Redefining Tuberculosis Through the Disease Spectrum: From Biological Continuum to Precision Prevention and Care

Tuberculosis has accompanied humanity for millennia and remains one of the world’s leading infectious causes of death. Yet our understanding of TB has undergone a fundamental transformation. Rather than existing as two discrete states, latent infection and active disease, it is now increasingly recognized as a dynamic spectrum of biological and clinical states, reflecting continuous interactions between Mycobacterium tuberculosis, the host immune response, and environmental and social determinants.This paradigm shift presents an opportunity to rethink TB prevention, diagnosis, treatment, and control. While current clinical practice and public health programs largely continue to operate within a binary framework, emerging evidence demonstrates that individuals transition through multiple stages, including incipient, subclinical, and clinically active disease, each characterized by distinct immunological, microbiological, and pathological features. Recognizing these transitions opens new possibilities for earlier diagnosis, individualized treatment, targeted preventive therapy, and interruption of transmission before symptomatic disease develops.The overarching theme of this Research Topic is "Redefining Tuberculosis Through the Disease Spectrum." The collection aims to explore how adopting a spectrum-based framework can bridge discoveries in basic science with advances in clinical medicine and public health implementation, moving beyond describing the spectrum toward understanding how this evolving concept should reshape TB research, policy, and patient care.Major knowledge gaps remain. Current diagnostic tools cannot reliably distinguish latent infection from incipient or subclinical disease, limiting opportunities for early intervention. Treatment strategies remain largely standardized despite substantial heterogeneity in disease severity, bacterial burden, host immune responses, and patient characteristics. The growing burden of non-communicable diseases such as diabetes, malnutrition, HIV co-infection, silicosis, and other comorbidities further illustrates the need for personalized approaches that account for diverse patient phenotypes. At the same time, multidrug-resistant and extensively drug-resistant TB highlight the intersection of microbial evolution, host biology, health systems, and access to care.This Research Topic welcomes high-quality original research, systematic reviews, and translational studies that advance understanding of the TB disease spectrum, with particular emphasis on longitudinal investigations characterizing transitions across the spectrum, validation of predictive biomarkers, evaluation of host-directed and precision therapeutic strategies, and integration of genomic, immunological, microbiological, imaging, and clinical data to refine disease classification and personalize patient management.The collection welcomes contributions on themes including longitudinal cohort studies across the TB spectrum, biomarker discovery and validation, clinical trials of diagnostics, preventive therapy or host-directed therapies, molecular epidemiology and genomics, AI, imaging and digital health applications, implementation and health systems research, incipient and subclinical TB, precision medicine approaches, drug-resistant TB across the disease spectrum, host-pathogen interactions, TB spectrum in HIV, diabetes, malnutrition and silicosis, and translation of spectrum science into national TB programs.If you are interested in submitting or have any questions please contact the journal email: tuberculosis@frontiersin.org Topic editors: Stephen Henry Gillespie, Stellah George Mpagama Source: https://www.frontiersin.org/research-topics/85502/redefining-tuberculosis-through-the-disease-spectrum-from-biological-continuum-to-precision-prevention-and-care