIDS have been minimally effective. Some have claimed the stigma to be worse than the disease, and healthcare providers may unintentionally reinforce stigma, as those with TB are often perceived as difficult or otherwise undesirable. A greater understanding of the social and cultural dimensions of tuberculosis may also help with stigma reduction.{{cite journal | vauthors = Mason PH, Roy A, Spillane J, Singh P | title = Social, Historical and Cultural Dimensions of Tuberculosis | journal = Journal of Biosocial Science | volume = 48 | issue = 2 | pages = 206–32 | date = March 2016 | pmid = 25997539 | doi = 10.1017/S0021932015000115 | doi-access = free }}

{{see also|International Congress on Tuberculosis}}

The BCG vaccine has limitations and research to develop new TB vaccines is ongoing.{{cite journal | vauthors = Martín Montañés C, Gicquel B | title = New tuberculosis vaccines | journal = Enfermedades Infecciosas y Microbiologia Clinica | volume = 29 | pages = 57–62 | date = March 2011 | issue = Suppl 1 | pmid = 21420568 | doi = 10.1016/S0213-005X(11)70019-2 }} A number of potential candidates are currently in phase I and II clinical trials.{{cite journal | vauthors = Zhu B, Dockrell HM, Ottenhoff TH, Evans TG, Zhang Y | title = Tuberculosis vaccines: Opportunities and challenges | journal = Respirology | volume = 23 | issue = 4 | pages = 359–368 | date = April 2018 | pmid = 29341430 | doi = 10.1111/resp.13245 | doi-access = free | hdl = 1887/77156 | hdl-access = free }} Two main approaches are used to attempt to improve the efficacy of available vaccines. One approach involves adding a subunit vaccine to BCG, while the other strategy is attempting to create new and better live vaccines. MVA85A, an example of a subunit vaccine, is in trials in South Africa as of 2006, is based on a genetically modified vaccinia virus.{{cite journal | vauthors = Ibanga HB, Brookes RH, Hill PC, Owiafe PK, Fletcher HA, Lienhardt C, Hill AV, Adegbola RA, McShane H | title = Early clinical trials with a new tuberculosis vaccine, MVA85A, in tuberculosis-endemic countries: issues in study design | journal = The Lancet. Infectious Diseases | volume = 6 | issue = 8 | pages = 522–8 | date = August 2006 | pmid = 16870530 | doi = 10.1016/S1473-3099(06)70552-7 }} Vaccines are hoped to play a significant role in treatment of both latent and active disease.{{cite journal | vauthors = Kaufmann SH | title = Future vaccination strategies against tuberculosis: thinking outside the box | journal = Immunity | volume = 33 | issue = 4 | pages = 567–77 | date = October 2010 | pmid = 21029966 | doi = 10.1016/j.immuni.2010.09.015 | doi-access = free }}

To encourage further discovery, researchers and policymakers are promoting new economic models of vaccine development as of 2006, including prizes, tax incentives, and advance market commitments.{{cite journal| vauthors = Webber D, Kremer M |url=https://www.who.int/bulletin/archives/79(8)735.pdf |title=Stimulating Industrial R&D for Neglected Infectious Diseases: Economic Perspectives|journal=Bulletin of the World Health Organization|volume=79|issue=8|year=2001|pages=693–801|url-status=live|archive-url=https://web.archive.org/web/20070926012031/http://www.who.int/bulletin/archives/79(8)735.pdf|archive-date=26 September 2007}}{{cite journal| vauthors = Barder O, Kremer M, Williams H |s2cid=154454583|url=http://www.bepress.com/ev/vol3/iss3/art1|title=Advance Market Commitments: A Policy to Stimulate Investment in Vaccines for Neglected Diseases|journal=The Economists' Voice|volume=3|year=2006|issue=3|doi=10.2202/1553-3832.1144|archive-url=https://web.archive.org/web/20061105083659/http://www.bepress.com/ev/vol3/iss3/art1|archive-date=5 November 2006|url-access=subscription}} A number of groups, including the Stop TB Partnership,{{cite book | author = Department of Economic and Social Affairs |title=Achieving the global public health agenda: dialogues at the Economic and Social Council|year=2009|publisher=United Nations|location=New York|isbn=978-92-1-104596-3|page=103|url=https://books.google.com/books?id=VeF9dv74C4MC&pg=PA103 |url-status=live|archive-url=https://web.archive.org/web/20150906212013/https://books.google.com/books?id=VeF9dv74C4MC&pg=PA103|archive-date=6 September 2015}} the South African Tuberculosis Vaccine Initiative, and the Aeras Global TB Vaccine Foundation, are involved with research.{{cite book| vauthors = Jong EC, Zuckerman JN |title=Travelers' vaccines|year=2010|publisher=People's Medical Publishing House|location=Shelton, CT|isbn=978-1-60795-045-5|page=319|url=https://books.google.com/books?id=BKRpWFEy66wC&pg=PA319|edition=2nd|url-status=live|archive-url=https://web.archive.org/web/20150906203627/https://books.google.com/books?id=BKRpWFEy66wC&pg=PA319|archive-date=6 September 2015}} Among these, the Aeras Global TB Vaccine Foundation received a gift of more than $280 million (US) from the Bill and Melinda Gates Foundation to develop and license an improved vaccine against tuberculosis for use in high burden countries.{{Cite web|last=Bill and Melinda Gates Foundation Announcement |title=Gates Foundation Commits $82.9 Million to Develop New Tuberculosis Vaccines |date=12 February 2004 |url=http://www.globalhealth.org/news/article/4134 |archive-url=https://web.archive.org/web/20091010163118/http://www.globalhealth.org/news/article/4134 |archive-date=10 October 2009 }}{{Cite web| vauthors = Nightingale K |title=Gates foundation gives US$280 million to fight TB|date=19 September 2007|url=http://www.scidev.net/en/news/gates-foundation-gives-us280-million-to-fight-tb.html|url-status=live|archive-url=https://web.archive.org/web/20081201175618/http://www.scidev.net/en/news/gates-foundation-gives-us280-million-to-fight-tb.html|archive-date=1 December 2008}}

In 2012 a new medication regimen was approved in the US for multidrug-resistant tuberculosis, using bedaquiline as well as existing drugs. There were initial concerns about the safety of this drug,{{cite journal | vauthors = Zumla A, Hafner R, Lienhardt C, Hoelscher M, Nunn A | title = Advancing the development of tuberculosis therapy | journal = Nature Reviews. Drug Discovery | volume = 11 | issue = 3 | pages = 171–172 | date = March 2012 | pmid = 22378254 | doi = 10.1038/nrd3694 | url = http://www.nature.com/articles/nrd3694 | url-status = live | access-date = 8 May 2020 | s2cid = 7232434 | archive-url = https://web.archive.org/web/20200112192759/https://www.nature.com/articles/nrd3694 | archive-date = 12 January 2020 | url-access = subscription }}{{cite news |date=31 December 2012 |title=J&J Sirturo Wins FDA Approval to Treat Drug-Resistant TB |url=https://www.bloomberg.com/news/2012-12-31/j-j-sirturo-wins-fda-approval-to-treat-drug-resistant-tb.html |url-status=live |archive-url=https://web.archive.org/web/20130104110903/http://www.bloomberg.com/news/2012-12-31/j-j-sirturo-wins-fda-approval-to-treat-drug-resistant-tb.html |archive-date=4 January 2013 |access-date=1 January 2013 |newspaper=Bloomberg News}}{{cite journal | vauthors = Avorn J | title = Approval of a tuberculosis drug based on a paradoxical surrogate measure | journal = JAMA | volume = 309 | issue = 13 | pages = 1349–1350 | date = April 2013 | pmid = 23430122 | doi = 10.1001/jama.2013.623 }}{{cite web |last=US Food and Drug Administration |title=Briefing Package: NDA 204–384: Sirturo |url=https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/Anti-%20InfectiveDrugsAdvisoryCommittee/UCM329258.pdf |url-status=dead |archive-url=https://web.archive.org/web/20140104212835/https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/Anti-%20InfectiveDrugsAdvisoryCommittee/UCM329258.pdf |archive-date=4 January 2014 |website=Food and Drug Administration}}{{cite journal |vauthors=Zuckerman D, Yttri J |date=January 2013 |title=Antibiotics: When science and wishful thinking collide |url=https://www.healthaffairs.org/do/10.1377/forefront.20130125.027503 |url-status=live |journal=Health Affairs |doi=10.1377/forefront.20130125.027503 |archive-url=https://web.archive.org/web/20220329211404/https://www.healthaffairs.org/do/10.1377/forefront.20130125.027503 |archive-date=29 March 2022 |access-date=29 March 2022|url-access=subscription }} but later research on larger groups found that this regimen improved health outcomes.{{cite journal | vauthors = Mbuagbaw L, Guglielmetti L, Hewison C, Bakare N, Bastard M, Caumes E, Fréchet-Jachym M, Robert J, Veziris N, Khachatryan N, Kotrikadze T, Hayrapetyan A, Avaliani Z, Schünemann HJ, Lienhardt C | title = Outcomes of Bedaquiline Treatment in Patients with Multidrug-Resistant Tuberculosis | journal = Emerging Infectious Diseases | volume = 25 | issue = 5 | pages = 936–943 | date = May 2019 | pmid = 31002070 | pmc = 6478224 | doi = 10.3201/eid2505.181823 }} By 2017 the drug was used in at least 89 countries.{{cite journal | vauthors = Khoshnood S, Taki E, Sadeghifard N, Kaviar VH, Haddadi MH, Farshadzadeh Z, Kouhsari E, Goudarzi M, Heidary M | title = Mechanism of Action, Resistance, Synergism, and Clinical Implications of Delamanid Against Multidrug-Resistant Mycobacterium tuberculosis | journal = Frontiers in Microbiology | volume = 12 | page = 717045 | date = 2021-10-07 | pmid = 34690963 | pmc = 8529252 | doi = 10.3389/fmicb.2021.717045 | doi-access = free }} Another new drug is delamanid, which was first approved by the European Medicines Agency in 2013 to be used in multidrug-resistant tuberculosis patients,{{Cite web |date=2013-12-03 |title=European Medicines Agency – News and Events – European Medicines Agency recommends two new treatment options for tuberculosis |url=http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2013/11/news_detail_001972.jsp&mid=WC0b01ac058004d5c1 |access-date=2024-04-09 |archive-url=https://web.archive.org/web/20131203022613/http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2013/11/news_detail_001972.jsp&mid=WC0b01ac058004d5c1 |archive-date=3 December 2013 }} and by 2017 was used in at least 54 countries.

Steroids add-on therapy has not shown any benefits for active pulmonary tuberculosis infection.{{cite journal | vauthors = Critchley JA, Orton LC, Pearson F | title = Adjunctive steroid therapy for managing pulmonary tuberculosis | journal = The Cochrane Database of Systematic Reviews | issue = 11 | pages = CD011370 | date = November 2014 | volume = 2014 | pmid = 25387839 | pmc = 6532561 | doi = 10.1002/14651858.CD011370 }}

Mycobacteria infect many different animals, including birds,{{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 }} fish, rodents,{{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 }} and reptiles.{{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 }} The subspecies Mycobacterium tuberculosis, though, is rarely present in wild animals.{{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}} An effort to eradicate bovine tuberculosis caused by Mycobacterium bovis from the cattle and deer herds of New Zealand has been relatively successful.{{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 }} Efforts in Great Britain have been less successful.{{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 }}{{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 }}

{{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.{{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}}{{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|url-status=live|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}}

{{Portal|Medicine}}

• Post-tuberculosis lung disease
• List of deaths due to tuberculosis
• Bibliography of tuberculosis

{{Reflist}}

{{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}}

{{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:Airborne diseases

Category:Articles containing video clips

Category:Health in Africa

Category:Healthcare-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)