Gut Mycobiota Dysbiosis in Pulmonary Tuberculosis Patients Undergoing Anti-Tuberculosis TreatmentOriginal paper
Karen Pendergrass is a microbiome researcher specializing in microbiome-targeted interventions (MBTIs). She systematically analyzes scientific literature to identify microbial patterns, develop hypotheses, and validate interventions. As the founder of the Microbiome Signatures Database, she bridges microbiome research with clinical practice. In 2012, based on her own investigative research, she became the first documented case of FMT for Celiac Disease, four years before the first published case study.
Read MoreWhat was studied?
This follow-up study examined the gut bacterial microbiota and, for the first time in tuberculosis, the fungal mycobiota. It tracked how active TB and first-line anti-TB treatment reshaped both kingdoms. Bacterial 16S rRNA (V3-V4) and fungal ITS2 amplicon sequencing were performed on fecal samples. Transkingdom correlation networks were built to assess bacterial-fungal interactions across time.
Who was studied?
The cohort was 29 treatment-naive active pulmonary TB patients and 22 healthy subjects in China. Fecal samples were collected at baseline, at 2 months, and at 6 months of treatment. Nineteen patients completed the 6-month sampling; 10 were lost to follow-up. All 29 received standard therapy: isoniazid, rifampin, ethambutol, and pyrazinamide for 2 months, then isoniazid and rifampin for 4 months. People with diabetes, obesity, HIV, or recent antibiotics were excluded.
What were the most important findings?
Naive TB patients showed reduced bacterial diversity and both bacterial and fungal dysbiosis versus healthy subjects. Anti-TB drugs further and significantly decreased the diversity of both bacteria and fungi. The fungus Purpureocillium lilacinum was enriched in naive TB patients and declined with treatment. The genus Aspergillus tended to increase during treatment, and both were elevated across TB groups versus healthy subjects. The bacterial-fungal transkingdom network was simplified in naive TB, severely altered after 2 months, and rebuilt after 6 months into a dysbiotic state dominated by fungal nodes.
What are the greatest implications of this study?
The work shows gut fungi, not just bacteria, are disrupted in tuberculosis and that anti-TB drugs profoundly reshape the bacterial-fungal ecosystem. A fungus-enriched network after treatment may raise the risk of fungal overgrowth and co-infection. This supports researching probiotics, prebiotics, or fecal transplantation to restore balance after therapy. Limitations include imperfect age and sex matching of healthy controls, loss to follow-up, and no post-treatment long-term data.