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).

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.

Predictive biomarkers for progression to active tuberculosis

Individuals with latent tuberculosis infection (LTBI) carry an increased risk of progression to active TB. However, a substantial but unknown proportion of people with LTBI will not develop TB. This may be because their immune systems are able to persistently control mycobacterial replication or because they are no longer infected with live bacteria. The risk of reactivation, disease, and mortality increases significantly in Mycobacterium tuberculosis-infected individuals who experience immune suppression. This immune suppression may result from HIV co-infection, treatment with tumor necrosis factor (TNF)-α inhibitors, the use of other immune regulators prescribed for inflammatory diseases and transplantation, or compromised immunity associated with noncommunicable diseases such as type 2 diabetes.

The outcome of M. tuberculosis infection is therefore not a simple two-state process of either LTBI or active TB. Instead, it represents a continuous spectrum of disease states that differ by pathogen and host “activity.” These differences require diverse diagnostic and treatment strategies.

When evaluating the positive predictive value (PPV) of diagnostic tests to identify which LTBI cases will progress to active TB, estimates remain low. Assuming a 2-year cumulative TB incidence of 2% and a 50% effectiveness of isoniazid preventive treatment, the optimal achievable PPV is approximately 16%. The minimal target PPV under the same scenario is about 6%. In contrast, current generations of interferon-γ release assays (IGRAs), as outlined in World Health Organization latent TB infection guidelines, have a PPV of only 2–3%. In parallel with the development of target product profiles (TPP), a framework for validating such tests is being formulated.

To improve prediction, a 16-gene transcriptomic correlate of risk (COR) was developed. Measurement of the 16-gene COR was transitioned from RNA sequencing (HiSeq2000; Illumina) to a high-throughput, microfluidic, real-time PCR platform to enable cheaper and simpler gene expression analysis. The PCR-based 16-gene transcriptomic COR signature was validated through blind prediction in two independent cohorts of South African and Gambian individuals—progressors and controls—from a prospective household TB contact study (GC6–74, the Biomarkers for TB Consortium). In these validation cohorts, the signature demonstrated a sensitivity of 54% and a specificity of 83%.

Ongoing analyses aim to further explore the biological processes that underlie TB progression in adolescents. Notably, all 16 genes comprising the COR signature are regulated by type I and type II interferons (IFNs). This suggests that chronic peripheral activation of the IFN response—previously associated with active TB disease at the time of diagnosis—also precedes the onset of active TB disease.

Sources:

1. Petruccioli, E., Scriba, T.J., Petrone, L., Hatherill, M., Cirillo, D.M., Joosten, S.A., Ottenhoff, T.H., Denkinger, C.M. and Goletti, D., 2016. Correlates of tuberculosis risk: predictive biomarkers for progression to active tuberculosis. European Respiratory Journal, 48(6), pp.1751-1763.

Tuberculosis in Yogyakarta

Tuberculosis remains a leading cause of mortality in Indonesia, particularly among individuals with chronic conditions like Diabetes Mellitus. This study was conducted at UGM Academic Hospital to understand the extent of TB co-infection among DM patients and assess whether active two-way screening could improve early detection. Using both a standardized symptom screening tool (PERJAKA 2M) and chest x-rays, researchers aimed to identify suspected TB cases systematically.

The descriptive cross-sectional design allowed the investigators to capture data over a six-week period among 109 consenting DM patients. The PERJAKA 2M instrument flagged about one in five patients as TB suspects based on symptoms alone. However, chest x-rays revealed radiologic signs of TB in only 3 patients, suggesting that symptom screening might overestimate suspicion rates without confirmatory imaging.

Sputum examinations, which serve as the definitive test, confirmed TB in only one individual. While this proportion appears low, it underscores the importance of maintaining vigilance in high-risk groups. Many DM patients with TB-like symptoms might have other pulmonary or metabolic complications mimicking TB presentations.

Despite limitations in scope and sample size, the findings highlight that active screening can detect cases potentially missed during routine care. The combination of symptom checklists, imaging, and sputum analysis ensures a more reliable diagnosis pathway, supporting national TB control efforts.

Future research should consider larger populations across multiple centers to strengthen the evidence base. Incorporating socioeconomic and nutritional variables may also clarify the risk profile of DM patients for TB infection. Overall, this study contributes valuable insights into operationalizing TB screening in a real-world clinical setting.

Source:

1. Hariyanto, S.W., Avidati, H., Ulfah, U., Nurlaily, A.N. and Tejaningrum, K.D., Tuberculosis Screening in Patients with Diabetes Mellitus at the Internal Medicine Clinic of UGM Academic Hospital: Descriptive Study. Academic Hospital Journal, 7(1), p.8.

Tuberculosis in Georgia

A retrospective cohort study conducted in Georgia investigated the relationship between BMI change during M/XDR-TB treatment and mortality. The researchers used routinely collected clinical and laboratory data, enabling them to follow a large cohort over a decade. Their focus on the early treatment period (3–6 months) was well justified, given that early weight changes may reflect treatment response, disease severity, and nutritional recovery.

The findings revealed that a majority of patients (nearly 70%) experienced BMI increases during treatment, highlighting a potential recovery trajectory. However, those who did not gain weight—or who lost weight—faced substantially higher risks of death, particularly among patients with low or normal BMI at treatment start. Notably, among individuals with normal BMI, weight loss was linked to a fivefold higher risk of death during treatment, and among those underweight at baseline, not gaining weight was associated with a fivefold higher post-treatment mortality risk.

Although some results did not reach statistical significance, likely due to limited sample size and the low number of deaths, the consistent patterns across analyses strengthen confidence in the findings. Importantly, this study underscores that weight gain is not just a marker of nutritional recovery but may be an independent prognostic factor for survival in TB treatment.

These results have significant clinical implications. Routine monitoring of BMI and targeted nutritional support for patients who fail to gain weight during the early months of treatment could be integrated into TB programs. Such interventions may improve survival, particularly for patients with undernutrition—a known risk factor for poor TB outcomes.

Overall, the study provides evidence that can inform TB care guidelines and highlights the need for additional research. Future studies should evaluate whether nutritional supplementation and metabolic support could reduce mortality in high-risk patients with drug-resistant TB.

Source:

1. Chakhaia, T., Blumberg, H.M., Kempker, R.R., Luo, R., Dzidzikashvili, N., Chincharauli, M., Tukvadze, N., Avaliani, Z., Stauber, C. and Magee, M.J., 2025. Lack of weight gain and increased mortality during and after treatment among adults with drug-resistant tuberculosis: a retrospective cohort study in Georgia, 2009–2020. ERJ Open Research.

Information system for tuberculosis

Indonesia, with one of the world’s highest TB burdens, relies on SITB to track and manage tuberculosis cases nationwide. This study thoroughly evaluated SITB through a multimethod approach that included heuristic evaluation, user satisfaction surveys, and in-depth interviews with health workers.

The heuristic evaluation revealed multiple usability issues, most notably inconsistent terminology, inadequate error prevention, and interface design flaws that could hamper efficient reporting. Among these, limited data entry capability due to server constraints was a critical limitation affecting system performance during busy hours.

User satisfaction measured through the EUCS model showed generally positive perceptions, with an average satisfaction score of 4.08. However, dimensions like ease of use and timeliness fell below optimal levels. Users reported frustration over the slow response time and difficulties learning to use the system without formal training.

Qualitative interviews further illuminated operational challenges. Although recent integration with the civil registration system (Dukcapil) improved data completeness and reduced some manual work, users still had to enter duplicate information into separate systems, highlighting the need for seamless EMR integration.

The study emphasizes that while SITB has significantly modernized TB reporting in Indonesia, its full potential will only be realized through targeted enhancements—especially improving system performance, refining user support materials, and completing integration with EMR platforms.

These findings will serve as a roadmap for policymakers and system developers aiming to optimize SITB’s functionality and support Indonesia’s TB elimination goals by 2030.

Source:

1. 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.

Syndemic of TB and diabetes

Tuberculosis and diabetes mellitus have emerged as a syndemic, with each condition exacerbating the other. Patients with both diseases experience diagnostic challenges, as diabetes can significantly delay TB diagnosis and treatment initiation. For example, studies in China demonstrate a fourfold longer median time from symptom onset to first healthcare contact among people with diabetes. Although some reports suggest quicker treatment initiation, the weight of evidence supports delayed diagnosis as a common scenario.

Clinical presentations in patients with concurrent TB and diabetes are frequently more severe. These include disseminated disease, cavitary lesions, and atypical radiographic features that can further complicate diagnosis and management. Poor glycemic control correlates with worse disease severity, underscoring the need for meticulous monitoring of glucose levels throughout TB treatment. Notably, many patients without prior diabetes can develop transient hyperglycemia during therapy, raising questions about optimal screening and retesting intervals.

Treatment outcomes are consistently poorer in patients with diabetes. These individuals have higher mortality rates, greater risks of relapse, longer times to sputum conversion, and increased likelihood of multidrug-resistant TB. The interplay between diabetes and TB medications, along with the higher pill burden, increases the risks of adverse effects and treatment interruptions. Furthermore, hyperglycemia, whether transient or chronic, predicts worse TB outcomes, pointing to a complex interaction beyond simple glucose elevation.

At the biological level, M. tuberculosis infection of adipose tissue may drive metabolic disruptions that mimic the inflammatory state seen in insulin resistance. This mechanistic link provides a plausible explanation for the bidirectional relationship between TB and dysglycemia. Diabetes impairs both innate and adaptive immunity against TB, compromising the host’s ability to clear infection and leading to higher bacterial loads.

Emerging evidence suggests that certain diabetes medications, such as metformin and statins, may exert beneficial effects on TB immunopathology, independent of their glucose-lowering properties. However, corticosteroids and some TB treatments may worsen hyperglycemia, necessitating careful therapeutic balancing. There is a clear need for rigorous studies, including randomized controlled trials and standardized registries, to clarify these interactions and optimize treatment strategies.

Overall, the syndemic of TB and diabetes requires integrated management approaches that address not only microbial eradication but also metabolic and immunological dysfunction. Enhanced screening, prompt diagnosis, tailored treatment regimens, and close glycemic monitoring will be crucial to improving outcomes in this vulnerable population.

Source:

1. 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.

Tuberculosis in Peru

TB transmission [2]

A study investigates how TB spreads in urban Lima by analyzing over 2,500 culture-positive TB cases using whole-genome sequencing. Researchers assessed whether various demographic, social, and biological factors influence who transmits TB. They identified 1,447 direct transmission pairs based on genetic similarity and diagnosis timing.

Results showed that younger adults, males, smokers, and drinkers were more likely to be transmitters. Notably, incarceration history had a strong influence—if both individuals in a pair had been incarcerated, the likelihood of transmission increased over tenfold. Clinical features like cavitary disease and prior TB also raised the odds of transmission.

The study’s strength lies in using advanced genomic tools and a large cohort to clarify TB spread patterns in a community. These findings suggest that public health efforts should prioritize high-risk groups—especially former prisoners and substance users—to better curb TB transmission. Importantly, the study provides a template for using genomic data in real-world public health planning.

Smoking cessation in tuberculosis patients [1]

A study conducted in the metropolitan area of Lima, Peru, sought to investigate whether recent smoking cessation among pulmonary tuberculosis (TB) patients could reduce the risk of TB infection in their child household contacts compared to continued active smoking. Researchers enrolled newly diagnosed pulmonary TB patients and their household child contacts aged 15 years or younger between September 2009 and August 2012. At enrollment, patients' smoking histories were categorized as never smoked, distant quitters (ceased smoking more than two months prior to diagnosis), recent quitters (ceased smoking within two months of diagnosis), or active smokers. Tuberculosis infection among child contacts was assessed using the tuberculin skin test (TST) at baseline, six months, and twelve months.

The study population included 905 TB patients and 1811 child contacts, with 78% of the index patients classified as never smokers, 11.7% as distant quitters, 7.9% as recent quitters, and 2.5% as active smokers. At baseline, 24.4% of the child contacts tested TST-positive, a figure that rose to 37.3% by six months. Multivariate analysis showed that child contacts of recent quitters had a significantly lower risk of TB infection compared to those of active smokers, with adjusted risk ratios (aRR) of 0.45 at baseline and 0.48 at six months. Furthermore, the risk of infection among contacts of recent quitters was comparable to that among contacts of never smokers.

These findings suggest that children exposed to TB patients who had recently quit smoking had a significantly reduced risk of TB infection compared to those exposed to active smokers. Sensitivity analyses adjusting for disease severity, timing of quitting, and restricting to younger children confirmed the robustness of the results. Overall, the study highlights the potential for smoking cessation interventions to rapidly and effectively reduce TB transmission within households.

Source: 

1. 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.
2. 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.

Tuberculosis in the Philippines

BPaL Regimen Costs [2]

A research sought to fill a knowledge gap about the real-world economic burden of BPaL, a WHO-endorsed treatment for DR-TB, in the Philippines. By analyzing patient and provider costs using rigorous economic evaluation methods, the study found that BPaL substantially reduces direct and indirect costs for patients. The use of patient surveys and financial reviews allowed for detailed cost capture, adding strength to the cost-effectiveness conclusions.

Crucially, BPaL not only demonstrated lower costs but also superior treatment success rates compared to current regimens. These results are especially impactful given the high burden of DR-TB in resource-constrained settings like the Philippines. The study's robust design — including standardized patient selection and multiple data sources — supports its credibility.

From a policy perspective, the data suggest that transitioning DR-TB treatment toward the BPaL regimen could improve both patient outcomes and economic efficiency. Lower healthcare visits and reduced catastrophic expenditures further emphasize its advantage in practical, real-world implementation.

The economic analysis, including favorable ACER and ICER values under established GDP thresholds, clearly supports the adoption of BPaL. With cost and health advantages converging, the study makes a strong case for the national TB program to prioritize BPaL in routine care beyond the operational research context.

Outpatient DM Costs [1]

In 2021, diabetes mellitus (DM) outpatient visits accounted for 3% to 13% of total outpatient visits across 11 study sites in the Philippines. The study assessed various unit costs associated with DM services, including risk assessments at USD 0.53 and screenings using fasting blood sugar (FBS) at USD 2.99 when conducted with a chemistry analyzer. Random plasma glucose (RPG) screenings were slightly lower, costing USD 1.67, while the oral glucose tolerance test (OGTT), offered in only one private hospital, had the highest cost at USD 23.72. HbA1c testing was available in select facilities, further contributing to screening and diagnostic costs.

The weighted mean monthly drug cost per DM patient was estimated at USD 7.67, with metformin costing USD 2.11 per month and gliclazide ranging from USD 2.92 to USD 3.22, depending on dosage. Among injectable drugs, biphasic isophane human insulin was the most commonly prescribed, with an average monthly cost of USD 29.45. Staff time was the primary cost driver for outpatient services not requiring laboratory tests, accounting for 70% to 92% of costs, while consumables made up 52% to 90% of the expenses for screening and diagnosis services.

The cost per DM case detected among TB patients was lowest when using the RPG plus FBS algorithm at USD 17.43 per case, and HbA1c plus FBS at USD 25.41. When screening was limited to patients aged over 45 years, these costs decreased to USD 11.73 and USD 16.17 per case, respectively. Overall, the monthly cost per DM outpatient ranged from USD 8.95 for drug prescriptions alone to USD 12.36 when monitoring and consultations were included. These findings provide essential data to inform planning and budgeting for integrated TB-DM care, although further research is needed to explore inpatient costs and the patient perspective.

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.

Tuberculosis in Lombok

A study investigating the treatment adherence of tuberculosis (TB) patients in East Lombok utilized a questionnaire grounded in the Health Belief Model (HBM) as its primary instrument. The questionnaire was designed to assess six key components: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. Responses were recorded using a 5-point Likert scale, ranging from “strongly disagree” to “strongly agree.” The study included 112 TB patients, most of whom were male (57.1%) and aged over 50 (44.6%). A significant portion of participants were smokers (41.1%), while alcohol use was minimal (8.9%). Educational levels were generally low, with 35.7% having only completed primary education, and unemployment was common among respondents (40.2%).

The findings revealed that most participants held moderate perceptions of vulnerability (44.6%) and seriousness (53.6%) regarding TB. Similarly, 49.1% had moderate perceptions of treatment benefits, while 40.2% reported relatively low perceived barriers. Half of the participants (50.9%) reported receiving external support, categorized as cues to action, and 31.3% exhibited low self-efficacy. In terms of health behaviors, 58% of TB patients were adherent to their treatment regimens, whereas 42% were not. Statistical analysis indicated that perceived susceptibility (p = 0.022) and perceived benefits (p = 0.006) were positively associated with adherence. Patients with high perceived susceptibility were 1.617 times more likely to adhere to treatment. On the other hand, perceived barriers (p = 0.045) were negatively associated with adherence, reducing the likelihood of adherence by 31.6%. Additionally, cues to action (p = 0.004) and self-efficacy (p = 0.009) also had significant positive effects.

While the results offer valuable insights, the study’s cross-sectional design limits the ability to infer causality between HBM components and TB-related health behaviors. Furthermore, reliance on self-reported data introduces the possibility of social desirability bias, where participants may have provided responses they deemed more socially acceptable. Despite these limitations, the study highlights the importance of addressing both psychological and contextual factors to improve TB treatment adherence. Interventions that strengthen positive perceptions and reduce barriers—while being sensitive to local cultural and social realities—may lead to more effective public health strategies in regions like East Lombok.

Source: 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.

Development of COPD after a TB episode

Several studies have shown that people who recover from tuberculosis (TB) often experience lasting airway obstruction or ongoing respiratory symptoms. In China alone, around 100 million individuals are estimated to have chronic obstructive pulmonary disease (COPD), making up nearly a quarter of the global COPD burden. This study used data from the CHERRY cohort, an electronic health database covering 98% of adults in Yinzhou District, to explore the long-term impact of TB on COPD development. We included participants over 35 years of age and excluded anyone diagnosed with TB after a COPD diagnosis.

Tuberculosis cases were identified using the national disease reporting system and defined through ICD-10 codes. Similarly, COPD diagnoses were captured through the same coding system. Once someone was diagnosed with COPD, they no longer contributed to follow-up. The main analysis measured the time between enrollment (or TB diagnosis, if it occurred later) and the earliest of three events: COPD diagnosis, death, or the end of the study in September 2021. We compared COPD incidence in people with and without TB using Poisson tests and adjusted for various factors through three multivariable models.

The study enrolled nearly 200,000 individuals, with a median age of 46.5 years and an even gender distribution. During nearly 10 years of follow-up, over 16,000 developed COPD, including 23.6% of those with prior pulmonary TB. In contrast, the overall COPD incidence was 8.3%. After adjusting for age, lifestyle factors, comorbidities, and medication use, pulmonary TB remained a strong predictor of future COPD. The hazard ratios ranged from 2.63 in minimally adjusted models to 1.77 in fully adjusted models. This association was especially strong in older adults and those with lower educational attainment.

Importantly, the increased COPD risk remained even after accounting for smoking status, alcohol use, and physical activity, and the results were consistent across sensitivity analyses. These findings highlight the long-term respiratory consequences of TB and suggest that a history of TB should be considered a key risk factor when evaluating COPD risk. Preventing TB may not only reduce TB-related morbidity but also offer additional benefits in lowering COPD rates in the general population.

Source: 

1. 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.

Tuberculosis in Spain

A study addresses the impact of exposure time to pulmonary tuberculosis (TB) on the risk of transmission among contacts in Catalonia, Spain. By examining over 7,000 individuals exposed to 847 TB cases, the researchers found a clear association between longer daily exposure and increased TB risk. Those exposed for more than 6 hours a day had nearly 7 times the risk of developing TB compared to those exposed less than 6 hours a week.

Particularly vulnerable groups included children under 5 years, who were over eight times more likely to develop TB, and immigrants, who had nearly double the risk compared to non-immigrants. Although smoking showed an increased risk, the association wasn't statistically significant. These findings suggest that exposure time is a critical determinant in TB transmission, reinforcing the need for timely and focused contact investigations.

Importantly, the research emphasizes the value of integrating TB screening into routine primary care systems, particularly for high-risk populations. By tailoring public health strategies to exposure time and personal risk factors, TB control programs can become more efficient and effective.

Source: 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.

Triglyceride-glucose Index and Risk of TB Infection

A study aimed to evaluate how the triglyceride-glucose (TyG) index and its related parameters correlate with the risk of latent TB infection in adults, considering different states of glucose metabolism. Drawing from the NHANES 2011–2012 data, researchers analyzed 4823 participants after strict exclusion criteria. The TyG index was calculated alongside its derived markers (TyG-WC, TyG-BMI, TyG-WHtR), and TB infection was assessed using standard diagnostic tests.

The results revealed that individuals with normal glucose tolerance (NGT) and those with impaired glucose tolerance (IGT) had significantly higher odds of TB infection when TyG index values were elevated. Particularly in the NGT group, even modest increases in TyG values were linked to a notable rise in TB risk. In contrast, no significant relationship was found between TyG markers and TB infection in people with diabetes (DM) or impaired fasting glucose (IFG).

While the findings support TyG as a potential early marker of TB susceptibility in metabolically healthier adults, the study design limits causal inferences. Additionally, the extremely high odds ratios in some subgroups call for careful interpretation and further research to confirm these patterns and understand the underlying mechanisms.

Source: 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.