Beyond Microbiological Cure: Precision Detection of Early Structural Lung Damage in Tuberculosis

Background: Tuberculosis (TB) remains a leading cause of infectious morbidity worldwide, with increasing recognition of post-tuberculosis lung disease (PTLD). Structural lung damage begins early in the disease course, often preceding clinical or radiographic detection. Methods: The objective of this study was to review diagnostic approaches for detecting early structural lung damage in TB. A structured narrative review was conducted using PRISMA principles, including studies published between 2018 and 2025. Results: We found high-resolution computed tomography (HRCT) is the most sensitive modality for early structural abnormalities such as tree-in-bud nodules and ground-glass opacities. Pulmonary function tests, particularly DLCO, detect early impairment. Biomarkers such as matrix metalloproteinases (MMPs) and cytokines reflect ongoing tissue damage. Conclusion: We concluded that a multimodal diagnostic approach integrating imaging, functional assessment, and biomarkers enables early detection and may prevent progression to chronic lung disease.