Interplay Between Gut Microbiota, Host Immunity, and Lung Pathology in TB Patients

Immunomodulation of the gut microbiota plays a critical role in the host anti-TB response, aiding in the prevention of TB infection, slowing latency progression, reducing disease severity, and lowering the incidence of drug resistance and coinfection. A positive correlation has been found between gut microbiota and peripheral CD4+ T cell count in TB patients. Many anti-TB regimens include broad-spectrum antibiotics like rifampicin and moxifloxacin, which are used at high intensity and for extended periods, potentially exerting selection pressure on gut flora. Anti-TB drugs have been shown to disrupt the gut microbiome and weaken host immunity to MTB. Studies in MDR-TB patients indicate that prolonged use of second-line drugs depletes intestinal flora.

Most TB patients have underlying conditions such as diabetes, chronic kidney disease, or immunosuppression. Notably, T2DM triples the risk of developing TB, and gut microbes may act as key mediators in the link between TB and T2DM. Cytokines such as IL-10, TNF‑α, IFNs I–III, TGF‑β, IL‑35, and regulatory T cells (T‑regs) all significantly influence host immune responses to MTB. Aging TB patients also exhibit reduced respiratory clearance and weakened lung immune defenses, predisposing them to respiratory infections.

Over two-thirds of TB patients experience lasting structural lung changes. Despite treatment, these changes are often irreversible. PTB patients frequently show damage to bronchial mucosa, pulmonary edema, proliferative lesions, and caseous necrosis—conditions conducive to pathogenic colonization. Lung fibrosis and cavitation, in particular, may promote active TB coinfection and further impair lung function. The rise in invasive procedures and structural lung damage has also led to increased fungal and opportunistic infections. Bronchodilation is believed to impair mucociliary clearance, contributing to pathogen retention in the bronchial tree.

Source:

1. Wu, Y., Wang, C. and Li, Y., 2025. Status and outlook of pulmonary tuberculosis coinfection. Journal of Research in Medical Sciences, 30(1), p.34.

Chronic hyperglycemia in response to Mycobacterium tuberculosis infection

An investigation explores the impact of chronic hyperglycemia on macrophage immune responses using a combination of cell culture and diabetic mouse models. The research specifically assesses how prolonged high glucose environments influence the innate defense capability of macrophages when challenged by Mycobacterium tuberculosis (Mtb) or inflammatory stimuli such as LPS.

Results reveal that although hyperglycemia alone increases baseline ROS production, it paradoxically dampens the macrophages' ability to elevate ROS levels in response to infection or inflammation. Moreover, the capacity to produce nitric oxide and other reactive nitrogen species is significantly reduced under hyperglycemic conditions. These findings suggest that chronic high glucose exposure may desensitize macrophages to vital immune triggers.

In addition to impaired oxidative responses, macrophages in a hyperglycemic state show a dysregulated cytokine profile. They produce lower levels of key pro-inflammatory cytokines like IL-1β and IL-6 and higher levels of the anti-inflammatory cytokine IL-10. This skewed cytokine response indicates a suppression of the classical inflammatory pathway, potentially facilitating immune evasion by pathogens.

Surface expression of important macrophage receptors such as TLR-4 and differentiation markers CD11b and CD11c is also significantly decreased, further limiting the immune competence of these cells. Together, these changes illustrate that chronic hyperglycemia undermines both the detection and destruction capacities of macrophages.

The study robustly concludes that sustained hyperglycemia alters the innate immune landscape by dampening macrophage responses to infection and inflammation. This may partly explain why individuals with poorly controlled diabetes are more susceptible to infections like tuberculosis.

References:

1. Chaubey, G.K., Modanwal, R., Dilawari, R., Talukdar, S., Dhiman, A., Chaudhary, S., Patidar, A., Raje, C.I. and Raje, M., 2024. Chronic hyperglycemia impairs anti-microbial function of macrophages in response to Mycobacterium tuberculosis infection. Immunologic Research, 72(4), pp.644-653.

Tuberculosis in Jakarta

A case-control study aimed to explore the role of housing conditions and interpersonal contact in the spread of pulmonary tuberculosis (TB) among adult patients at the Ciracas Primary Health Center. The researchers focused on key environmental risk factors, notably residential density and direct contact with TB patients, given their suspected influence on TB transmission in high-density urban settings.

The methodology was well-structured for the research question. By employing a case-control design, the study efficiently compared patients diagnosed with TB (cases) and those without TB (controls). The matching technique—both frequency and individual—helped control for major confounders such as age, sex, and contact history. Data collection combined clinical records and validated questionnaires to ensure both reliability and validity of findings.

Results confirmed that high housing density and previous contact with TB patients were strongly associated with TB infection. Interestingly, despite high levels of TB-related knowledge among TB patients, this did not correlate with a lower risk of infection. Similarly, sociodemographic traits, although descriptively different between groups, were not statistically associated with TB risk.

These findings underscore the importance of environmental and behavioral interventions in TB control. The fact that good knowledge alone does not prevent disease suggests that structural conditions—like crowded living spaces—play a more decisive role. When TB patients share small, poorly ventilated homes with others, the likelihood of airborne transmission rises significantly.

To reduce TB transmission, public health strategies must move beyond individual-level education and include structural reforms. These may include improving housing conditions, enhancing ventilation, and tracing and managing close contacts of TB patients more proactively. Addressing these key factors could help break the cycle of infection in high-density communities.

References:

1. Sopiani, P., Maemun, S., Azijah, I., Pratiwi, T.Z. and Saputra, R., 2025. Analysis of Risk Factors for Pulmonary Tuberculosis in Cirascas District, East Jakarta, 2022. The Indonesian Journal of Infectious Diseases, 11(1), pp.42-51.

Tuberculosis-diabetes comorbidities

A study offers crucial insight into how diabetes mellitus alters the immune and metabolic response in individuals with tuberculosis (TB). By comparing inflammatory and lipid profiles across individuals with TB, DM, and both (TB-DM), the researchers found that TB-DM presents a unique biological signature. This includes elevated inflammatory proteins not seen in TB or DM alone, and a pro-atherogenic lipid profile marked by high VLDL and ApoB.

Notably, the study demonstrates that while inflammation generally decreases after two months of TB treatment, certain inflammatory markers remain disproportionately high in TB-DM, suggesting sustained immune activation. These inflammatory profiles were also linked to worse TB outcomes, particularly continued sputum positivity, which suggests persistent infection and increased treatment failure risk.

Lipid metabolism was equally impacted. TB-DM patients exhibited lipid patterns more closely resembling diabetic individuals, but with distinct increases in risk-associated markers like ApoB. Even during treatment, lipid levels, especially LDLs and ApoB, rose more significantly in TB-DM, reinforcing cardiovascular risk concerns.

These findings underscore the need to view TB-DM as a distinct clinical phenotype, not merely a coexistence of two conditions. Therapeutic strategies may need to be adapted for this group, including consideration of statins or anti-inflammatory agents. The data also support the potential use of inflammatory and lipid biomarkers to predict treatment response and tailor interventions.

Importantly, the study provides one of the largest datasets to date in this domain, strengthening the reliability of the conclusions and providing a framework for future personalized approaches in TB-DM care.

Sources:

1. Brake, J., Ajie, M., Sumpter, N.A., Koesoemadinata, R.C., Soetedjo, N.N., Santoso, P., Alisjahbana, B., Ruslami, R., Hill, P. and van Crevel, R., 2025. Inflammation and dyslipidaemia in combined diabetes and tuberculosis; a cohort study. iScience, 28(6).

Economic Burden and Transmission Dynamics

Economic Burden and Cost-Effectiveness of TB Treatments

• The BPaL regimen for drug-resistant TB in the Philippines significantly reduces both direct and indirect patient costs compared to existing regimens.
• Economic evaluations (ACER and ICER) showed BPaL is cost-effective under GDP-based thresholds.
• BPaL also improves treatment success rates, highlighting economic and health benefits.
• Lower catastrophic health expenditures and reduced healthcare visits make BPaL advantageous for real-world implementation.
• The study recommends national TB programs transition toward routine BPaL adoption.

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Diabetes Costs and Integration with TB Care

• DM outpatient visits in the Philippines accounted for 3–13% of all visits; monthly drug costs per patient averaged USD 7.67.
• Costs varied by diagnostic test: RPG USD 1.67, FBS USD 2.99, OGTT USD 23.72.
• Staff time was the largest cost driver for non-lab services, while consumables dominated lab costs.
• The cost per DM case detected among TB patients was lowest using RPG plus FBS algorithms (USD 17.43).
• Findings highlight the need for planning integrated TB-DM services and understanding economic burdens.

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Transmission Dynamics and Risk Factors for TB

• In Lima, Peru, genomic sequencing of 2,500 TB cases identified over 1,400 direct transmission pairs.
• Higher transmission was linked to younger age, male gender, smoking, drinking, and incarceration.
• Cavitary disease and previous TB increased transmissibility.
• The study demonstrates the power of genomic tools in identifying high-risk groups for targeted interventions.
• Former prisoners and substance users should be prioritized in TB control efforts.

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Impact of Smoking Cessation on Household TB Transmission

• Recent smoking cessation among TB patients significantly reduced TB infection risk in child contacts.
• Children of recent quitters had infection rates similar to those of never-smokers.
• Risk ratios for infection were about half compared to contacts of active smokers.
• Results were consistent after adjusting for disease severity and restricting to younger children.
• The study underscores smoking cessation as an effective, rapid intervention to lower TB spread in households.

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TB and Diabetes Syndemic: Challenges and Opportunities

• Diabetes delays TB diagnosis, worsens disease severity (e.g., cavitary lesions), and increases mortality and relapse rates.
• Hyperglycemia—whether pre-existing or treatment-induced—predicts worse TB outcomes.
• M. tuberculosis infection can disrupt metabolism, contributing to insulin resistance.
• Certain diabetes medications (e.g., metformin) may improve TB immunopathology, while TB treatments can worsen glycemic control.
• Integrated care models with enhanced screening, tailored regimens, and glycemic monitoring are critical to improving outcomes in this syndemic.

See also: Lin TB Lab

References:

1. Yamanaka, T., Castro, M.C., Ferrer, J.P., Solon, J.A., Cox, S.E., Laurence, Y.V. and Vassall, A., 2024. Health system costs of providing outpatient care for diabetes in people with TB in the Philippines. IJTLD open, 1(3), pp.124-129.
2. Evans, D., Hirasen, K., Casalme, D.J., Gler, M.T., Gupta, A. and Juneja, S., 2024. Cost and cost-effectiveness of BPaL regimen used in drug-resistant TB treatment in the Philippines. IJTLD open, 1(6), pp.242-249.
3. Chu, A.L., Lecca, L.W., Calderón, R.I., Contreras, C.C., Yataco, R.M., Zhang, Z., Becerra, M.C., Murray, M.B. and Huang, C.C., 2021. Smoking cessation in tuberculosis patients and the risk of tuberculosis infection in child household contacts. Clinical Infectious Diseases, 73(8), pp.1500-1506.
4. Trevisi, L., Brooks, M.B., Becerra, M.C., Calderón, R.I., Contreras, C.C., Galea, J.T., Jimenez, J., Lecca, L., Yataco, R.M., Tovar, X. and Zhang, Z., 2024. Who transmits tuberculosis to whom: a cross-sectional analysis of a cohort study in Lima, Peru. American Journal of Respiratory and Critical Care Medicine, 210(2), pp.222-233.
5. Magodoro, I., Kotze, L., Stek, C.J., West, A., Le Roux, A., Sobratee, N., Taliep, A., Hamada, Y., Dave, J.A., Rangaka, M.X. and Parihar, S.P., 2025. Clinical, metabolic and immune interaction between tuberculosis and diabetes mellitus: implications and opportunities for therapies. Expert Opinion on Pharmacotherapy.
6. Pratiwi, R.D., Alisjahbana, B., Subronto, Y.W., Priyanta, S. and Suharna, S., 2025. Implementation of an information system for tuberculosis in healthcare facilities in Indonesia: evaluation of its effectiveness and challenges. Archives of Public Health, 83(1), pp.1-18.

Yoseph Samodra

TBC 068

Tuberculosis in Uganda

A study evaluates Uganda’s national community tuberculosis (TB) intervention using a before-and-after design within the RE-AIM framework, focusing on reach, adoption, outputs, and effectiveness. The intervention involved two biannual campaigns in 2022, aimed at enhancing TB detection and treatment initiation through a community-based approach involving village health teams.

Campaign 1 reached about 2.9% of Uganda’s population, while Campaign 2 significantly scaled up to 11.6%. The screening led to identifying thousands of presumptive and confirmed TB cases, with the majority initiating treatment. The strategy also successfully implemented preventive therapy for high-risk contacts, with over 23,000 individuals reached in the second campaign alone.

Adoption of the intervention expanded markedly between the two campaigns. While the first involved 76% of districts and about 38% of diagnostic units, the second campaign achieved full national coverage, indicating strong governmental and partner support. The logistical execution—mobilizing village teams, use of mobile diagnostics, and integration of educational tools—enhanced local engagement.

Effectiveness was clearly demonstrated through increased TB case notification rates: Campaign 1 improved the rate by 24%, while Campaign 2 achieved a 59% increase compared to pre-intervention periods. These gains were corroborated by inter-district comparisons, showing better outcomes in intervention districts. Furthermore, the initiative integrated leprosy screening, adding another dimension to its community health impact.

The study’s quasi-experimental design is well-suited to evaluating national public health initiatives where randomized control trials are not feasible. By using a control period from the previous year and stratifying by region, the study controls for seasonal and reporting biases. However, it does acknowledge potential variability in health infrastructure and service uptake across regions.

In conclusion, Uganda’s community TB intervention has proven to be an effective, scalable, and impactful public health strategy. With sustained support and refinement, it holds potential for long-term improvements in TB control, especially in high-burden and hard-to-reach communities.

Sources:

1. Turyahabwe, S., Bamuloba, M., Mugenyi, L., Amanya, G., Byaruhanga, R., Imoko, J.F., Nakawooya, M., Walusimbi, S., Nidoi, J., Burua, A. and Sekadde, M., 2024. Community tuberculosis screening, testing and care, Uganda. Bulletin of the World Health Organization, 102(6), p.400.

Dose–response relationship between BMI and tuberculosis

Tuberculosis remains a pressing public health problem in China, especially in regions with limited resources and high disease burden. Recognizing that factors such as age, sex, diabetes, and undernutrition may influence TB risk, this study set out to clarify the role of body mass index (BMI) in determining TB incidence in adults. The researchers conducted a large-scale, prospective cohort study in Dongchuan County, Yunnan Province, following over 26,000 participants for more than two years.

The methodology was robust, using repeated TB screenings and carefully measured BMI classifications. By categorizing individuals into underweight, normal weight, and overweight/obese groups, the investigators were able to track how different BMI levels related to new cases of active TB. They found that TB incidence rates were highest among those who were underweight and lowest among individuals classified as overweight or obese. Importantly, the study documented a clear dose–response relationship: for every one-unit increase in BMI, TB incidence decreased by almost 8%.

Multivariate analyses confirmed that overweight and obesity were significantly protective against TB even after adjusting for important confounders, including diabetes status and prior TB history. Subgroup analyses revealed that this protective effect was consistent in men, women, and the elderly, suggesting the findings are broadly applicable across different demographic profiles.

These results align well with prior evidence linking malnutrition to higher susceptibility to TB infection and progression. Notably, the study highlighted that BMI improvements could have contributed to recent TB declines in China, underscoring the role of nutritional status in TB control strategies. While underweight status was associated with higher TB rates, this association did not reach statistical significance in adjusted models, possibly due to limited power in the underweight subgroup.

Overall, this research provides valuable evidence that higher BMI can be an independent protective factor against TB. These findings support prioritizing targeted TB screening among individuals with low BMI and suggest that community-level nutritional interventions could help lower TB incidence further. For policymakers and clinicians, the study highlights an opportunity to integrate nutrition-focused strategies into TB prevention programs, especially in regions where undernutrition remains prevalent.

References:

1. Chen, J., Zha, S., Hou, J., Lu, K., Qiu, Y., Yang, R., Li, L., Yang, Y. and Xu, L., 2022. Dose–response relationship between body mass index and tuberculosis in China: a population-based cohort study. BMJ open, 12(3), p.e050928.

Interferon-γ release assays for diagnostic evaluation of tuberculosis

A multicenter cohort study evaluated the diagnostic performance of four interferon gamma release assays (IGRAs) in over 800 patients presenting with suspected active tuberculosis across English hospitals. Researchers compared traditional tests—T-SPOT.TB and QFT-GIT—to newer second-generation assays designed to incorporate novel M. tuberculosis antigens. The within-patient testing design minimized variability and allowed a robust head-to-head comparison of test characteristics.

The study found that T-SPOT.TB had moderately high sensitivity (81.4%) and specificity (86.2%), whereas QFT-GIT showed lower sensitivity (67.3%) and slightly lower specificity (80.4%). These findings align with prior reports indicating limited diagnostic accuracy of existing IGRAs in distinguishing active tuberculosis from latent infection or other conditions. In practical terms, neither T-SPOT.TB nor QFT-GIT demonstrated sufficient predictive values to function as reliable rule-in or rule-out tools in routine care.

By contrast, the second-generation IGRAs achieved sensitivity near 90% and negative predictive values approaching 90%, significantly outperforming older tests. This improvement was particularly notable in smear-negative and extrapulmonary tuberculosis cases, where conventional diagnostics often struggle. However, specificity was modest (around 80%), highlighting the persistent challenge of false positives in low-prevalence populations.

Importantly, the proportion of indeterminate results was lower for second-generation assays, suggesting they may be more robust in diverse clinical settings, including among patients with HIV and diabetes. The study also showed that adjusting test cutoffs did not meaningfully improve accuracy, underscoring that current assays are unlikely to achieve major gains simply by changing interpretive thresholds.

Overall, this work provides compelling evidence that while traditional IGRAs remain limited in their clinical utility, newer assays offer incremental benefits that could inform diagnostic pathways. These findings are relevant for clinicians, policymakers, and laboratories considering the adoption of advanced immunodiagnostic tools to support tuberculosis management.

References:

1. Whitworth, H.S., Badhan, A., Boakye, A.A., Takwoingi, Y., Rees-Roberts, M., Partlett, C., Lambie, H., Innes, J., Cooke, G., Lipman, M. and Conlon, C., 2019. Clinical utility of existing and second-generation interferon-γ release assays for diagnostic evaluation of tuberculosis: an observational cohort study. The Lancet Infectious Diseases, 19(2), pp.193-202.

The re-emerging association between tuberculosis and diabetes

Diabetes mellitus and tuberculosis are two major global health challenges whose intersection has been observed for more than a century. Historical records show that even before the discovery of insulin, TB was a frequent complication among patients with poorly controlled diabetes. Early studies, while limited in design, suggested that TB prevalence among diabetic patients was considerably higher than in the general population. This trend persisted across different eras and geographies.

The introduction of insulin therapy improved the survival of diabetic patients, inadvertently increasing the number of individuals who lived long enough to develop TB. Meanwhile, global shifts in lifestyle and nutrition led to a dramatic rise in obesity and type 2 diabetes, especially in regions where TB remains endemic. In contemporary times, some communities report that up to half of TB patients also have diabetes, underscoring the importance of this dual burden.

Beyond prevalence, disease severity and chronicity of diabetes have consistently emerged as key determinants of TB risk. Patients with prolonged hyperglycemia or a history of diabetic coma appear especially susceptible, likely due to compromised immune surveillance against Mycobacterium tuberculosis. This observation is consistent across older autopsy studies and modern epidemiological analyses.

Importantly, the association between TB and diabetes may not be unidirectional. While diabetes increases TB risk, evidence also suggests that TB can worsen glucose tolerance, either transiently through stress hyperglycemia or possibly by inflicting damage on pancreatic tissue. However, rigorous studies clarifying this pathway remain limited.

Treatment outcomes for patients with both diseases have historically been poor. Delays in diagnosis, limited therapeutic options, and socioeconomic disadvantage all contributed to high mortality rates among TB-DM patients in the past. Even today, diabetes remains a predictor of delayed TB clearance, treatment failure, and relapse.

Overall, the historical literature, despite its methodological limitations, provides valuable insights that remain relevant. It underscores the need for integrated strategies addressing both diabetes management and TB control, especially in low-resource settings where the co-occurrence of both conditions is increasingly common.

References:

1. Cadena, J., Rathinavelu, S., Lopez-Alvarenga, J.C. and Restrepo, B.I., 2019. The re-emerging association between tuberculosis and diabetes: lessons from past centuries. Tuberculosis, 116, pp.S89-S97.

Pulmonary Tuberculosis Incidence Rate with Genexpert Examination Method

Tuberculosis remains a significant public health problem in many regions, necessitating rapid and accurate diagnostic methods. GeneXpert is a molecular diagnostic tool capable of simultaneously detecting Mycobacterium tuberculosis and rifampicin resistance within two hours. This study applied GeneXpert to screen suspected TB patients at Mlati II Sleman Health Center from 2020 to 2023. The analysis relied on a descriptive cross-sectional approach using secondary medical record data.

Over four years, 587 patients suspected of pulmonary tuberculosis were examined. Of these, 15% tested positive for TB. A noteworthy finding is that while the proportion of positive cases decreased across the years, the absolute number of TB diagnoses increased, correlating with a rise in the number of patients screened, particularly in 2022 and 2023. This may reflect improved case-finding efforts or heightened awareness and reporting during this period.

Demographic analysis showed that TB was more common among males (58%) and that adults aged 26 to 65 accounted for most positive cases. Younger children (1–11 years) represented only 8% of TB cases, which may suggest differences in exposure risk or diagnostic practices across age groups.

The methodology was appropriate for providing descriptive epidemiological data. However, since no inferential statistics or comparative analysis were performed, caution should be exercised when interpreting these trends as indicative of underlying causes. Factors such as HIV co-infection, socio-economic status, and prior TB treatment were not analyzed, though they can significantly influence TB incidence.

Overall, GeneXpert proved to be a feasible diagnostic option in this health center, supporting early diagnosis and treatment initiation. The study underlines the importance of consistent TB screening, especially in endemic areas, and demonstrates how scaling up molecular testing can improve TB detection rates.

References:

1. Wati, N., Mu’awanah, I.A.U. and Amalia, A.A., 2024. Pulmonary Tuberculosis Incidence Rate with Genexpert Examination Method at Mlati II Public Health Center, Sleman In 2020-2023. International Journal of Health, Economics, and Social Sciences, 6(4), pp.1124-1129.

Biomarkers & Social Determinants

1. Metabolic and Immunological Predictors of TB Risk

• TyG index as a risk indicator Elevated TyG index and its derivatives (TyG-WC, TyG-BMI, TyG-WHtR) are linked to increased risk of latent TB infection in adults with normal or impaired glucose tolerance. The association is especially notable in metabolically healthy individuals and is not significant in those with diabetes, indicating TyG is more predictive in earlier stages of metabolic dysfunction.
• Immune response differences after TB exposure Among individuals exposed to TB, those who remain uninfected show distinct immune gene expression profiles compared to those who develop latent infection. Key differences include heightened CD8+ T-cell activity in uninfected individuals and increased IL-17, TNF, and mast cell signaling in infected individuals.
• Potential biomarkers for early TB risk detection Specific genes such as ATG-7, CXCL-3, and TNFRSF1B may serve as early warning markers for TB susceptibility after exposure, offering opportunities for early diagnosis or risk stratification.

See also: Lin TB Lab

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2. Environmental and Behavioral Risk Factors for TB Spread and Management

• Exposure time strongly influences TB transmission Individuals exposed to active TB cases for more than 6 hours per day are nearly seven times more likely to contract the infection than those exposed for under 6 hours per week. Children under 5 and immigrants are particularly high-risk groups for TB transmission, suggesting the need for prioritized interventions in these populations.
• Health beliefs and treatment adherence TB patients with higher perceived risk (susceptibility), perceived treatment benefits, and support from others are more likely to follow their treatment regimen. Perceived barriers and low self-efficacy negatively affect adherence, highlighting the role of psychological and social factors in treatment outcomes.
• Behavior change can improve outcomes Tailoring interventions to improve risk perception, reduce perceived barriers, and build patient confidence may significantly boost adherence and overall TB control efforts.

See also: YL Samodra

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3. Long-Term Health Consequences of TB

• Pulmonary TB increases long-term risk of COPD Individuals with a history of TB are two to three times more likely to develop chronic obstructive pulmonary disease (COPD), even after accounting for smoking and other lifestyle factors. This association is strongest among older adults and people with lower education, indicating a compounded effect of biological vulnerability and social disadvantage.
• Implication for post-TB care TB history should be routinely considered in COPD risk assessment and follow-up care, even years after TB recovery. Preventing TB can have added benefits in reducing the future burden of chronic lung disease.

References:

1. Qi, M., Qiao, R. and He, J.Q., 2025. The association between triglyceride-glucose index and related parameters and risk of tuberculosis infection in American adults under different glucose metabolic states: a cross-sectional study. BMC Public Health, 25(1), pp.1-11.
2. Qi, X., Yang, Q., Cai, J., Wu, J., Gao, Y., Ruan, Q., Shao, L., Liu, J., Zhou, X., Zhang, W. and Jiang, N., 2024. Transcriptional profiling of human peripheral blood mononuclear cells in household contacts of pulmonary tuberculosis patients provides insights into mechanisms of Mycobacterium tuberculosis control and elimination. Emerging Microbes & Infections, 13(1), p.2295387.
3. Godoy, S., Parrón, I., Millet, J.P., Caylà, J.A., Follia, N., Carol, M., Orcau, A., Alsedà, M., Toledo, D., Plans, P. and Ferrús, G., 2024. Risk of tuberculosis among pulmonary tuberculosis contacts: the importance of time of exposure to index cases. Annals of Epidemiology, 91, pp.12-17.
4. Wang, J., Yu, L., Yang, Z., Shen, P., Sun, Y., Shui, L., Tang, M., Jin, M., Chen, B., Ge, Y. and Lin, H., 2025. Development of chronic obstructive pulmonary disease after a tuberculosis episode in a large, population-based cohort from Eastern China. International journal of epidemiology, 54(2), p.dyae174.
5. Suprijandani, S., Setiawan, S., Pathurrahman, P., Wardoyo, S. and Rahayyu, A.M., 2025. The behaviour of TB patients in East Lombok through a health belief model approach. Journal of Health, Population and Nutrition, 44(1), p.23.

Yoseph L. Samodra

TBC 067