Tuberculosis Infection: Diagnosis and Management

Tuberculosis (TB) infection remains the largest reservoir sustaining the global TB epidemic and a critical target for TB elimination. Contemporary evidence has fundamentally reframed TB infection from a static latent state to a dynamic spectrum encompassing early clearance, contained infection, incipient disease, and asymptomatic TB, with heterogeneous risks of progression. This review synthesizes evidence on the natural history, epidemiology, diagnosis, treatment, and programmatic management of TB infection. It reviews World Health Organization (WHO)-recommended diagnostic tools, including interferon-γ release assays and antigen-specific skin tests, and highlights the limitations of current tests in predicting individual progression. Advances in TB preventive treatment, particularly short-course rifamycin-based regimens and evidence-based preventive therapy for drug-resistant TB exposure, are examined alongside persistent implementation gaps across the prevention cascade. The article also addresses priority populations, ethical considerations, and emerging research directions, including prognostic biomarkers, postexposure vaccines, and digital innovations. Effective TB infection management is presented as a central, integrated pillar of future TB elimination strategies.