Abstract
Over the past 200 years, tuberculosis (TB) has caused more deaths than any other infectious disease, likely infecting more people than it has at any other time in human history. Mycobacterium tuberculosis (Mtb), the etiologic agent of TB, is an obligate human pathogen that has evolved through the millennia to become an archetypal human-adapted pathogen. This review focuses on the evolutionary framework by which Mtb emerged as a specialized human pathogen and applies this perspective to the emergence of specific lineages that drive global TB burden. We consider how evolutionary pressures, including transmission dynamics, host tolerance, and human population patterns, may have shaped the evolution of diverse mycobacterial genomes.
Highlights
Tuberculosis (TB) is a critical health crisis in our modern world
Despite years of coordinated global efforts to reduce the burden of TB, it is estimated that around 10 million new infections developed around the world in 2017 [1]
This balance between host and pathogen is central to the evolutionary survival strategy of Mycobacterium tuberculosis (Mtb) as an obligate human pathogen
Summary
Tuberculosis (TB) is a critical health crisis in our modern world. TB is one of the top ten causes of death worldwide, killing an estimated 1.7 million people in 2017 [1]. We discuss the features of Mtb that were central to its emergence as a human pathogen and how genetic diversity among strains contributes to phenotypic diversity in disease presentation, with a focus on the evolutionary interplay between pathogen and host. There are few studies that have compared patterns of disease presentation among a diverse range of strains from more than two lineages in a large sample population (summarized in Figure 1 and Table 1).
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