The financial consequences of tuberculosis (TB) are broadly classified into direct and indirect costs. Direct costs include medical expenses such as drugs, laboratory tests, physician fees, radiological investigations, and hospitalization. These costs are often high relative to per capita income and place a substantial burden on household finances, particularly in low- and middle-income countries. Indirect costs arise from illness-related loss of income, reduced work capacity, and decreased labor supply due to disability or death. TB also imposes significant pressure on healthcare systems through increased hospital expenditures and welfare costs, although potential revenues could be generated through effective cost recovery for services such as diagnostics, drugs, radiology, and human resources.
Tuberculosis remains highly stigmatized in many communities, primarily due to fear of transmission, but also because of its strong association with HIV, poverty, low social status, malnutrition, and socially disapproved behaviors. This stigma can lead to social isolation, abandonment by family, exclusion from workplaces or communities, and job loss. Negative and often poorly informed societal perceptions reinforce discrimination against TB patients. Because TB has long been associated with poverty, poor hygiene, and social marginalization, affected individuals may face social disregard. Limited awareness and misinformation contribute significantly to this prejudice, and in some cases, stigma within healthcare settings further compromises access to diagnosis, treatment adherence, and clinical outcomes.
Tuberculosis and malnutrition are closely linked, with malnutrition acting both as a risk factor for infection and as a consequence of disease. Malnutrition is associated with poorer prognosis, increased mortality, and false-negative tuberculin test results, which may delay diagnosis. Nutritional deficiencies can cause secondary immunodeficiency, increasing susceptibility to TB. Conversely, TB reduces appetite, impairs nutrient absorption, alters metabolism, and leads to muscle wasting due to impaired protein utilization. Deficiencies in micronutrients such as zinc, selenium, iron, copper, and vitamins A, C, D, and E further compromise immune function. Low serum vitamin D levels have been observed in patients with active TB and multidrug-resistant TB during treatment. Improving nutritional status and providing adequate supplementation may support recovery and represent an effective strategy for TB control in resource-limited settings.
Since the introduction of antibiotics in the 1940s, tuberculosis has become a treatable disease. Current TB elimination strategies focus on early detection and treatment of active cases to interrupt transmission, alongside screening and treatment of latent TB infection to prevent disease progression.
Bacillus Calmette-Guérin (BCG) vaccination is the most widely administered vaccine worldwide and provides protection against severe forms of TB in young children, particularly miliary and disseminated disease. However, it does not consistently protect against pulmonary TB.
To improve adherence in the treatment of latent TB infection, the World Health Organization has recommended since 2020 a three-month regimen of weekly rifapentine and isoniazid (3HP).
Close contact remains an important route of TB transmission. Even routine parental behaviors such as kissing children may pose a risk when caregivers are infected, highlighting the need for awareness and preventive caution.
Following the introduction of X-rays in 1895, chest radiography became an essential tool for identifying pulmonary TB lesions. From the 1940s onward, radiographic screening enabled earlier detection of active disease, including cases without overt clinical symptoms, allowing timely initiation of treatment and improved disease control.
Source: Varotto, E., Martini, M., Vaccarezza, M., Vittori, V., Mietlińska-Sauter, J., Gelsi, R., Galassi, F.M. and Papa, V., 2025. Historical and Social Considerations upon Tuberculosis. Journal of Preventive Medicine and Hygiene, 66(1), pp.E145-E152.
