Tuberculosis: The Insidiousness of Early Manifestations
Tuberculosis (TB) remains one of the leading global public health challenges, affecting millions of people worldwide every year. The insidiousness of this disease lies in its ability to masquerade as other ailments or to remain virtually asymptomatic in the early stages. This is particularly characteristic of extrapulmonary forms of tuberculosis, which significantly complicates timely diagnosis and the initiation of treatment.
For example, prostate tuberculosis (PTB) often lacks specific symptoms and can develop unnoticed. In some cases, the only manifestation may be an elevated level of prostate-specific antigen (PSA) in the blood, which often leads to a mistaken suspicion of prostate cancer [1]. Such non-specificity of symptoms makes early detection of PTB extremely difficult, and without timely intervention, the disease can progress, causing irreversible damage to organs and tissues [1].
Why is early diagnosis so important?
Late detection of tuberculosis, whether pulmonary or extrapulmonary, is fraught with serious consequences. The progression of the disease not only complicates treatment but also significantly increases the risk of developing dangerous complications. One of the most alarming aspects is the increased risk of comorbid cardiovascular diseases in patients with TB.
Studies show that patients with tuberculosis face a significantly increased risk of myocardial infarction (MI) [2] and coronary artery disease (CAD) [3, 7]. Diagnosing MI in patients with TB is particularly complex due to overlapping clinical symptoms, which may be mistakenly attributed to the underlying disease [2]. Moreover, cardiovascular diseases are a leading cause of mortality among patients with tuberculosis [3]. Early detection of TB and its potential complications is critical for preventing irreversible damage and improving prognosis.
Modern diagnostic methods: from biomarkers to lipidomics
To address the problem of early and accurate diagnosis of tuberculosis and its comorbidities, innovative integrated strategies using advanced technologies are being developed.
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Biomarkers for the diagnosis of myocardial infarction in TB patients
Given the difficulties in diagnosing MI in TB patients, scientists have developed a model based on a panel of four biomarkers: high-sensitivity cardiac troponin I (hs-cTnI), myoglobin (Myo), creatine kinase-MB (CK-MB), and interleukin-6 (IL-6). This model, using a high-throughput suspension array platform, demonstrated superior diagnostic performance (area under the curve of 0.98) compared to using the single marker hs-cTnI alone [2]. This approach allows for a significant increase in the accuracy and speed of MI detection in this group of patients.
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Lipidomics for detecting TB-CAD comorbidity
Both tuberculosis and coronary artery disease are often accompanied by lipid metabolism disorders [3]. Studies using a broad-spectrum lipidomics approach (UHPLC-MS/MS) have allowed for the identification of specific lipid biomarkers that can serve for the early diagnosis of TB-CAD comorbidity. In particular, a decrease in the levels of sphingolipids, glycerolipids, and glycerophospholipids was found in patients with the combined disease [3]. The identification of 49 differential lipids opens new possibilities for early diagnosis and risk stratification.
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Immune markers and monocytes
Chronic inflammation and immune dysregulation play a central role in TB, HIV, and CAD. Studies using mass cytometry allow for the characterization of monocyte heterogeneity and the identification of specific phenotypes associated with TB and CAD. Expansion of monocyte subpopulations is observed in individuals with these conditions, and the study of their activation markers (soluble CD14 and sCD163) helps to better understand the mechanisms of inflammation and immune response [7].
The role of imaging in detecting tuberculosis and its complications
Medical imaging methods play a key role in the diagnosis of tuberculosis, especially in cases where clinical symptoms are non-specific or absent. They allow not only for the detection of changes characteristic of TB but also for the assessment of the extent of organ damage and the diagnosis of comorbid conditions.
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Ultrasound (US)
For the diagnosis of extrapulmonary forms of tuberculosis, such as prostate tuberculosis, multiparametric transrectal ultrasound can provide characteristic images that assist in differential diagnosis. This allows urologists and imaging specialists to more accurately identify PTB in the early stages, avoiding misdiagnoses [1].
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Computed Tomography (CT)
Computed tomography is a powerful tool for assessing the condition of internal organs. In the context of tuberculosis and its complications, coronary CT angiography is used to diagnose coronary artery disease in patients with TB, which is an important step in managing comorbidity [7]. Although lung CT is not discussed in the article, it is a standard method for diagnosing pulmonary tuberculosis.
Perspectives and challenges in tuberculosis diagnosis
Early and accurate diagnosis of tuberculosis remains the cornerstone of effective disease control. Modern research is actively aimed at developing and implementing comprehensive diagnostic strategies that combine biomarker analysis, lipidomic profiles, and advanced imaging methods. These approaches allow not only for the detection of TB at the earliest stages but also for the timely diagnosis of its dangerous comorbidities, such as cardiovascular diseases.
Despite significant progress, challenges remain regarding the accessibility of these technologies, their cost, and the need for training medical personnel. However, the potential for improving early detection and, consequently, preventing irreversible organ damage and reducing mortality is enormous. Continued research and the implementation of evidence-based practices are key to combating tuberculosis and its complications [1].
Sources
- [1] Prostate tuberculosis mimicking prostate cancer: Case report and literature review. (Medicine, 2023) https://pubmed.ncbi.nlm.nih.gov/38013327/
- [2] Early Diagnosis and Longitudinal Monitoring of Myocardial Infarction in Tuberculosis Patients with High-Throughput Suspension Array Testing of a Biomarker Panel. (Analytical Chemistry, 2026) https://pubmed.ncbi.nlm.nih.gov/42314097/
- [3] Lipidomics-Based Identification of Plasma Lipid Biomarkers in Tuberculosis-Coronary Artery Disease Comorbidity. (Infection and Drug Resistance, 2025) https://pubmed.ncbi.nlm.nih.gov/41409620/
- [7] Characterization of Distinct Monocyte Subtypes and Immune Features Associated with HIV, Tuberculosis, and Coronary Artery Disease in a Ugandan Cohort Using Mass Cytometry. (Pathogens and Immunity, 2026) https://pubmed.ncbi.nlm.nih.gov/41640845/
Disclaimer: The information presented in this article is for reference purposes only and is not intended for self-diagnosis or self-treatment. Always consult a qualified medical professional for diagnosis and treatment planning.