The Pulmonary Microbiome in Tuberculosis: From Dysbiosis to Diagnostics and Therapeutics

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), remains one of the leading infectious causes of death worldwide, killing over one million people each year. Despite decades of research focused on the pathogen itself, our understanding of the broader pulmonary microbial environment in which Mtb establishes infection remains limited. The lung is not a sterile organ — it harbours a dynamic microbial community that plays a fundamental role in shaping local and systemic immune tone. Disruption of this community, through infection, antibiotic treatment, or host-related factors, may tip the balance between pathogen control and disease progression in ways that are only beginning to be understood.Emerging evidence demonstrates that active TB is associated with significant dysbiosis of the pulmonary microbiome, characterised by reduced microbial diversity, altered community composition, and increased microbial mobility across respiratory compartments. These changes do not occur in isolation: the gut–lung axis links intestinal and pulmonary microbial communities bidirectionally, with perturbations in one compartment reverberating in the other. Standard anti-TB drug regimens further compound this disruption, often reducing microbiota diversity in ways that are only partially restored upon treatment completion. Crucially, these microbial shifts appear to influence host immune responses — including macrophage polarisation, T helper cell differentiation, and mucosal barrier integrity — with direct implications for TB susceptibility, severity, and treatment outcomes.This Research Topic invites original research articles, systematic reviews, and perspectives that advance our mechanistic and clinical understanding of the pulmonary microbiome in the context of TB. We particularly encourage contributions addressing the following themes:-Characterisation of the respiratory microbiome across the spectrum of TB disease — from latent infection to active pulmonary and extrapulmonary TB-Mechanisms of dysbiosis induced by Mtb infection and/or anti-TB therapy, including bacteriome, mycobiome, and virome alterations-The gut–lung axis in TB, including cross-compartment microbial signals, metabolite-mediated immune crosstalk, and systemic inflammatory consequences-Microbiome–immunity interactions, including modulation of innate and adaptive immune responses relevant to TB pathogenesis and protection-Microbiome-based diagnostics, such as respiratory or stool microbial signatures that distinguish active TB, latent infection, or treatment response-New therapy strategies: Phage-based interventions targeting dysbiosis, Engineered postbiotics, Inhaled microbiome-modulating formulations, Microbiome-informed drug dosing strategies, Sequential microbiome restoration protocols alongside anti-TB regimens-Host-microbiome interactions in vulnerable populations, including individuals with HIV coinfection, diabetes, malnutrition, or drug-resistant TBTopic Editor Daniel Szulczyk is employed by MSD Poland. All other Topic Editors declare no competing interests with regards to the Research Topic subject. Topic editors: Daniel Szulczyk, Sumanta Kumar Naik Source: https://www.frontiersin.org/research-topics/82339/the-pulmonary-microbiome-in-tuberculosis-from-dysbiosis-to-diagnostics-and-therapeutics