One of humanity’s oldest and deadliest killers is staging a modern-day comeback.
The so-called “white plague” reclaimed its title as the world’s deadliest infectious disease in 2023, after being briefly overtaken by COVID-19 during the first three years of the pandemic.
And the US isn’t immune. While the country still has one of the lowest rates globally, cases have been climbing steadily since 2020 — reversing three decades of decline.
Just this week, in fact, the man accused of murdering 18-year-old Loyola University Sheridan Gorman failed to show up for a detention hearing because he’s being treated for tuberculosis.
In 2025, provisional data from the CDC shows that 10,260 tuberculosis (TB) cases were reported nationwide, including a staggering 967 in New York alone.
But the real toll could be even higher. TB symptoms are often mistaken for more common illnesses like the flu or RSV, meaning cases can be missed or treatment delayed.
Public health experts say that’s a problem in itself. The longer TB goes undiagnosed, the more it can spread, and the higher the risk that the bacteria causing it will develop antibiotic resistance to its medicines, making it harder to treat.
The good news: TB is preventable — and with proper treatment, many people are cured. Here’s what you need to know about the disease quietly making a comeback across America.
What is tuberculosis?
Also known as consumption and “the robber of youth,” TB is an infectious disease that usually attacks the lungs but it can also spread to other parts of the body, including the kidneys, spine and brain.
It’s caused by bacteria that travel through the air. When someone with TB coughs, sneezes, talks or sings, they release tiny, germ-filled droplets that others may breathe in.
But not everyone who contracts TB gets sick — or can pass it on to others.
There are two main TB-related conditions. The first is active TB, which causes symptoms and can spread from person to person. Left untreated, someone with active TB in the lungs can infect an average of 10 to 15 people each year, especially those they’re in close contact with, like family members and friends
The second is latent TB. In this form, the bacteria remain dormant in the body, meaning the person has no symptoms and cannot spread the infection.
However, latent TB isn’t always harmless. If the immune system weakens and can no longer keep the bacteria under control, the infection can become active — a progression that occurs in about 5% to 10% of cases.
In the US, the CDC estimates that up to 13 million people are living with latent TB. In fact, more than 80% of TB cases nationwide are the result of longstanding, untreated latent infections becoming active.
What are the symptoms of active TB?
Symptoms of active TB vary depending on where the bacteria are growing in the body.
Some are general and easy to overlook, such as fever, chills, night sweats, weight loss, fatigue, weakness and loss of appetite, according to the CDC.
When TB affects the lungs — the most common form — symptoms usually develop gradually and worsen over time. These can include a persistent cough, chest pain and coughing up blood or mucus.
Outside the lungs, the signs can vary widely.
For example, TB in the lymph nodes may cause firm red or purple swelling under the skin. If it affects the kidneys, it can lead to blood in the urine.
TB in the brain, meanwhile, may trigger headaches or confusion, while TB in the spine can cause back pain. When it affects the larynx, it may lead to hoarseness.
Older adults, young children and people with weakened immune systems face the highest risk of severe illness.
How is tuberculosis treated?
Both active and latent TB can be treated with antibiotics — but treatment is longer and more complex than for most common infections.
Patients typically need a cocktail of medications for at least six to nine months to fully clear the bacteria.
“Unfortunately, the sheer length of these regimens increases the risk of significant side effects,” Dr. Kohta Saito, an assistant professor of medicine and assistant attending physician at Weill Cornell Medicine, said in an interview.
“For people being treated for latent TB infection, this is a challenge, as they experience the side effects of medications they’re taking to prevent a disease they may not go on to develop.”
He added that people with active TB often start to feel better long before they’re cured — and may begin to feel worse from side effects than from the illness itself.
In both cases, Saito said, “this makes it difficult for people to complete their course of treatment, increasing the chances of treatment failure and the potential for antibiotic resistance.”
In the US, 589 TB cases were resistant to at least one front-line drug in 2023, according to the CDC.
Is tuberculosis deadly?
It can be.
Globally, about half of people with untreated active TB die from the disease.
“Without treatment, it destroys your lungs, and you waste away,” Dr. Michelle Barron, UCHealth’s senior medical director of infection prevention and control, said in an interview.
“It produces chemicals in your body that suppress your appetite. You stop eating, and your body stops functioning,” she explained.
Around the world, TB kills an estimated 1.6 million people each year. That’s more than HIV/AIDS and malaria combined.
Can you prevent TB?
Yes — but access to the vaccine depends on where you live.
The Bacille Calmette-Guérin (BCG) shot has been given to infants and young children since 1921 to protect against severe forms of TB.
In the US, however, it’s not routinely used. It’s more common in parts of the world where TB remains widespread, including regions of Africa, Asia, Latin America and Eastern Europe.
Even so, TB remains a concern in the US.
“There is no country in the world that has eliminated TB or that is TB free,” Dr. Lucica Ditiu, a physician and executive director of the Stop TB Partnership, told Vox. “As long as we breathe, we are all at risk.”
In the US, the best defense is early detection. Identifying and treating latent TB can stop it from becoming active — and contagious.
That means seeing a doctor if you have symptoms, or getting tested if you’re at higher risk, such as having a weakened immune system or recent close contact with someone who has active TB.
If you are around someone with active TB, experts recommend wearing a mask, avoiding close contact and making sure indoor spaces are well ventilated to reduce the risk of transmission.
