Gut microbiome disruption in Tanzanian pulmonary tuberculosis patients: links to treatment, nutritional status, and host immunity.

UNLABELLED: Tuberculosis (TB) and its treatment disrupt the gut microbiome, potentially impacting immune regulation and treatment outcomes. However, host-microbial interactions during TB disease are not well characterized. This cross-sectional study investigated the gut microbiome of pulmonary tuberculosis patients—both newly diagnosed and those treated for two months—compared to healthy controls in Tanzania. TB treatment was associated with reduced microbial diversity, distinct clustering, and depletion ofand. Treated patients also showed increasedandcompared to controls. In contrast, newly diagnosed patients had gut microbiomes similar to controls. Malnutrition and elevated inflammatory cytokines were more common in newly diagnosed patients. Within this group, gut microbial composition varied by nutritional status, cytokine levels, and exposure to pre-diagnosis non-antituberculous antibiotics. Our findings demonstrate that TB treatment significantly alters the gut microbiome and suggest complex interactions between gut microbial populations, host inflammation, nutrition, and treatment history. This study also underscores the need for more microbiome research in Sub-Saharan Africa to better understand immune-microbiome dynamics in TB.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12866-026-04882-3.