Abstract
BACKGROUND: The gut microbiome plays a critical role in modulating systemic immunity and may influence susceptibility to infectious diseases, such as tuberculosis (TB). This study aimed to compare gut microbial profiles between individuals with active pulmonary TB and healthy controls to identify potential microbial signatures associated with disease development. METHODS: A hospital-based case-control study was conducted with 90 participants: 45 treatment-naïve TB patients and 45 healthy controls. Stool samples were collected and analyzed using 16S rRNA sequencing. Microbial diversity was assessed using the Shannon index, and relative abundances of key bacterial phyla were compared. Statistical analysis included Mann-Whitney U tests and LEfSe for differential taxa identification. RESULTS: TB patients showed significantly lower alpha diversity (Shannon index: 2.91 ± 0.37) compared to controls (3.81 ± 0.28, P < 0.001). The relative abundance of Proteobacteria was significantly higher in TB cases, while Firmicutes and Bacteroidetes were more abundant in controls. These findings indicate a pro-inflammatory gut microbiota shift in active TB. CONCLUSION: Active tuberculosis is associated with gut microbial dysbiosis, marked by reduced diversity and altered bacterial composition. These microbial signatures could aid in early diagnosis and serve as future targets for microbiome-based interventions.