A tuberculosis (TB) cluster in Kota Tinggi, Johor, has infected 33 people after being traced to a single source confirmed on 25 January, the Johor State Health Department said.

All patients are receiving treatment and remain under close monitoring at health facilities. One death was reported in the cluster but authorities confirmed TB was not the cause.

TB in Malaysia and globally Malaysia recorded 26,183 TB cases in 2024, a slight rise from 26,149 cases in 2023.

Globally, TB remains the leading cause of death from a single infectious agent. In 2024 an estimated 10.7 million people developed TB and about 1.23 million people died of the disease, including roughly 150,000 people living with HIV.

Around 34% of new cases were in the South‑East Asia Region, 27% in the Western Pacific and 25% in Africa. Thirty high‑burden countries accounted for about 87% of new cases; India, Indonesia, the Philippines, China and Pakistan together made up roughly two‑thirds of the global total.

What TB is and how it spreads

Tuberculosis is an infectious disease caused by bacteria of the Mycobacterium tuberculosis complex, most commonly Mycobacterium tuberculosis in humans. TB most often affects the lungs (pulmonary TB) but can involve other organs (extrapulmonary TB), such as the lymph nodes, kidneys, spine and brain.

TB is transmitted when a person with infectious pulmonary TB expels airborne particles by coughing, sneezing, speaking or singing.

A person with latent TB infection carries live bacteria but has no symptoms and is not contagious; roughly one quarter of the world’s population is estimated to have latent infection.

Approximately 5–10% of people with latent infection will develop active TB disease during their lifetime; the risk is higher in infants, young children, and people whose immune systems are weakened (for example people living with HIV).

Symptoms and when to seek care Active pulmonary TB commonly produces:

• a persistent cough (often defined as lasting two to three weeks or more), sometimes with blood;
• chest pain;
• prolonged fever and night sweats;
• fatigue and weakness;
• unintended weight loss and loss of appetite.

Extrapulmonary TB causes symptoms related to the affected organ and may require specialist assessment. Some people with active TB have few or no symptoms, particularly early on, which can delay diagnosis and encourage onward transmission.

If you have a prolonged cough, persistent fever, night sweats or unexplained weight loss — or if you are a close contact of someone with TB or living with HIV — seek medical evaluation promptly.

Diagnosis: modern tests and practical realities

WHO recommends rapid molecular tests (for example Xpert MTB/RIF and related assays) as the initial diagnostic test for people with signs and symptoms of TB where they are available; these tests detect TB bacteria and commonly identify rifampicin resistance, guiding early treatment decisions. Rapid assays and some point‑of‑care biomarker tests can often return results within hours to a couple of days, though turnaround varies with local laboratory capacity.

Other diagnostic tools include:

• chest X‑ray to identify abnormalities suggestive of pulmonary TB;
• sputum microscopy and culture;
• drug‑susceptibility testing (DST) by molecular or culture methods to detect resistance to first‑line and second‑line drugs;
• tests for latent infection such as the tuberculin skin test (TST), interferon‑gamma release assays (IGRA) or newer antigen‑based skin tests — used to identify people who might benefit from preventive therapy.

Diagnosis in children and for extrapulmonary TB is often more complex and may require specialist input, multiple specimen types and a combination of radiological, microbiological and clinical evidence.

Treatment and monitoring TB disease is treatable and, in drug‑sensitive cases, usually curable with a standard multi‑drug regimen. The commonly recommended first‑line treatment globally is:

• two months of four drugs — isoniazid, rifampicin, pyrazinamide and ethambutol (HRZE) — followed by
• four months of isoniazid and rifampicin (HR).

Adherence to the full prescribed course is essential. Premature interruption increases the risk that bacteria will become drug resistant. Routine monitoring during treatment includes clinical review and investigations as indicated (for example baseline and periodic liver function tests because of hepatotoxicity risk, visual testing for vision changes with ethambutol, and pregnancy testing where relevant).

Management of adverse effects and drug interactions (notably rifampicin with many antiretroviral and other drugs) requires clinician oversight.

Drug‑resistant TB Multidrug‑resistant TB (MDR‑TB) is defined by resistance to at least isoniazid and rifampicin. MDR‑TB and extensively drug‑resistant TB (XDR‑TB) are more difficult to treat, require longer and often more toxic regimens, and pose a major public‑health threat.

In 2024, only about two in five people with drug‑resistant TB accessed appropriate treatment globally, underscoring large diagnostic and treatment gaps.

WHO now recommends expanded access to all‑oral MDR regimens and, for eligible patients, shorter six‑month all‑oral regimens such as BPaLM/BPaL (regimens that include bedaquiline, pretomanid and linezolid-based combinations) as a preferred option in many cases.

Eligibility depends on drug‑susceptibility patterns, previous treatment history and clinical assessment; specialist management and cardiac and other safety monitoring (for example for QT prolongation with some drugs) are required.

TB and HIV People living with HIV are around 12 times more likely to develop TB disease than people without HIV. TB is the leading cause of death among people with HIV.

In 2024, about 150,000 people died of HIV‑associated TB. Integrated TB/HIV care — including routine HIV testing for people with TB symptoms, prompt initiation of antiretroviral therapy (ART) for people with HIV, and TB preventive therapy where indicated — substantially reduces morbidity and mortality and is strongly recommended.

Note that rifampicin interacts with some ART drugs, so treatment must be coordinated by clinicians experienced in TB/HIV co‑management.

Prevention and public‑health measures TB is both preventable and curable. Prevention strategies include:

• BCG vaccination in infancy where countries include it in national schedules: BCG reduces the risk of severe and disseminated TB in children (for example TB meningitis and miliary disease) but provides inconsistent protection against adult pulmonary TB; national policies vary. (In Malaysia, BCG vaccination is mandatory and administered at birth as part of the National Immunisation Programme) 
• Active case finding and rapid diagnosis in people with symptoms and in high‑risk groups (contacts, people living with HIV).
• TB preventive treatment (TPT) for people with latent infection who are at high risk of progression (for example household contacts and people living with HIV); regimens include isoniazid for several months or shorter rifapentine‑ or rifampicin‑containing courses, depending on local guidance. Complete the full prescribed course.
• Infection prevention and control measures in health and congregate settings: adequate ventilation, prompt triage and isolation of suspected infectious patients, and use of N95/FFP2 respirators by healthcare workers where indicated.
• Individual measures such as cough hygiene and mask use during the infectious period.

Impact, costs and investments

TB predominantly affects adults in their most productive years and disproportionally burdens low‑ and middle‑income countries: over 80% of cases and deaths occur in these settings.

Households affected by TB face severe financial strain: about half of people treated for TB and their families experience catastrophic costs (over 20% of household income).

Global progress has saved an estimated 83 million lives since 2000, but gaps persist in diagnosis, treatment access, and funding.

WHO and UN bodies estimate that about US$22 billion per year is needed to meet prevention, diagnosis, treatment and care targets through 2027; current financing and research investment remain inadequate.

What this means for the public

• If you have a prolonged cough, night sweats, unexplained weight loss or fever, seek medical assessment promptly. Early diagnosis and full adherence to treatment are critical to recovery and preventing spread.
• Households and close contacts of people with TB should be screened and offered preventive therapy if indicated.
• People living with HIV should be routinely screened for TB and promptly started on ART when needed; coordinated TB/HIV care is essential.
• Individuals with suspected or confirmed drug‑resistant TB require specialist care and should not stop or change drugs without medical advice.

Always consult your medical professionals for medical advice!

Kota Tinggi’s cluster is a reminder that TB remains an active public‑health challenge in Malaysia and worldwide.

Continued vigilance, rapid diagnostic access, safe and complete treatment, integrated TB/HIV services, social and financial support for patients, and sustained investment in diagnostics, drugs and health systems are all necessary to reduce the burden of disease and move towards ending TB.