Abstract：Tuberculosis constitutes a major global public health concern. With the widespread implementation of active screening, asymptomatic tuberculosis patients as a hidden source of infection has drawn increasing attention. This paper reviews the definition, epidemiological and transmission risks, active case-finding strategies, and research progress in short-course treatment of asymptomatic tuberculosis. It also analyzes the challenges, including inconsistent diagnostic criteria, excessive reliance on symptom-based assessment, insufficient implementation of objective detection methods in primary healthcare settings, and poor patient adherence to treatment and follow-up. It is necessary to abandon the symptom-oriented prevention and control strategy, accelerate the formulation of unified diagnostic criteria, promote the large-scale application of objective detection technologies in primary healthcare settings, and continuously optimize short-course treatment regimens. It is also necessary to strengthen the screening for latent tuberculosis infection and the development of novel vaccines, build a multi-dimensional, full-chain prevention and control system to achieve the goal of ending tuberculosis epidemic.
[1] World Health Organization.Global tuberculosis report 2025[R].Geneva:WHO,2025. [2] Drain P K,Bajema K L,Dowdy D,et al.Incipient and subclinical tuberculosis:a clinical review of early stages and progression of infection[J/OL].Clin Microbiol Rev,2018,31(4)[2026-06-16].https://doi.org/10.1128/CMR.00021-18. [3] Stuck L,Klinkenberg E,Abdelgadir Ali N,et al.Prevalence of subclinical pulmonary tuberculosis in adults in community settings:an individual participant data meta-analysis[J].Lancet Infect Dis,2024,24(7):726-736. [4] Ge S J,Liu K,Jiang X N,et al.Prevalence,progression,and treatment of asymptomatic tuberculosis:a prospective cohort study in Lanxi County,Zhejiang Province,China[J/OL].Open Forum Infect Dis,2025,12(5)[2026-06-16].https://doi.org/10.1093/ofid/ofaf275. [5] Xu C H,Wen Y X,Zhao Y L,et al.Epidemiological characteristics of asymptomatic tuberculosis:China,2021-2024[J].China CDC Wkly,2026,8(13):374-380. [6] Emery J C,Dodd P J,Banu S,et al.Estimating the contribution of subclinical tuberculosis disease to transmission:an individual patient data analysis from prevalence surveys[J/OL].eLife,2023,12[2026-06-16].https://doi.org/10.7554/eLife.82469. [7] Wei X L,Zhang W H.The hidden threat of subclinical tuberculosis[J].Lancet Infect Dis,2024,24(7):669-670. [8] Li M,Cai L,Gao Q.Estimating the contribution to transmission of asymptomatic tuberculosis from population-based genomic epidemiology studies[J/OL].Emerg Microbes Infect,2026,15(1)[2026-06-16].https://doi.org/10.1080/22221751.2026.2640282. [9] Wood R C,Olson A M,Lochner K A,et al.Tongue swab Mycobacterium tuberculosis qPCR for community screening of asymptomatic TB vs.clinic-based triage of symptomatic TB[J/OL].medRxiv,2026[2026-06-16].https://doi.org/10.64898/2026.02.12.26346160. [10] Iem V,Chittamany P,Suthepmany S,et al.Pooled testing of sputum with Xpert MTB/RIF and Xpert Ultra during tuberculosis active case finding campaigns in Lao People's Democratic Republic[J/OL].BMJ Glob Health,2022,7(2)[2026-06-16].https://doi.org/10.1136/bmjgh-2021-007592. [11] Sun Q F,Li S S,Ren W C,et al.Discovering biomarkers for asymptomatic tuberculosis via Olink proteomics and machine learning[J].J Proteome Res,2025,24(11):5617-5627. [12] Jesudason T.New WHO recommendations for tuberculosis diagnosis[J/OL].Lancet Infect Dis,2026[2026-06-16].https://doi.org/10.1016/S1473-3099(26)00171-4. [13] Mendelsohn S C,Mulenga H,Tameris M,et al.Screening for asymptomatic tuberculosis among adults with household exposure to pulmonary tuberculosis:a prospective observational cohort study[J].Lancet Glob Heal,2025,13(11):1869-1879. [14] Jeong Y J,Park J S,Kim H W,et al.Characteristics of subclinical tuberculosis compared to active symptomatic tuberculosis using nationwide registry cohort in Korea:prospective cohort study[J/OL].Front Public Health,2023,11[2026-06-16].https://doi.org/10.3389/fpubh.2023.1275125. [15] Zhang W H.Asymptomatic TB with innovative modified short-course regimens(SWIFT)[EB/OL].[2026-06-16].https://clinicaltrials.gov/study/NCT06153069.
