Tuberculosis (TB) remains one of our most formidable public health challenges. Despite extensive global initiatives, strides in TB control are persistentlyobstructed by factors like drug resistance, missed diagnoses, and the financialburden on patients. A nuanced understanding of these challenges, coupled with groundbreaking research and innovative approaches, promises a brighter future for TB management. Several recent articles in the current issue have shed light on these multi-dimensional efforts, offering insights into the contemporary landscape of TB control and possible pathways forward.

Traditional methods of diagnosing tuberculosis require significant time and resources, particularly in countries where the disease is prevalent and healthcare systems are less developed. Additionally, more and more tuberculosis cases are becoming resistant to drugs, posing a significant hazard to public health. Culture-based TB diagnosis, which has long been considered the most reliable method, faces challenges due to its long testing times. To address this issue, MTB/RIFassays such as GeneXpert and Truenat were developed. These are rapid molecular tests that detect Mycobacterium tuberculosis DNA and rifampicin resistance. However, as of 2022, their use remains limited, with only 33% of people globally using them as initial diagnostic tests.

From the time of Hippocrates, Tuberculosis was known as phthisis, a term derived from the Greek language which means “decaying”. There is no more dangerous disease than pulmonary phthisis; no other is so common. It destroys a very great part of the human race. Antoine Portal, Paris, 1832 The swollen glands of the neck were known as scrofula and the King’s evil. Although Tuberculosis (TB) is essentially a medical disease, a sizeable proportion of patients fall into the realm of surgery, may it be due to the primary disease or its sequelae. TB was the leading cause of death in the 17th century. Patients were nursed in sanatoriums and treated with plenty of sunlight and good food. Surgery then became widely prevalent as a treatment modality, and Pulmonary Tuberculosis (TB) became the history of thoracic surgery.

Treating multidrug-resistant tuberculosis (MDR-TB), characterized by Mycobacterium tuberculosis strains resistant to both isoniazid and rifampicin, presents significant challenges, especially in resource-constrained settings. Persistent sputum culture positivity despite the administration of second-line TB medications leaves limited options for patients, particularly when the disease has progressed too far for surgical intervention to be viable. In this context,  salvage therapy is employed, which involves formulating a treatment plan that combines new and previously used medications in a last effort to achieve sputum conversion before declaring the treatment unsuccessful.

Tuberculosis (TB) continues to be a major global health challenge, with approximately one-third of cases going undiagnosed despite significant efforts. This article explores the factors leading to missed diagnoses, including barriers to healthcare access, stigma, and underreporting from private healthcare providers. Additionally, the financial burden on TB patients, particularly in high-burden countries, is examined. Social protection programs and the involvement of private practitioners are highlighted as key components in addressing TB control. The article also underscores the importance of new diagnostic innovations and multisectoral approaches to combat the growing threat of multidrug-resistant TB (MDR-TB) and achieve TB elimination by 2025.

After a brief dip in Tuberculosis (TB) incidence and mortality driven by Covid-19 pandemic, Mycobacterium tuberculosis (Mtb) emerged yet again as one of the leading cause of deaths in humans across globe. The rise of Multi Drug Resistant TB (MDR-TB) exacerbates the success of “end TB strategy”. Thus, the statistics of TB clearly highlight the requirement for stepping up efforts for comprehensive health initiatives and concerted action plan to combat TB. Two-pronged approach could be by, on one hand, hitting the pathogen Mtb at its adaptability by gleaning into its mechanisms of adaptation and on the other, by reinforcing the host immune onslaught and pressures against Mtb. With two research stories, one involving mathematics and statistics for TB and other against TB, this article accentuates the merit of integrating mathematics and statistics with the biology of host as well as pathogen for performing data-backed theoretical investigations to not only further mechanistic insights but also suggest potential novel targets against TB.