Incipient and subclinical tuberculosis: A clinical review of early stages and progression of infection

Paul K. Drain, Kristina L. Bajema, David Dowdy, Keertan Dheda, Kogieleum Naidoo, Samuel G. Schumacher, Shuyi Ma, Erin Meermeier, David M. Lewinsohn, David R. Sherman

Research output: Contribution to journalReview articlepeer-review

246 Scopus citations


Tuberculosis (TB) is the leading infectious cause of mortality worldwide, due in part to a limited understanding of its clinical pathogenic spectrum of infection and disease. Historically, scientific research, diagnostic testing, and drug treatment have focused on addressing one of two disease states: latent TB infection or active TB disease. Recent research has clearly demonstrated that human TB infection, from latent infection to active disease, exists within a continuous spectrum of metabolic bacterial activity and antagonistic immunological responses. This revised understanding leads us to propose two additional clinical states: incipient and subclinical TB. The recognition of incipient and subclinical TB, which helps divide latent and active TB along the clinical disease spectrum, provides opportunities for the devel-opment of diagnostic and therapeutic interventions to prevent progression to active TB disease and transmission of TB bacilli. In this report, we review the current understanding of the pathogenesis, immunology, clinical epidemiology, diagnosis, treatment, and prevention of both incipient and subclinical TB, two emerging clinical states of an ancient bacterium.

Original languageEnglish (US)
Article numbere00021-18
JournalClinical Microbiology Reviews
Issue number4
StatePublished - Oct 2018


  • Mycobacterium tuberculosis
  • Tuberculosis

ASJC Scopus subject areas

  • Epidemiology
  • Immunology and Microbiology(all)
  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)
  • Infectious Diseases


Dive into the research topics of 'Incipient and subclinical tuberculosis: A clinical review of early stages and progression of infection'. Together they form a unique fingerprint.

Cite this