Tuberculosis (TB), once considered a virtual “death sentence,” is now entering a new era of hope thanks to advances in molecular medicine and AI-driven healthcare technologies. Although this airborne infectious disease primarily affects the lungs, it can also attack other vital organs such as the bones, kidneys, and brain (extrapulmonary TB). Today, rapid diagnostic systems, shorter treatment regimens, and more effective preventive strategies are transforming the fight against TB.
From sputum testing to molecular diagnosis: a revolution in detection
Modern medicine is increasingly relying on advanced molecular diagnostic techniques rather than traditional sputum smear microscopy. Tests such as NAAT (Nucleic Acid Amplification Test) enable faster diagnosis and help identify multidrug-resistant (MDR) TB at an early stage.
CBNAAT/TrueNat
These tests can detect the TB bacterium within a very short time (approximately two hours) and determine whether it is resistant to *Rifampicin, one of the key anti-TB drugs. India’s indigenously developed TrueNat testing platform is now available even in many rural areas.
IGRA (Interferon-Gamma Release Assay)
This simple blood test helps detect latent TB infection, where the bacteria remain dormant in the body. It allows doctors to identify individuals at risk of developing active disease in the future and provide preventive treatment. However, IGRA alone cannot distinguish between active TB and latent TB.
Bronchoscopy
In complex cases where sputum tests fail to confirm the disease, bronchoscopy is used to collect samples directly from the lungs for further examination.
Artificial Intelligence and digital monitoring
The AI era has brought significant changes to TB diagnosis. Even in remote villages, AI-powered software integrated with X-ray machines (Computer-Aided Detection – CAD) can identify TB-related abnormalities in the lungs within minutes. This enables accurate screening even in areas without radiologists.
The combination of portable digital X-ray units and AI-assisted screening has expanded TB testing to populations that may not otherwise have access to healthcare facilities. However, although Kerala has 40 AI-powered X-ray machines, we currently do not have enough trained personnel for operating the same.
One of the greatest challenges in TB treatment is of patients discontinuing medication before completing the prescribed course. This increases the risk of drug resistance. To address this issue, Digital Adherence Technologies have been introduced, including:
* Smart pill boxes that remind patients when to take their medication.
* Systems such as 99DOTS, which confirm medication intake through phone calls or SMS.
* Video DOT (Directly Observed Therapy) systems that verify medication consumption through video monitoring.
In the future, host-directed therapies, which strengthen the patient’s immune response rather than targeting only the bacteria, may represent a new direction in TB treatment.
BCG vaccine
The BCG (Bacillus Calmette-Guérin) vaccine plays a crucial role in the fight against tuberculosis.
Timing: The vaccine should be administered as soon as possible after birth, usually before the newborn is discharged from the hospital.
Benefits: It helps protect children against severe and potentially fatal forms of TB, such as TB meningitis, which affects the brain.
Limitations: BCG does not completely prevent pulmonary TB in adults. Therefore, even vaccinated individuals should seek medical evaluation if TB symptoms develop.
In addition to BCG, new TB vaccines designed to provide better protection for adults are currently undergoing clinical trials.
Furthermore, according to recent World Health Organization (WHO) guidelines, treatment duration for certain non-severe, drug-susceptible TB cases in children can be reduced from six months to four months.
* The BPaL Regimen: A breakthrough against drug-resistant TB
For patients with drug-resistant TB, a new short-course treatment known as BPaL (Bedaquiline, Pretomanid, and Linezolid) is now available.
Previously, treatment for drug-resistant TB often lasted for years and involved injectable medications with significant side effects. In contrast, the six-month all-oral BPaL regimen has shown excellent outcomes in selected patients with drug-resistant TB.
For individuals who have been in close contact with TB patients, short-course preventive treatments lasting 1–3 months are now available instead of much longer preventive regimens.
The BPaL regimen represents one of the most significant recent advances in the management of drug-resistant tuberculosis.
A collective responsibility
When we notice symptoms of TB in people around us, we should encourage them to undergo proper medical evaluation rather than allowing stigma or fear to keep the disease hidden.
Through timely diagnosis, effective treatment, nutritional support, and community awareness, we can work together to build a TB-free society.
Credits to: Dr Elizabeth Sunila
Consultant - Pulmonology, Allergist & Respiratory Disease, Aster Medcity, Kochi