Cioboata Ramona, Balteanu Mara Amalia, Osman Andrei, Vlasceanu Silviu Gabriel, Zlatian Ovidiu Mircea, Mitroi Denisa Maria, Catana Oana Maria, Socaci Adriana, Tieranu Eugen-Nicolae
Pneumology Department, University of Medicine and Pharmacy, 200349 Craiova, Romania.
Department of Pulmonology, Faculty of Medicine, Titu Maiorescu University, 031593 Bucharest, Romania.
J Clin Med. 2025 Mar 21;14(7):2154. doi: 10.3390/jcm14072154.
Tuberculosis (TB) continues to be a major public health challenge in low- and middle-income countries (LMICs), where high burdens of coinfections exacerbate the disease's impact. In 2023, an estimated 8.2 million people were newly diagnosed with tuberculosis worldwide, reflecting an increase from 7.5 million in 2022 and 7.1 million in 2019. In LMICs, limited access to healthcare, inadequate nutrition, and poor living conditions contribute to higher coinfection rates among TB patients, leading to delayed diagnosis and treatment, which in turn exacerbates disease severity and facilitates transmission. This narrative review synthesizes the epidemiology, clinical implications, diagnostic challenges, and management strategies related to TB coinfections with viral pathogens including HIV, SARS-CoV-2, and influenza, bacteria such as , , , and , fungi such as and species, and parasites. This review highlights that overlapping symptoms, immune system compromise, and socioeconomic barriers in LMICs lead to delayed diagnoses and suboptimal treatment outcomes, while also addressing the challenges of managing drug interactions particularly in HIV-TB coinfections and underscoring the need for integrated diagnostic approaches, improved treatment regimens, and strengthened healthcare systems, thereby consolidating current evidence to inform future research priorities and policy interventions aimed at reducing the overall burden of TB and its coinfections in resource-limited settings.
结核病（TB）仍是低收入和中等收入国家（LMICs）面临的一项重大公共卫生挑战，在这些国家，高负担的合并感染加剧了该疾病的影响。2023年，全球估计有820万人新诊断出患有结核病，这一数字高于2022年的750万和2019年的710万。在低收入和中等收入国家，获得医疗保健的机会有限、营养不足和生活条件差导致结核病患者的合并感染率更高，进而导致诊断和治疗延迟，这反过来又加剧了疾病的严重程度并促进了传播。这篇叙述性综述综合了与结核病合并感染相关的流行病学、临床影响、诊断挑战和管理策略，这些合并感染的病原体包括病毒（如艾滋病毒、严重急性呼吸综合征冠状病毒2型和流感病毒）、细菌（如 、 、 、 和 ）、真菌（如 属和 属物种）以及寄生虫。本综述强调，低收入和中等收入国家重叠的症状、免疫系统受损和社会经济障碍导致诊断延迟和治疗效果欠佳，同时还探讨了管理药物相互作用的挑战，特别是在艾滋病毒 - 结核病合并感染方面，并强调需要采用综合诊断方法、改进治疗方案以及加强医疗保健系统，从而整合现有证据，为未来的研究重点和政策干预提供参考，旨在减轻资源有限环境中结核病及其合并感染的总体负担。
